Author Interviews, Gastrointestinal Disease, Opiods / 24.05.2021
Significant Reduction in Overall Emergency Department Costs and Patient Length of Stay When Treating Opioid-Induced Constipation with FDA-Approved Medications
MedicalResearch.com Interview with:
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Dr. Peacock[/caption]
Frank Peacock, MD, FACEP, FACC
Professor of Emergency Medicine, Associate Chair
Research Director, Department of Emergency Medicine
Baylor College of Medicine
Houston, Texas
MedicalResearch.com: What is the background for this study?
Response: Emergency medicine (EM) physicians, like myself, are always looking for ways to improve the patient experience. Often times, we will encounter a patient in the emergency department (ED) who is presenting with one of the most common side effects of opioids, which is opioid-induced constipation (OIC). OIC impacts 40-80% of patients on long-term opioid therapy[i],[ii] and may lead to emergency room visits which are associated with a significant burden on patients and the healthcare system. We wanted to compare the impact of treating OIC patients with FDA-approved prescription medications for OIC versus the impact of not treating OIC patients with an FDA-approved prescription medication for OIC in the ED setting to better understand the impact to overall ED costs and the length of stay for a hospitalized patient.
Dr. Peacock[/caption]
Frank Peacock, MD, FACEP, FACC
Professor of Emergency Medicine, Associate Chair
Research Director, Department of Emergency Medicine
Baylor College of Medicine
Houston, Texas
MedicalResearch.com: What is the background for this study?
Response: Emergency medicine (EM) physicians, like myself, are always looking for ways to improve the patient experience. Often times, we will encounter a patient in the emergency department (ED) who is presenting with one of the most common side effects of opioids, which is opioid-induced constipation (OIC). OIC impacts 40-80% of patients on long-term opioid therapy[i],[ii] and may lead to emergency room visits which are associated with a significant burden on patients and the healthcare system. We wanted to compare the impact of treating OIC patients with FDA-approved prescription medications for OIC versus the impact of not treating OIC patients with an FDA-approved prescription medication for OIC in the ED setting to better understand the impact to overall ED costs and the length of stay for a hospitalized patient.
Dr. Carlson[/caption]
Susan E. Carlson Ph.D.
Associate Dean for Research
Program Director,, AJ Rice Professor
Department of Dietetics and Nutrition
University of Kansas Medical Center
Kansas City, KS
MedicalResearch.com: What is the background for this study? What are its benefits?
Response: DHA is an omega-3 fatty acid. Good food sources include some types of seafood (e.g., salmon, tuna, trout) and chicken eggs. Persons in the USA and in much of the developing world consume little dietary DHA. DHA supplements in pregnancy have been linked to lower risk of preterm birth for 20 years, especially early preterm births (<34 weeks gestation). For about 10 years, prenatal supplements with about 200 mg DHA have been readily available in the USA, however, no study has asked if this amount of DHA is optimal to reduce early preterm birth. Participants were given a supplement of 1000 mg or 200 mg DHA beginning before 20 weeks gestation using an adaptive randomization that periodically assigned more participants to the group with the fewest early preterm births.
Dr. Hwang[/caption]
Geelsu Hwang, Ph.D.
Assistant Professor
Department of Preventive and Restorative Sciences
Center for Innovation and Precision Dentistry (CiPD)
School of Dental Medicine
University of Pennsylvania
MedicalResearch.com: What is the background for this study? What is the significance of this oral biofilm?
Response: Dental caries is one of the most common and costly biofilm-dependent diseases that afflict children and adults worldwide. Particularly, Early Childhood Caries (ECC) is a hyper-virulent type of chronic tooth decay that most frequently afflicts underprivileged preschool children. The onset and progression of carious lesions in ECC are rapid and aggressive, causing rampant destruction of the smooth surfaces of teeth.
ECC is painful and often requires surgical procedure under general anesthesia, while current treatment modalities are inefficient and recurrence of ECC is common. Notably, interactions between a fungus, Candida albicans, and a bacterium, Streptococcus mutans, have been known to play important roles in the pathogenesis of dental caries.
Thus, we attempted to strategically develop a targeted measure to effectively prevent cross-kingdom interactions and subsequent biofilm development.
Dr. Clarke[/caption]
Katherine Clark, MD MBA
Division of Cardiovascular Medicine
Department of Internal Medicine
Yale School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Racial and ethnic disparities affect cardiac transplantation outcomes. In cohort analyses of racial and ethnic groups from the previous three decades, Black patients were constantly at a higher risk of mortality after cardiac transplantation. In 2018, the United Network for Organ Sharing (UNOS) revised the allocation system to expand access to organs for the most medically urgent patients and reduce disparities and regional differences. We sought to evaluate contemporary trends and impact of the new 2018 allocation system.
Dr. Hoberman[/caption]
Alejandro Hoberman, M.D.
Vice Chair of Clinical Research, Division Director, General Academic Pediatrics, and Professor of Pediatrics and Clinical and Translational Science
Jack L. Paradise, MD Endowed Professor of Pediatric Research, UPMC Children's Hospital of PittsburghPresident, UPMC Children's Community Pediatrics
MedicalResearch.com: What is the background for this study?
