Author Interviews, Genetic Research, Nature / 04.03.2015

Fernando Pardo-Manuel De Villena, PhD Professor and Associate Chair for Research Department of Genetics School of Medicine University of North Carolina at Chapel HMedicalResearch.com Interview with: Fernando Pardo-Manuel De Villena, PhD Professor and Associate Chair for Research Department of Genetics School of Medicine University of North Carolina at Chapel Hill Medical Research: What is the background for this study? What are the main findings? Response: We set out to identify mutations that affect diseases through changes in gene expression. Our first major finding is that some mouse populations such as the Collabaorative Cross are exceptionally good models to achieve this goal. We also wanted to sort out an ongoing controversy about the number, location and type of genes that are differentially expressed when you inherit them from your mom or your dad (so called imprinted genes).  We conclude that to some extent both sides were right; there are only a limited number of imprinted genes in the classical sense but there are also hundreds or thousands of genes that are preferentially expressed from the father. (more…)
Author Interviews, Cancer Research, MD Anderson, PNAS / 04.03.2015

MedicalResearch.com Interview with: Kristen Turner PhD. (first author) and Wei Zhang, Ph.D. Professor Department of Pathology Director, Cancer Genomics Core Lab University of Texas MD Anderson Cancer Center Houston, Texas 77030 Medical Research: What is the background for this study? What are the main findings? Response: Glioblastoma (GBM) is the most commonly diagnosed type of brain tumor and is among the most aggressive and challenging cancer types to treat. The traditional approaches to combat this pervasive cancer include surgery combined with radiation and chemotherapy (temozolomide); yet, most will succumb to the disease in just over one year. In this study, we investigated the Akt family of proteins that are known to be highly active in the majority of Glioblastoma cases. We compared each Akt family member and its ability to initiate glioma progression. We discovered that activation of the third Akt member (Akt3) led to glioma progression and very aggressive tumors. We then studied these tumors to compare their molecular attributes and found evidence of increased DNA repair. Finally, we discovered that the Akt3-induced DNA repair function led to increased survival of Glioblastoma cells after treatment with the DNA damaging agents, radiation and temozolomide. (more…)
Author Interviews, Neurological Disorders / 04.03.2015

MedicalResearch.com Interview with: Dr. Richard H. Myers Ph.D. Department of Neurology and Genome Science Institute Boston University School of Medicine, Boston, MAMedicalResearch.com Interview with: Dr. Richard H. Myers Ph.D. Department of Neurology and Genome Science Institute Boston University School of Medicine, Boston, MA MedicalResearch: What is the background for this study? What are the main findings? Dr. Myers:  Andy Hoss, who is a graduate student in my group is the primary investigator for this project. We are investigating changes that occur in the brain of individuals who had Huntington's disease. We were focused on studying regulatory mechanisms that control the levels of messenger RNAs (mRNAs) in the brain, since that is an area that has been implicated in this disease. MicroRNAs (miRNAs) are known to target mRNAs for degradation or to be sequestered for storage and later use. A few limited studies of microRNAs had been done, but we sought to measure the levels of all of the  miRNAs  present in the brains of persons with Huntington's disease and in controls using next-generation sequencing. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 04.03.2015

MedicalResearch.com Interview with: Sophie Coronini-Cronberg Honorary research Fellow Department of Primary Care and Public Health, Imperial College London Consultant in public health Centre Medical Directorate with Bupa, United Kingdom. Medical Research: What is the background for this study? What are the main findings? Dr. Coronini-Cronberg: From April 2011, England’s National Health Service (NHS) was challenged to find £20 billion of efficiency savings over four years, in part by reducing the use of ineffective, overused or inappropriate procedures. However, there was no clear instruction as to which procedures are of 'limited clinical value' and also under which circumstances they should be reduced. We looked at hospital admissions statistics for six procedures that appear on local and/or unofficial lists to see which had been affected and whether cuts were applied consistently across commissioners in the first year of the savings programme. We found a significant drop in three procedures considered potentially ‘low value’ compared to the underlying time trend: removal of cataracts, hysterectomy for heavy menstrual bleeding, and myringotomy to relieve eardrum pressure. There was no significant change in three other ‘low-value’ procedures: spinal surgery for lower back pain, inguinal hernia repair, and primary hip replacement, or in two ‘benchmark’ procedures (coronary revascularisation, gall bladder removal). Myringotomy, a procedure to relieve pressure in the ear which is considered relatively ineffective, declined by 11.4 per cent overall. Two procedures considered only effective in certain circumstances also fell overall. Hysterectomy for heavy menstrual bleeding declined by 10.7 per cent overall, and cataract removal declined by 4.8 per cent.ý ýWe also found the reductions were inconsistently applied by commissioning groups (so-called Primary Care Trusts). (more…)
Author Interviews, HIV, Nature, Scripps / 04.03.2015

