Author Interviews, Education, NEJM / 09.07.2016

MedicalResearch.com Interview with: [caption id="attachment_25942" align="alignleft" width="200"]Marsha Regenstein, Ph.D, Professor From the Department of Health Policy and Management Milken Institute School of Public Health George Washington University Washington, DC Prof. Marsha Regenstein[/caption] Marsha Regenstein, Ph.D, Professor From the Department of Health Policy and Management Milken Institute School of Public Health George Washington University Washington, DC MedicalResearch.com: What is the background for this study? Response: Despite the billions of dollars in public spending on graduate medical education (GME) in the United States, little is known about the true cost of training a resident, with the few studies that exist showing wide variation in their methods and results. At the same time, the U.S. appears to be producing too few primary care physicians to meet the health care needs of the population, and especially those who live in underserved areas with high health care needs and shortages of health professionals. The Teaching Health Center (THC) Graduate Medical Education funding program was established under the Affordable Care Act to increase the number of medical and dental residents training in six primary care specialties in underserved areas. The Teaching Health Center funding supports community-based residency training in settings such as Federally-qualified health centers, rural clinics, mental health clinics and other non-profit community-based organizations. Hospitals commonly serve as training partners, but THC funding goes directly to the community-based partner, bringing funding and training closer to the communities where underserved patients live. The Health Resources and Services Administration (HRSA), which manages and funds the program, set an interim payment of $150,000 per resident; currently, 59 THCs are training 690 residents in 27 states and the District of Columbia. The interim payment rate was based on the best available information at the time and was meant to cover the full cost of training a resident.
Author Interviews, Education, Medical Imaging, Radiology / 03.07.2016

MedicalResearch.com Interview with: [caption id="attachment_25779" align="alignleft" width="100"]David Leswick MD FRCPC Radiologist Saskatoon Health Region and the University of Saskatchewan Dr. David Leswick[/caption] David Leswick MD FRCPC Radiologist Saskatoon Health Region and the University of Saskatchewan MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is that the use of computed tomography (CT) is increasing, and there is a significant radiation dose imparted to the population through imaging. There have been multiple prior studies showing limited knowledge of both dose levels and its associated risk from medical imaging procedures, and we wanted to evaluate local knowledge in our Health Region. We surveyed a total of 308 health care providers, including 217 referring physicians, 32 radiologists and 59 technologists. Overall, most respondents were aware of the risk of malignancy from CT, with only 23% of physicians, 3% of radiologists, and 25% of technologists believing there was no increased risk of malignancy from a single CT scan. Underestimating radiation dose levels from a procedure is more concerning than overestimating as it may lead to minimization of the perceived risk. Although relatively few respondents (20%) selected the most appropriate dose estimate for an abdominal CT scan in chest x-ray equivalents, the majority (54%) correctly or overestimated dose, with better knowledge amongst radiologists and imaging technologists than referring physicians. In general, respondents were appropriately more concerned regarding radiation dose when imaging pregnant and pediatric patients as risks from radiation are higher in those groups of patients.
Author Interviews, Education, Exercise - Fitness / 28.06.2016

MedicalResearch.com Interview with: [caption id="attachment_25601" align="alignleft" width="157"]Peter Krustrup PhD Professor of Team Sport and Health Department of Nutrition, Exercise and Sports Copenhagen Centre for Team Sport and Health University of Copenhagen, Denmark Dr. Peter Krustrup[/caption] Peter Krustrup PhD Professor of Team Sport and Health Department of Nutrition, Exercise and Sports Copenhagen Centre for Team Sport and Health University of Copenhagen, Denmark Dr. Krustrup discusses ideas formulated in the Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time. MedicalResearch.com: What is the background for this study? What are the main findings? Response: A desire to improve children’s and youth’s health, well-being and social inclusion motivated researchers at University of Copenhagen, Department of Nutrition, Exercise and Sports to gather 24 international top level researchers from a variety of academic disciplines at a consensus conference in Denmark on 4-7 April 2016. The aim of the Copenhagen Consensus Conference in 2016 was to reach an evidence-based consensus within the four themes: 1) Physical activity in children and youth: Fitness and health. 2) Physical activity in children and youth: Cognitive functioning 3) Physical activity in children and youth: Engagement, motivation and psychological well-being 4) Physical activity in children and youth: Social inclusion and physical activity implementation strategies.
Author Interviews, Education, PNAS, Surgical Research / 23.06.2016