Response: Acute otitis media (AOM) is the most frequently diagnosed illness in children in the United States for which antibiotics are prescribed. Recurrent AOM is the principal indication for tympanostomy-tube placement, the most frequently performed operation in children after the newborn period. Supporting the performance of tympanostomy-tube placement for recurrent acute otitis media has been the commonplace observation, after surgery, of acute otitis media–free periods of varying duration. Counterbalancing this view have been the cost of tympanostomy-tube placement; risks and possible late sequelae of anesthesia in young children; the possible occurrence of refractory tube otorrhea, tube blockage, premature extrusion, or dislocation of the tube into the middle-ear cavity; various structural tympanic membrane sequelae; and the possible development of mild conductive hearing loss. Tempering support for surgery is the progressive reduction in the incidence of acute otitis media that usually accompanies a child’s increasing age.
Previous trials of tympanostomy-tube placement for recurrent acute otitis media, all conducted before the introduction of pneumococcal conjugate vaccine, have given mixed results and were limited, variously, by small sample size, uncertain validity of diagnoses of acute otitis media determining trial eligibility, short periods of follow-up, and substantial attrition of participants. Official recommendations regarding tympanostomy-tube placement for children with recurrent acute otitis media differ — an otolaryngologic guideline recommends the procedure for children with recurrent acute otitis media, provided that middle-ear effusion is present in at least one ear; a contemporaneous pediatric guideline discusses tympanostomy-tube placement as an “option [that] clinicians may offer.”
Given these uncertainties, we undertook the present trial involving children 6 to 35 months of age who had a history of recurrent acute otitis media to determine whether tympanostomy-tube placement, as compared with medical management (comprising episodic antimicrobial treatment, with the option of tympanostomy-tube placement in the event of treatment failure), would result in a greater reduction in the children’s rate of recurrence of acute otitis media during the ensuing 2-year period.
Dr. Salciccioli[/caption]
Justin Salciccioli, MBBS, MA
Research Fellow in Medicine
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Dr. Israel[/caption]
Elliot Israel, MD
Professor of Medicine, Harvard Medical School
Pulmonary and Critical Care, Rheumatology, Medicine
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: Asthma attacks account for almost 50% of the cost of asthma care, which costs $80 billion each year in the United States. Asthma is more severe in African-American/Black and Hispanic/Latinx patients, with these groups having double the rates of attacks and hospitalizations as the general population. The PREPARE study is an ongoing national clinical trial for African American/Black and Hispanic/Latinx adults with moderate-to-severe asthma from different U.S. cities in which reporting of asthma control and asthma exacerbations was monitored entirely remotely.
With the arrival of the Covid19 pandemic, several studies suggested that asthma exacerbations may have decreased during the pandemic. However, multiple reports have suggested people were avoiding health services because of the pandemic, making it difficult to tell whether exacerbations truly decreased or whether people were simply avoiding their doctors. This is the first study done to assess asthma exacerbations before and during the pandemic that is unlikely to be impacted by patient healthcare avoidance.
Dr. Andersson[/caption]
Niklas Worm Andersson, MD
Department of Epidemiology Research
Statens Serum Institut,
Copenhagen Denmark
MedicalResearch.com: What is the background for this study?
Response: "Findings from some previous fetal safety studies on topical corticosteroid use in pregnancy have raised concerns for an increased risk of newborns being small for gestational age or having low birth weight, in particular among pregnancies where larger amounts of potent to very potent agents have been used."
Dr. Mezue[/caption]
Kenechukwu Ndubisi Mezue, M.D
Fellow in 
Dr. Wong[/caption]
John B. Wong, M.D.
Chief Scientific Officer
Vice chair for Clinical Affairs
Chief of the Division of Clinical Decision Making and
Primary care Clinician
Department of Medicine at Tufts Medical Center
MedicalResearch.com: What is the background for this study?
Response: Hypertension affects nearly half of all adults in the United States and is a major risk factor for many serious health conditions. Fortunately, by screening all adults for hypertension, clinicians can improve their patient’s health. The Task Force continues to recommend screening all adults for hypertension so that they can get the care they need to help prevent health conditions such as heart attack, stroke, and kidney failure.
Dr. Jinhee Hur[/caption]
Jinhee Hur, PhD
Research Fellow
Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Response: Early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis) is rapidly rising in the US since the mid-1980s, with an unclear understanding of its etiology and contributors to the rise. Sugar-sweetened beverages (SSBs) exert adverse metabolic repercussions throughout the life course, including insulin resistance and inflammation. Higher SSB intake can induce obesity, which has been linked to risk of EO-CRC. A recent experimental study also suggests that high fructose corn syrup, a primary sweetener in SSBs, may promote colon tumor growth, independent of metabolic dysregulation. In the US, SSB consumption has dramatically increased during the 2nd half of the 20th century, and adolescents and young adults have been the heaviest SSB drinkers across all age groups. Thus, we expect SSBs may be an emerging risk factor for EO-CRC and likely contribute to the rising incidence of EO-CRC.
Dr. Navlakha[/caption]
Saket Navlakha PhD
Simons Center for Quantitative Biology
Cold Spring Harbor Laboratory
Cold Spring Harbor, NY
MedicalResearch.com: What is the background for this algorithm? How does it aide in patient care?
Response: The machine learning algorithm helps to predict if and when a patient will develop severe COVID symptoms, based on information on how the patient presents on the day of infection. This could lead to improved patient outcomes, by getting a “heads up” on what may happen in the near future.