Dr. Michael Farzan PhD Vice Chairman Department of Immunology and Microbial Science Florida Campus The Scripps Research InstituteMedicalResearch.com Interview with: Dr. Michael Farzan PhD Vice Chairman Department of Immunology and Microbial Science Florida Campus The Scripps Research Institute Medical Research: What is the background for this study? Dr. Farzan: The key points are that HIV-1 needs two receptors – CD4 and CCR5 – to infect cells.  CD4’s primary job is to initially bind the viral entry protein, which upon CD4 binding, uncloaks its CCR5 binding site.   A number of years ago we observed that CCR5 had an unusual modification that was really important to HIV-1.  We later showed that antibodies – protein your body makes to protect from pathogens – mimics CCR5 by incorporating this modification.  We develop a peptide from one of these antibodies that mimics CCR5. Medical Research: What are the main findings? Dr. Farzan: By combined a soluble form of CD4 with this CCR5-mimicking peptide, we created a protein that neutralizes all HIV-1 isolates tested, including the hardest-to-stop viruses, as well as distantly related viruses found in monkeys.  It does so better than the best HIV-1 antibodies.  We expressed this protein using a commonly used gene-therapy vector, and showed that after a one-time inoculation we could protect from doses much higher than most humans are likely to see, and we did so 34 weeks after the inoculation. (more…)
Author Interviews, BMJ, End of Life Care, Heart Disease / 04.03.2015

MedicalResearch.com Interview with: Prof. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute University of Zurich Department of Cardiology Clinic St. Anna, Lucerne and University Hospital Zurich Zurich, SwitzerlandProf. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute University of Zurich Department of Cardiology Clinic St. Anna, Lucerne and University Hospital Zurich Zurich, Switzerland MedicalResearch: What is the background for this study? What are the main findings? Prof. Erne: Very little is known on this important subgroup of patients with Acute Coronary Syndrome (ACS) at admission who for various reasons receive restricted or palliative treatment only. Reasons for withholding comprehensive and/or invasive therapy may be the very limited life expectancy, advanced age or severe comorbidities. These patients are not represented in prospective trials and often not included in outcome statistics and registries. This study provides evidence that the population which received palliative therapy is older and sicker when compared to patients who underwent conservative or reperfusion treatment. However, this study shows that these decisions are very individually addressed. Acute Coronary Syndrome patients treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. Changes of treatment decisions over time and the proportion of patients surviving 1 year suggest in part non homogenous and potentially questionable decision criteria. While refraining from more active therapy may be the most humane and appropriate approach in many patients, in others it represents under treatment. (more…)
Author Interviews, PNAS, Statins / 04.03.2015

Professor Andrew W. Munro FRSC FSB Professor of Molecular Enzymology Manchester Institute of Biotechnology Faculty of Life Sciences University of Manchester Manchester UKMedicalResearch.com Interview with: Professor Andrew W. Munro FRSC FSB Professor of Molecular Enzymology Manchester Institute of Biotechnology Faculty of Life Sciences University of Manchester Manchester UK MedicalResearch: What is the background for this study? What are the main findings? Dr. Munro: Statins are blockbuster drugs that inhibit the key enzyme in cholesterol synthesis: 3-beta-hydroxymethylglutaryl CoA reductase (HMG-CoA reductase), which catalyzes the rate-limiting step in the biosynthesis of cholesterol. As a consequence, statin drugs reduce levels of low-density lipoprotein (LDL-) cholesterol, are effective against hypercholesterolemia and reduce the risk of atherosclerosis and heart attack. One of the major statin drugs is pravastatin, which is derived from a fungal natural product called compactin. The process of conversion of compactin into pravastatin involves the use of an oxygen-inserting enzyme called a cytochrome P450 (or P450), which catalyzes the hydroxylation of compactin to form pravastatin. In order to produce a more cost-efficient and streamlined route to pravastatin production, our teams from the University of Manchester (UK) and DSM (Delft, The Netherlands) developed a single-step process for pravastatin production. This process involved harnessing the productive efficiency of an industrial strain of the beta-lactam (penicillin-type) antibiotic producing fungus Penicillium chrysogenum. The beta-lactam antibiotic genes were deleted from this organism, and replaced by those encoding for compactin biosynthesis (transferred from a different Penicillium species). This led to high level production of compactin, but also to substantial formation of a partially degraded (deacylated) form. To get around this problem and in order to further improve compactin production, the enzyme responsible for the deacylation (an esterase) was identified and the gene encoding this activity was deleted from the production strain. The final stages of development of the novel, one-step pravastatin production process involved the identification of a suitable P450 enzyme that could catalyze the required hydroxylation of compactin. A bacterial P450 was identified that catalyzed hydroxylation at the correct position on the compactin molecule. However, the stereoselectivity of the reaction was in favour of the incorrect isomer – forming predominantly epi-pravastatin over the desired pravastatin. This was addressed by mutagenesis of the P450 – ultimately leading to a variant (named P450Prava) that hydroxylated compactin with the required stereoselectivity to make pravastatin in large amounts. Determination of the structure of P450Prava in both the substrate-free and compactin-bound forms revealed the conformational changes that underpinned the conversion of the P450 enzyme to a pravastatin synthase. The expression of P450Prava in a compactin-producing strain of P. chrysogenum enabled pravastatin production at over 6 g/L in a fed-batch fermentation process, facilitating an efficient, single-step route to high yield generation of pravastatin. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 03.03.2015