MedicalResearch.com Interview with: [caption id="attachment_25468" align="alignleft" width="152"]Sunita Sah MD PhD Management & Organizations Johnson Graduate School of Management Cornell University Dr. Sunita Sah[/caption] Sunita Sah MD PhD Management & Organizations Johnson Graduate School of Management Cornell University MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Sah: Physicians often recommend the treatment they specialize in, e.g., surgeons are more likely to recommend surgery than non-surgeons. Results from an observational study and a randomized controlled laboratory experiment found that when physicians revealed their bias toward their own specialty, patients were more likely to report increased trust in the physician’s expertise and take the treatment in accordance with the physician’s specialty.   
Author Interviews, Education, JAMA, Pharmacology, UCSF / 21.06.2016

MedicalResearch.com Interview with: Colette DeJong Medical student at UCSF and Research Fellow at the UCSF Center for Healthcare Value. MedicalResearch.com: What is the background for this study? Response: Data released under the U.S. Sunshine Act reveals that in the last five months of 2013, over half of American physicians received free meals, gifts, or payments from the pharmaceutical industry. Recent studies have shown that doctors who receive large payments from drug companies—such as speaking fees and royalties—are more likely to prescribe expensive brand-name drugs, even when generics are available. Our findings, however, suggest that physicians’ prescribing decisions may be associated with much smaller industry payments than previously thought. We found that doctors who receive a single industry-sponsored meal—with an average value under $20—are up to twice as likely to prescribe the brand-name drug being promoted.
Author Interviews, Education, Gender Differences / 07.06.2016