MedicalResearch.com Interview with: Dr. Kevin Vagi, Ph.D Division of Violence Prevention, CDC’s Injury Center. MedicalResearch: What is the background for this study? What are the main findings? Dr. Vagi: Although there has been research on teen dating violence (TDV) for several decades, the subject has only received attention as a public health concern in recent years. Over time, prevalence estimates of physical teen dating violence victimization from CDC’s national Youth Risk Behavior Survey (YRBS) (first measured in 1999) have remained around 9% with similar rates among female and male students. Until recently, there have been no ongoing national studies of sexual TDV to our knowledge. This article describes new physical and sexual teen dating violence victimization questions first administered in the 2013 YRBS, shares the prevalence and frequency of TDV and national estimates using these new questions, and assesses associations of teen dating violence experience with health-risk behaviors. By including questions on both physical and sexual TDV, we are able to look at those youth who experienced physical TDV only, sexual TDV only, both physical and sexual TDV, any TDV, and none. These distinctions were important when investigating health outcomes associated with different types or combinations of TDV, as some health-risk behaviors have been shown to be associated with certain types of teen dating violence but not others. In 2013, among high school students who dated, 1 in 5 females and 1 in 10 males experienced physical and/or sexual TDV in the 12 months before the survey. The majority of students who experienced physical and sexual teen dating violence experience it more than once. Students who experienced both physical and sexual TDV are more likely to have other health-risks, such as suicidal ideation and behavior, fighting, carrying a weapon, being electronically bullied, alcohol and drug use, and risky sexual behaviors. This report also offers the first national estimate of sexual TDV. Findings suggest that comprehensive prevention efforts should focus on helping students develop healthy relationship skills to prevent teen dating violence and other risk behaviors. (more…)
Author Interviews, Compliance, Diabetes, Pediatrics / 03.03.2015

Dr. Yang Lu Ph.D Los Angeles Biomedical Research Institute Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic interventions, and cost effectiveness studiesMedicalResearch.com Interview with: Dr. Yang Lu Ph.D Los Angeles Biomedical Research Institute Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic interventions, and cost effectiveness studies MedicalResearch: What is the background for this study? Response: Non-adherence is a serious issue in type 1 diabetes management. It leads to poor glycemic control and peaks in adolescence and young adulthood. Peer support is critical for young patients yet few studies examined whether pairing youth with slightly older and more experienced peers with diabetes improves their diabetes self-management and glycemic control. This study had two aims: (1) assess whether adolescents (as prospective mentees) and young adults (as prospective mentors) with diabetes would be interested in peer mentoring as a way to improve adherence, and (2) identify contents and delivery modes for a peer mentoring topic from the perspective of patients and their parents. Fifty-four adolescents and 46 young adults with type 1 diabetes were surveyed. (more…)
Author Interviews, CDC, OBGYNE, Sexual Health / 03.03.2015

MedicalResearch.com Interview with: Amy Branum M.S.P.H., Ph.D and Jo Jones Ph.D Center for Health Statistics Division of Vital Statistics, Reproductive Statistics Branch Medical Research: What is the background for this study? Response: This data brief was based on multiple years of the National Survey of Family Growth (NSFG).  The NSFG, first conducted in 1973, is administered by NCHS in response to a legal mandate that says that NCHS “shall collect statistics on …family formation, growth, and dissolution.” (PHS Act, Sec 306). Up through the 2002 NSFG, the survey was conducted periodically; with the 2006-2010 data collection, the NSFG is a continuous survey with interviews conducted over multiple years.  We felt it was important to examine long-term trends in  Long-acting Reversible Contraception use due to fluctuations over time in IUD and implant acceptability and availability as contraception methods, especially in light of recent efforts to promote LARC use to prevent unintended pregnancies and for birth spacing. Medical Research: What are the main findings? Response: We found that Long-acting Reversible Contraception use declined between 1982 and 1988, remained stable through 2002 and then increased almost five-fold between 2002 and 2011-2013 (from 1.5% to 7.2).  Long-acting Reversible Contraception use has, and continues to be, generally highest among women aged 25-34 but has increased the most among women 15-24 since 2002.  Hispanic women used Long-acting Reversible Contraception at higher rates in 1982 compared to non-Hispanic white and non-Hispanic black women but patterns of use diverged after 1995 so that by 2011-2013, patterns of use were more similar by race and Hispanic origin.  Women who have at least one previous live birth have used, and continue to use, LARCs at a higher rate compared to women with no previous births. (more…)
Author Interviews, Mental Health Research / 03.03.2015

Julie M. Zito, PhD Professor of Pharmacy and Psychiatry Department of Pharmaceutical Health Services Research University of Maryland School of Pharmacy Baltimore, MD 21201MedicalResearch.com Interview with: Julie M. Zito, PhD Professor of Pharmacy and Psychiatry Department of Pharmaceutical Health Services Research University of Maryland School of Pharmacy Baltimore, MD 21201 MedicalResearch: What is the background for this study? Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with Atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’. MedicalResearch: What are the main findings? Dr. Zito: The continued expansion in Atypical antipsychotics use for behavioral conditions, particularly in poor and foster care youth prompted several government reports asking states to implement oversight programs. In our survey of state Medicaid agencies, we identified programs implementing a new and promising approach to increase the likelihood that these medications are used appropriately. These ‘peer review’ programs have been launched in 15 of the 31 prior authorization state Medicaid programs. There is a distinct advantage in having a qualified peer review, on a case-by-case basis, of the rationale for use of an atypical antipsychotic in a condition or age group that is ‘off-label’ according to the FDA product information label. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease / 03.03.2015

Mallika L. Mendu, MD, MBA Division of Renal Medicine Brigham and Women’s Hospital, Harvard Medical School Boston, MAMedicalResearch.com Interview with: Mallika L. Mendu, MD, MBA Division of Renal Medicine Brigham and Women’s Hospital, Harvard Medical School Boston, MA MedicalResearch: What is the background for this study? What are the main findings? Dr. Mendu: Chronic kidney disease affects a significant number of adults in the United States, approximately 13%, and is associated with significant morbidity, mortality and cost. We conducted a review of 1487 patients referred for initial evaluation of chronic kidney disease to two academic medical centers in Boston over a 3-year period, and examined how often laboratory and imaging tests were ordered and how often these tests affected diagnosis and/or management. The main finding was that a number of tests (renal ultrasound, paraprotein testing, serologic testing) were commonly ordered despite low diagnostic and management yield. Urine quantification and hemoglobin A1c testing had the highest diagnostic and management yield. (more…)
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics, JAMA / 03.03.2015

MedicalResearch.com Interview with: Dr. Enrico Mossello Research Unit of Medicine of Ageing Department of Experimental and Clinical Medicine University of Florence MedicalResearch: What is the background for this study? What are the main findings? Dr. Mossello: In spite of the high prevalence of high blood pressure (HBP) and cognitive impairment in old age, their relationship is still controversial. While several (but not all) studies have identified high blood pressure as a risk factor for incident cognitive impairment, evidence regarding the prognostic role of blood pressure in cognitively impaired older subjects is scarce and inconsistent. To our knowledge, no longitudinal study has been published up to now regarding Ambulatory Blood Pressure Monitoring (ABPM) in subjects with cognitive impairment. Moreover recent European and American guidelines on HBP leave decisions on antihypertensive therapy of frail elderly patients to the treating physician and do not provide treatment targets for cognitively impaired patients. In the present cohort study of subjects with dementia and Mild Cognitive Impairment (MCI) low values of day-time systolic blood pressure measured with ABPM were associated with greater progression of cognitive decline after a median 9-month follow-up. This association was limited to subjects treated with anti-hypertensive drugs and was independent of age, vascular comorbidity and baseline cognitive level, holding significant both in dementia and in Mild Cognitive Impairment subgroups. A similar trend of association was observed for office systolic blood pressure, although this was weaker and did not reach statistical significance in all analyses. (more…)
Author Interviews, Heart Disease, JAMA, Nutrition / 03.03.2015

Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer EpidemiologistMedicalResearch.com Interview with: Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer Epidemiologist MedicalResearch: What is the background for this study? What are the main findings? Dr. Shu: Nuts are rich in nutrients, such as unsaturated fatty acids, fiber, vitamins, phenolic antioxidants, arginine, and other phytochemicals. These are all known to be beneficial to cardiovascular health, probably through their anti-oxidative, anti-inflammatory, and endothelial function maintenance properties.   Previous studies, primarily conducted in white and affluent populations, have shown that nut consumption may be related to cardiovascular health. Much of the nut consumption in those populations would be tree nuts. In our study, we found that peanut consumption was associated with reduced total mortality and CVD mortality in a predominantly low-income black and white population in the US, and among Chinese men and women living in Shanghai. Because peanuts are much less expensive than tree nuts, as well as more widely available to people of all races and all socioeconomic backgrounds, increasing peanut consumption may provide a potentially cost-efficient approach to improving cardiovascular health. (more…)
Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Erectile Dysfunction, Heart Disease / 03.03.2015

Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX MedicalResearch.com Interview with: Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX   Medical Research: What is the background for this study? Dr. Pastuszak: The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been growing stronger in recent years, and recommendations have recently been made to screen men with ED for CVD risk factors.  The arteries in the penis are much smaller than those in the heart, and if vascular disease contributes to ED, which we know it does, then ED should be detected before CVD in affected men.  We also know that treating men with CVD risk factors results in improvement in their risk of having acute cardiovascular events (i.e. heart attack, stroke, etc.).  Because of these relationships, we wanted to assess the economic impact of screening men with erectile dysfunction for CVD, identifying men with CVD risk factors, and treating these men on the incidence of cardiovascular events and new cases of ED.  Specifically, we wanted to look at the costs associated with screening and treatment of CVD and erectile dysfunction, and the cost savings resulting from screening and treating men with CVD risk factors and ED when preventing acute cardiovascular events. Medical Research: What are the main findings? Dr. Pastuszak: We modeled the reduction in acute cardiovascular events and the associated cost savings over 20 years.  We predicted that approximately 5.8 million men with both CVD and ED would be identified over 20 years if we screened men with ED for CVD risk factors, and the cost of this screening would be $2.7 billion.  We assumed that if we treated these at-risk men, there would be an approximately 20% decrease in cardiovascular events, which would prevent 1.1 million cardiovascular events over 20 years, saving $21.3 billion that would otherwise be put to treatment of these acute events.  Since ED and CVD arise from the same pathology, we predicted that in treating the CVD risk factors, a similar decrease in ED cases would be seen as well, which would save $9.7 billion that would otherwise be put to ED treatment.  In screening these men, a combined $28.5 billion would be saved over 20 years. (more…)
Author Interviews, JAMA, Pediatrics, Smoking / 03.03.2015

Rebecca S. Williams, MHS, PhD University of North Carolina at Chapel Hill Chapel Hill, NCMedicalResearch.com Interview with: Rebecca S. Williams, MHS, PhD University of North Carolina at Chapel Hill Chapel Hill, NC MedicalResearch: What is the background for this study?  Dr. Williams: In recent years, the e-cigarette industry has ballooned into a multi-billion dollar market, with at least 466 brands and 7764 unique flavors of e-cigarettes sold online. With both smokers and people who never smoked turning to e-cigarettes, there are concerns about their safety, lack of regulation and accessibility to teens. The CDC reported that 17% of high school seniors use e-cigarettes, more than twice as many as use traditional cigarettes; furthermore, that hundreds of thousands of youth annually are using e-cigarettes who never smoked cigarettes. Our previous studies of Internet cigarette sales indicated that Internet Tobacco Vendors did a poor job of preventing sales to minors, which helped inform development of state and federal regulations to regulate such sales.  In 2013, North Carolina passed a law requiring age verification for online e-cigarette sales. This study was the first study to examine age verification used by Internet e-cigarette vendors and the first to assess compliance with North Carolina’s e-cigarette age verification law. MedicalResearch: What are the main findings? Dr. Williams: It was very easy for minors to buy e-cigarettes online. It took little effort for them to bypass the age verification practices of the vendors because there was very little use of rigorous age verification.  With only 5 orders rejected by vendors due to age verification, there was a youth e-cigarette purchase success rate of 94.7%.  No vendors used age verification at delivery, and few used rigorous methods of age verification that could potentially block youth access. While 7 vendors claimed to use age verification techniques that could potentially comply with North Carolina’s law, only one actually did. (more…)
Author Interviews, Cost of Health Care, Pharmacology / 03.03.2015