MedicalResearch.com Interview with: [caption id="attachment_24982" align="alignleft" width="175"]Sara E. Brownell PhD School of Life Sciences Arizona State University Tempe, AZ Dr. Sara Brownell[/caption] Sara E. Brownell PhD School of Life Sciences Arizona State University Tempe, AZ MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Brownell: Our group has been broadly interested in gender biases in introductory biology since we published a study that showed that women underperform on course exams and under participate in whole class discussions compared to men (http://www.lifescied.org/content/13/3/478.full). We were curious why women might be under performing on these course exams so in this new study, we examined characteristics of the exams to see if that had an impact. What we found was that women and men perform equally on questions that test basic memorization. However, when questions tested more higher-level critical thinking skills, women were not scoring as high as men. This happened even when we took into account the academic ability of the students - women and men who had the same ability coming into the class. We also found that students from lower socioeconomic statuses also underperformed on these higher-level critical thinking questions compared to students from higher socioeconomic statuses, again even when we took into account academic ability.
Author Interviews, Education, JAMA, Sexual Health, University of Michigan / 17.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24422" align="alignleft" width="125"]Reshma Jagsi, MD, DPhil Department of Radiation Oncology, University of Michigan Ann Arbor, MI 48109 Dr. Reshma Jagsi[/caption] Reshma Jagsi, MD, DPhil Department of Radiation Oncology, University of Michigan Ann Arbor, MI 48109 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Jagsi: There has recently been considerable media attention to certain egregious individual cases of sexual harassment, but it has been less clear whether these cases were isolated and uncommon incidents or whether they are indicative of situations more commonly experienced by academic medical faculty.  An excellent survey study had previously documented that 52% of female faculty in 1995 had experienced harassment, but many of those women had attended medical school when women were only a small minority of the medical students (let alone faculty).  More recent estimates of faculty experiences are necessary to guide ongoing policies to promote gender equity in an era when nearly half of all medical students are women. We found that in a modern sample of academic medical faculty, 30% of women and 4% of men had experienced harassment in their careers.
Author Interviews, Education, PLoS / 15.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24200" align="alignleft" width="200"]Mallory Kidwell, B.A. Project Coordinator at the Center for Open Science Mallory Kidwell[/caption] Mallory Kidwell, B.A. Project Coordinator at the Center for Open Science MedicalResearch.com: What is the background for this study? What are the main findings? Response: Open and transparent sharing of research data and materials is a core value of science that facilitates critique, replication, and extension within the scientific community. However, current norms provide few incentives for researchers to share such evidence, resulting in only a small portion of articles with accessible research data and materials. Efforts to improve rates of data sharing are occurring across research disciplines. In January 2014, the journal Psychological Science adopted an intervention to encourage data and materials sharing -- badges to acknowledge open practices, developed and freely distributed by the Center for Open Science. The badges, visual icons placed on publications, certify when the authors of a research publication have followed open practices to make their data or research materials publicly accessible. In the two years prior to adopting badges, we found that only about 3% of publications at Psychological Science reported that the underlying data was publicly accessible. After 2014, the rate of publications reporting data sharing increased dramatically, reaching 39% in the first half of 2015 -- the last time period included in the study. Materials sharing also increased, but to a weaker degree and with greater variability. We also found that, with badges, authors were more likely to follow through in making the data accessible and sharing data that was correct, usable, and complete for other researchers to reuse or reanalyze. A comparison group of journals in psychology showed no change in data sharing rates over the same time period, and among the authors that did report sharing data in the other journals, the data was less likely to actually be available, correct, usable, or complete.
Author Interviews, Education, Genetic Research, Nature / 13.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24316" align="alignleft" width="128"]Dr. Daniel J. Benjamin PhD Associate Professor (Research), USC, 2015-present Associate Professor (with tenure), Cornell, 2013-2015 Assistant Professor, Cornell University, 2007-2013 Research Associate, NBER, 2013-present Faculty Research Fellow, NBER, 2009-2013 Dr-Daniel Benjamin[/caption] Dr. Daniel J. Benjamin PhD Associate Professor (Research), USC, 2015-present Associate Professor (with tenure), Cornell, 2013-2015 Assistant Professor, Cornell University, 2007-2013 Research Associate, NBER, 2013-present Faculty Research Fellow, NBER, 2009-2013  MedicalResearch.com: What is the background for this study? Dr. Benjamin: Educational attainment is primarily determined by environmental factors, but decades of twin and family studies have found that genetic factors also play a role, accounting for at least 20% of variation in educational attainment across individuals. This finding implies that there are genetic variants associated statistically with more educational attainment (people who carry these variants will tend on average to complete more formal education) and genetic variants associated statistically with less educational attainment (people who carry these variants will tend on average to complete less formal education). But none of these genetic variants had been identified until our 2013 paper on educational attainment. That paper, which studied a sample of roughly 100,000 individuals, identified 3 genetic variants associated with educational attainment, each of which has a very small effect. In the current paper, we expanded our sample to roughly 300,000 individuals, with the goal of learning much more about the genetic factors correlated with educational attainment.
Author Interviews, Cost of Health Care, Education, JAMA / 11.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24158" align="alignleft" width="120"]Dr. James Song-Jeng Weh, MD Brigham and Women's Hospital Boston MA Dr.  Yeh[/caption] Dr. James Song-Jeng Yeh, MD Brigham and Women's Hospital Boston MA MedicalResearch.com: What is the purpose for this study? Dr. Yeh: A number of factors influence physicians’ prescribing behavior, including physician’s knowledge and understanding of the drugs.  Pharmaceutical detailing and financial incentives may affect such behavior.  My interest in evidence-based medicine and how medical knowledge is translated into practice lead me to think about how physicians’ financial relationships with the pharmaceutical industry may affect prescribing patterns. In our study, we linked the Massachusetts physicians open payment database with the Medicare drug prescription claims database to determine if financial relationships with the industry are associated with increased brand-name statin drug prescribing.  The open payment database reports payments that physicians receive from pharmaceutical and medical device industries.  The open payment database when linked to the drug prescription claims database allowed us to answer this question. We looked at year 2011, when two of the most commonly prescribed brand-name statin drugs (Lipitor and Crestor) were not yet available in generic formulation. The outcome measured was what percentage of all statin prescription claims (both generic and brand-name) were brand-names.
Author Interviews, Education, Gender Differences, Surgical Research / 04.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24030" align="alignleft" width="142"]Alison M. Fecher, MD Assistant Professor of Surgery Indiana University Health Dr. Alison Fecher[/caption] Alison M. Fecher, MD Assistant Professor of Surgery Indiana University Health MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Fecher: It has long been known that female faculty are underrepresented in departments of surgery at U.S. medical schools. Our study wanted to identify obstacles women face in entering certain surgical subspecialties and in career advancement. We found that women are poorly represented in some of the most competitive subspecialties, including cardiothoracic and transplant surgery. We also found that women tend to advance more slowly up the career ladder, with many of them spending more years at the assistant professor level than their male counterparts. One reason for this may be that they tend to publish less peer-reviewed articles than male faculty; however, our results show that the publications of female faculty often has a greater impact on the field, as measured by citations and recentness of articles.
Author Interviews, Education, Pediatrics, Pediatrics / 29.04.2016