Eili Y. Klein Ph.D. Assistant Professor Department of Emergency Medicine Johns Hopkins University Baltimore, MD 21209MedicalResearch.com Interview with: Eili Y. Klein Ph.D. Assistant Professor Department of Emergency Medicine Johns Hopkins University Baltimore, MD 21209 Medical Research: What is the background for this study? What are the main findings? Dr. Klein: Antibiotic prescriptions rates vary widely across the country. We saw this at the state level, where rates in the highest prescribing states were as high as 1,200 prescriptions per 1,000 people to the lowest rates which were around 500 prescriptions per 1,000 people (see resistancemap.org). Europe has similar variation in prescribing rates across countries, and research there has documented a number of potential reasons for this such as education, access to health insurance, use of childcare centers, and cultural differences. However, the healthcare system in the US is structured differently than in Europe, so we set out to see if similar factors underlay differences in antibiotic prescribing in the US. Understanding the drivers of differences in prescribing is important because it can help predict how future changes in demographics and socioeconomic characteristics will affect future antibiotic consumption. It also enables predictions in consumption as a result of interventions that target the healthcare delivery system, and also enables better targeting of information campaigns, such as the CDC's Get Smart Program, on appropriate antibiotic prescribing to specific sub-populations. Finally, it allows providers to better understand how their practice is driven by external factors. The results of the study found that a primary factor driving differences in prescribing was the density of physicians. In other words, the more physicians there are per capita, the more prescriptions per capita. This result could just be due to more physicians making it easier to access a doctor and thus people go to visit a physician more. However, it could also suggest that physicians are competing to attract or retain patients in some manner and this is driving up prescriptions. To try to understand which of these effects was dominating the change, we examined the role of retail and urgent care clinics. Stand-alone urgent care clinics and clinics incorporated into the retail arm of a store (e.g., CVS minute clinic) are truly an American-style invention, and bear little similarity to how most Europeans receive healthcare. Over the last decade these establishments have exploded in popularity and greatly expanded their reach. Surprisingly what we found was that in low-income areas, a clinic increased the prescribing rate, but didn't affect the rate that physicians were prescribing antibiotics. Thus, in these areas the story is all about access. Improving access to healthcare increases the likelihood that people will go to the doctor when they are sick and that increases the rate that people get prescribed antibiotics. This contrasted with wealthier areas, where we found that a clinic increased the rate of prescribing by physicians, which is likely due to competition. This competition can take multiple forms, from increasing the probability of getting an antibiotic as a physician is worried you won't come back otherwise, to changes in how physician offices work so that it is easier to walk-in to your doctor or get a same-day appointment. Though we were not able to quantify which of these effects was dominant in this research. (more…)
Author Interviews, Gender Differences, Heart Disease, Women's Heart Health / 03.03.2015

Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center UtrechtMedicalResearch.com Interview with: Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center Utrecht Medical Research: What is the background for this study? What are the main findings? Response: Although cardiovascular diseases are often considered a disease of men, more women than men die each year of cardiovascular diseases. Sex-differences are increasingly being researched and acknowledged. For treatment and prognosis of coronary artery disease, however, many discrepancies exist between studies that investigated sex-differences. For example, it remains unclear whether the observed differences in the outcome after coronary artery bypass grafting (CABG) are due to a different risk burden between men and women or whether female sex is an independent risk factor. In a group of 2553 patients followed up during a median of 2.5 years after CABG we found an increased risk for worse outcome in women versus men. We found a strong indication for female sex as an independent risk factor, but lacked power to definitively prove th (more…)
Author Interviews, JAMA, Outcomes & Safety, Surgical Research / 03.03.2015

MedicalResearch.com Interview with: Dr. Stephen Duquette MD Indiana University Department of Surgery, Division of Plastic Surgery R.L Roudebush VA  Indianapolis, IN Medical Research: What is the background for this study? What are the main findings? Dr. Duquette: Carpal tunnel syndrome is the most common compressive peripheral neuropathy, causing pain, numbness and weakness.  Conservative treatment options include splinting, NSAID pain medications, and steroid injections.  Most often the definitive therapy is carpal tunnel release (CTR).  Over 500,000 procedures are performed in the US yearly, making it one of the most commonly performed hand surgery procedures.  In the United States it is most common to perform this operation in the operating room, under sedation and locoregional anesthesia.  Because it is a very common disease that is treated surgically, process improvement can have a major impact in time to OR, patient recovery, patient satisfaction, and overall throughput.  This is especially valuable in the Veterans Administration (VA) system, where recent problems have arisen due to lack of adequate resources to care for all veterans. This study examined the impact of opening an office-based procedure room in a VA to perform awake hand surgery under local anesthesia only.   This was compared to the prior practice of operating room carpal tunnel release though a number of performance metrics, including time to OR and complications.  Although office carpal tunnel releases are performed routinely in Canada, some surgeons still believe that the complications would increase outside the very sterile environment of the operating room. The current study showed that wait times from initial consultation and initial visit to surgical intervention were significantly decreased in the procedure room group compared to the operating room.  The complication rate was the same for both groups, showing that the procedure room and the operating room were both equally safe and efficacious in providing an environment that was ideal for the performance of carpal tunnel releases. (more…)
Author Interviews, Health Care Systems, Medicare / 02.03.2015

Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of MedicineMedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Sheehy: Outpatient (observation) and inpatient status determinations are important for hospitalized Medicare beneficiaries. The Recovery Audit program, more commonly known as the RACs (Recovery Audit Contractors), is charged with surveillance and enforcement of such status determinations. Surveillance in the Medicare program is necessary, and Medicare fraud and abuse should not be tolerated. However, there are increasing concerns regarding RAC accuracy, auditor financial incentives, and the volume of audits and overpayment determinations auditors allege. We therefore studied Complex Medicare Part A RAC audits at 3 academic medical centers, the University of Wisconsin, the University of Utah, and Johns Hopkins, to determine the impact and trends of such audits. There was a nearly 300% increase in RAC overpayment determinations in just 2 years at the study hospitals. Each year, the hospitals won a greater percent of contested cases, winning 68.0% of cases with decisions in 2013. Two-thirds of all favorable decisions for the hospitals occurred in the discussion period. Because discussion is not considered part of the formal appeals process, this is omitted from reports of RAC accuracy. None of the overpayment determinations contested the need for the care delivered, rather contested the billing location, outpatient or inpatient. The hospitals averaged 5 FTE each to manage the audit and appeals process. Claims still in appeals had been in process for a mean of 555 days without decisions. (more…)
Author Interviews, Pain Research / 02.03.2015

Prof. Dr. med. Andreas Michalsen Stiftungsprofessur für klinische Naturheilkunde Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie Charité - Universitätsmedizin Berlin Immanuel Krankenhaus BerlinMedicalResearch.com Interview with: Prof. Dr. med. Andreas Michalsen Stiftungsprofessur für klinische Naturheilkunde Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie Charité - Universitätsmedizin Berlin Immanuel Krankenhaus Berlin Medical Research: What is the background for this study? What are the main findings? Response: Chronic neck and back pain is an increasing health care problem in Europe and the U.S. Chronic neck pain is associated with distress and there is a need to evaluate methods of stress reduction in the management of chronic neck pain. The main findings of this trial were, that an 8-week meditation program teaching a traditional meditation technique, Jyoti meditation, leads to significant pain relief and reduced pain-related bothersomeness. (more…)
Author Interviews, Mental Health Research, Pediatrics / 02.03.2015

David C. Rettew, MD Associate Professor of Psychiatry and Pediatrics Director, Child & Adolescent Psychiatry Fellowship Director, Pediatric Psychiatry Clinic University of Vermont College of MediciMedicalResearch.com Interview with: David C. Rettew, MD Associate Professor of Psychiatry and Pediatrics Director, Child & Adolescent Psychiatry Fellowship Director, Pediatric Psychiatry Clinic University of Vermont College of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Rettew: We did this study because while everyone knew that antipsychotic medication rates were going up, there was very little data that drilled deeper and was able to get at the question about the appropriateness of this increase. There’s good news and bad news in this study.  The bad news is that our data show that about half the time, kids are not being treated with antipsychotic medications according to best practice guidelines.  The good news is that it doesn’t look like these medications are being used casually or in a knee jerk way.  In the vast majority of cases, youth are getting to this class of medications only after many other things have failed. (more…)
Author Interviews, BMJ, Pediatrics / 02.03.2015