MedicalResearch.com Interview with: Jorijn Hornman, BSc (MD PhD student) Departments of Health Sciences University Medical Center Groningen University of Groningen, Netherlands MedicalResearch.com: What is the background for this study? Response: Preterm children are at increased risk of emotional and behavioral problems compared to full-term children. Prevalences vary with degree of prematurity and assessment age. Unknown was whether stability of these problems upon school entry differs between preterm and full-term children. MedicalResearch.com: What are the main findings? Response: We found that preterm children had higher rates than full-term children of persistent (7.2% versus 3.6%), emerging (4.3% versus 2.3%), and resolving (7.5% versus 3.6%) emotional and behavioral problems. Early preterm children –born at <32 weeks gestation- had the highest rates of persistent (8.2%) and emerging (5.2%) problems, and moderately preterm children –born at 32-35 weeks gestation- the highest rates of resolving problems (8.7%).
Author Interviews, Education, Pediatrics, PNAS, Social Issues / 26.04.2016

MedicalResearch.com Interview with:

[caption id="attachment_23783" align="alignleft" width="140"]Joan L. Luby, MD Samuel and Mae S. Ludwig Professor of Child Psychiatry Director, Early Emotional Development Program Washington University School of Medicine St. Louis, Missouri Dr. Joan Luby[/caption]

Joan L. Luby, MD Samuel and Mae S. Ludwig Professor of Child Psychiatry Director, Early Emotional Development Program Washington University School of Medicine St. Louis, Missouri

MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Luby: The study was designed to investigate brain development in early onset mental disorders. The main findings validate depression in preschoolers with brain change evident this young similar to that known in adults. We also found effects of maternal support on brain development in this process which is what the current paper focuses on .
Author Interviews, BMJ, Cancer Research, Education / 08.04.2016