MedicalResearch.com Interview with: Ina S. Santos (on behalf of the co-authors) Iná S. Santos, MD, PhD Professora Titular Depto Medicina Social Programa Pós-graduação Epidemiologia Universidade Federal de Pelotas,  Brasil MedicalResearch: What is the background for this study? What are the main findings? Response: Early regulatory problems (excessive crying, sleeping and feeding problems in infancy) have been considered early markers for similar processes of inadequate or under-controlled behavior in childhood and psychosocial problems in childhood are associated with psychological disorders later in life. The prevalence of excessive crying during the first 3 months of life in representative community-based samples from high-income countries has been reported to range between 14% and 29%. There is no consensus regarding the definition of excessive crying. A frequently used definition is the excessive paroxysmal crying, that is most likely to occur about the same time every day (usually in the late afternoon or evenings) without any identifiable cause in an otherwise healthy baby aged 2 weeks to 4 months and lasting more than three hours per day, occurring in more than three days in any week for three weeks (rule of three) that is typically known as colic. Others give less emphasis to the amount of crying and give relevance to maternal or parental stress due to the child unresponsiveness to soothing or to the maternal perception of the intensity of crying. Negative consequences of excessive crying on maternal and child health have been described: it is associated with early weaning from breast milk, frequent changes of formulae, and maternal mental symptoms, besides being the most common proximal risk factor for shaken baby syndrome. In a study conducted in a middle-sized city located in Southern Brazil, 4231 children enrolled in the 2004 Pelotas Birth Cohort were followed-up from birth to four years of age. At the 3-month post-partum follow-up mothers were asked whether their infants cried more, less or as the same as others of the same age. Infants whose mothers perceived them as crying more than others of the same age were classified as “crying babies”. When the cohort reached four years old, all children were screened to assess their risk of presenting psychological problems. After taking into account a series of maternal and child characteristics (like, maternal age, maternal level of education, type of delivery, gestational age at birth, and child sex, among others) “crying babies” were at increased risk of presenting behavior problems in comparison to “non-crying babies”. (more…)
Author Interviews, Emory, Frailty, Surgical Research / 02.03.2015

MedicalResearch.com Interview with: Louis M. Revenig, MD and Kenneth Ogan MD, Department of Urology Emory University School of Medicine Atlanta, Georgia 30322 MedicalResearch: What is the background for this study? What are the main findings? Response: Numerous groups from a variety of institutions have investigated different methods of quantifying frailty in surgical populations. All have shown that frailty not only can be measured, but more importantly, reliably identifies the patients who are at higher risk for poor postoperative outcomes compared to their peers.  One obstacle to more widespread use of frailty assessments is the extra burden it places on an already busy clinical setting. In our study we chose what we thought was the already simplest and most clinically applicable frailty assessment, the 5-component Fried Frailty Criteria, and prospectively enrolled a large cohort of surgical patients and followed their outcomes. We critically analyzed the data to assess which components of the frailty assessment were most important. Our results showed that of the 5 components (weight loss, grip strength, gait speed, exhaustion, and activity level), weight loss and grip strength alone carried the same prognostic information for post-operative outcomes as the full assessment. Additionally, when combined with two already routinely collected pre-operative variables (serum hemoglobin and ASA score) we created a novel, simple, and easy to use risk stratification system that is more amenable to a busy clinical setting. (more…)
Aging, Author Interviews, Geriatrics, Social Issues / 01.03.2015

Angela L. Curl PhD MSW School of Social Work University of Missouri Columbia, MOMedicalResearch.com Interview with: Angela L. Curl PhD MSW School of Social Work University of Missouri Columbia, MO MedicalResearch: What is the background for this study? What are the main findings? Dr. Curl: Often people think of stopping driving as just effecting one person: the person who stops driving. In reality, for married couples driving cessation affects both spouses. Using longitudinal data (1998-2010) from 1,457 married couples participating in the Health and Retirement Study, we found that husbands and wives who are no longer able to drive are less likely to work, and less likely to engage in formal volunteering (for charitable organizations) and informal volunteering (helping friends and neighbors not-for-pay). Having a spouse in the household who is still able to drive does reduce these negative consequences a little, but not entirely. Furthermore, the spouse who continues to drive is also less likely to continue working or volunteering following the driving cessation of their partner, presumably because he/she is providing transportation or social support to the non-driver. (more…)