MedicalResearch.com Interview with: Dr Alex Ghanouni Research Associate UCL Research Department of Epidemiology and Public Health Health Behaviour Research Centre London MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ghanouni: This study comes out of growing concern among academics, doctors, and policymakers about the unintended harms of healthcare interventions. One prominent issue in the ongoing debate is ‘overdiagnosis’, that is detection of disease that would not have caused symptoms or death if it had remained undetected. There are many contexts in which overdiagnosis can occur but one of the most prominent is cancer screening, in which asymptomatic individuals undergoing testing may have slow-growing cancers detected that would never have otherwise come to light. However, because it is impossible to be sure which cancers are slow-growing and which are aggressive, most are treated. This means that overdiagnosis can lead to harm through the anxiety caused by a disease label and the negative effects of treatment (e.g. surgery) that is actually unnecessary. Despite professional concern about overdiagnosis, previous research has found that the public is mostly unaware that it exists. One study that was particularly relevant to our research was an Australian survey in which members of the public were asked whether they had encountered the term before and what they thought it meant. Although around half the sample stated that they had heard or seen the term before, only 41% were able to provide a definition that was approximately correct. We tested the extent to which this was true as part of an online survey of adults aged 50-70 years in the UK. We found that recognition of the term was very low (only 30%) and almost no-one (3%) gave an answer that was strictly accurate. Responses often indicated misconceptions (e.g. “misdiagnosis”, “false positive diagnosis”, or being “overly health conscious”).
Author Interviews, Education, JAMA, Pain Research / 27.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22729" align="alignleft" width="142"]Dr. Daniel C. Cherkin PhD Senior Investigator Group Health Research Institute Seattle, WA Dr. Daniel Cherkin[/caption] Dr. Daniel C. Cherkin PhD Senior Investigator Group Health Research Institute Seattle, WA MedicalResearch.com: What is the background for this study? Dr. Cherkin: Chronic low back pain is a widespread, costly, and potentially disabling problem. It’s the most common cause of pain of any kind. It affects eight in 10 Americans at some point in their lives. In recent years, the United States has been spending more on back pain treatments—but unfortunately with worse results in how much pain bothers people and interferes with their lives. Group Health is addressing the problem in several ways, including this innovative research. MedicalResearch.com: What are the main findings? Dr. Cherkin: In a randomized controlled trial involving more than 300 patients at Group Health, we found that training in a kind of mindfulness meditation—mindfulness-based stress reduction (MBSR)—led to meaningful improvements in functioning and chronic low back pain at six months and one year. MBSR, which is becoming increasingly popular and available in the United States, involves training in observing, acknowledging, and accepting thoughts and feelings including pain. The training also includes some easy yoga poses to help participants become more aware of their bodies. Results with  mindfulness-based stress reduction were significantly better than with usual care (whatever patients would be doing for their back pain if they weren’t in the study, including medications and physical therapy—but not mindfulness meditation or cognitive behavioral therapy). And results with  mindfulness-based stress reduction were very similar to those with cognitive behavioral therapy (CBT). CBT includes education about chronic pain, relationships between thoughts and emotional and physical reactions, instruction and practice in changing dysfunctional thoughts, setting and working towards behavioral goals, relaxation skills, activity pacing, and pain coping strategies. Prior studies had already proven that CBT helped adults of various ages with back pain.
Author Interviews, Education, NYU/NYMC, Pediatrics, PNAS, Weight Research / 15.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22656" align="alignleft" width="200"]Michele Leardo Assistant Director Institute for Education & Social Policy New York University New York, NY 10012 Michele Leardo[/caption] Michele Leardo Assistant Director Institute for Education & Social Policy New York University New York, NY 10012 MedicalResearch.com: What is the background for this study? What are the main findings? Response: US school districts increasingly distribute annual fitness and body mass index (BMI) “report cards” to students and parents. Such personalized informational interventions have appeal in economics because they can inform parents about their children's obesity status at relatively low costs. Awareness of the weight status can lead to behavioral responses that can improve health. New York City public schools adopted Fitnessgram in 2007-2008, reporting each student’s BMI alongside categorical BMI designations. We examined how being classified as “overweight” for the previous academic year affected the students’ subsequent BMI and weight. Specifically, we compared female students whose BMI was close to their age-specific cutoff for being considered overweight with those whose BMI narrowly put them in the “healthy” category. We find that being labeled overweight had no beneficial effects on students’ subsequent BMI and weight.
Author Interviews, Education, OBGYNE / 08.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22482" align="alignleft" width="200"]Cynthia R. Daniels PhD Professor, Political Science Department. Rutgers University New Brunswick, N.J. 08901 Dr. Cynthia Daniels[/caption] Cynthia R. Daniels PhD Professor, Political Science Department. Rutgers University New Brunswick, N.J. 08901  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Daniels: The study found that over 30% of information regarding embryological and fetal development is medically misleading in the informed consent materials states require women see before receiving an abortion.  Nearly half of the information provided about the 1st trimester of pregnancy, when most women have abortions, was medically inaccurate, meaning either 'false' or 'misleading.'
Author Interviews, Education / 04.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22329" align="alignleft" width="160"]Paul L. Morgan, Ph.D. Associate Professor, Department of Education Policy Studies Director, Educational Risk Initiative Faculty Affiliate, Child Study Center Research Associate, Population Research Institute Faculty Affiliate, Prevention Research Center The Pennsylvania State University University Park, PA Dr. Paul L. Morgan[/caption] Paul L. Morgan, Ph.D. Associate Professor, Department of Education Policy Studies Director, Educational Risk Initiative Faculty Affiliate, Child Study Center Research Associate, Population Research Institute Faculty Affiliate, Prevention Research Center The Pennsylvania State University University Park, PA MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Morgan: The U.S. is at of risk declining economic competitiveness due to its lower levels of educational attainment in science, technology, engineering, and mathematics (STEM) relative to other countries (see http://www.nap.edu/catalog/12999/rising-above-the-gathering-storm-revisited-rapidly-approaching-category-5). Concurrently, the U.S. has a well-established “leaky STEM pipeline” in which children who are racial or ethnic minorities, females, or from low income families are especially unlikely to grow up to be employed in STEM positions. Large science achievement gaps are disproportionately experienced by these same groups of children. Yet the U.S. is increasingly transitioning to a knowledge economy necessitating higher levels of scientific thinking, problem solving, and technical competency. The causes of these science achievement gaps have been poorly understood. Most of the existing empirical work on science achievement gaps has used cross-sectional designs. The samples also have largely been of older students attending middle or high schools. As a result, the early onset, over-time dynamics, and risk factors for science achievement gaps have been largely unknown. Our study helps inform policy, research, and practice by establishing that science achievement gaps emerge by the elementary grades and then largely remain stable as children continue throughout middle school. These gaps are mostly explained by children’s knowledge about their general surroundings acquired by the primary grades. Children’s reading and mathematics achievement also help to explain their science achievement, as do income inequality and school racial and income segregation. We find that children from traditionally marginalized groups (e.g., those who are Black, Hispanic, or from low-income families) are especially likely to enter school with general knowledge gaps. These same children often continue to experience science achievement gaps throughout elementary and middle school. However, factors modifiable by parents, educators, and policymakers largely explain these children’s gaps and so might be the target of early and sustained intervention efforts. 
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Education, Mayo Clinic, Neurology / 25.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22061" align="alignleft" width="125"]Prashanthi Vemuri, PhD Mayo Clinic Rochester, Minnesota Dr. Prashanthi Vemuri[/caption] Prashanthi Vemuri, PhD Mayo Clinic Rochester, Minnesota  Medical Research: What is the background for this study? What are the main findings? Dr. Vemuri: Lifetime Intellectual enrichment has been found to delay the symptoms of dementia but the impact on brain changes due to Alzheimer’s disease has been poorly understood. In this study we studied the impact of lifetime intellectual enrichment (education, occupation, and midlife cognitive activities) on the brain changes related to Alzheimer’s disease. We obtained serial imaging on 393 individuals from a population based sample. We found that in majority of the individuals, there were minimal effects of intellectual enrichment on brain changes due to Alzheimer’s disease. However in those with higher genetic risk of Alzheimer’s, lifetime intellectual enrichment had a protective effect on the brain.
Asthma, Author Interviews, Education, Pediatrics / 25.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22192" align="alignleft" width="130"]Joy Hsu, MD, MS Air Pollution and Respiratory Health Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health CDC Atlanta GA 30341 Dr. Joy Hsu[/caption] Joy Hsu, MD, MS Air Pollution and Respiratory Health Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health CDC Atlanta GA 30341 Medical Research: What is the background for this study? Dr. Hsu: Asthma is a leading cause of missed school days related to chronic illness. This study is based on survey data from 2006 to 2010 on children aged 17 years and younger with asthma from 35 states and the District of Columbia. 
Author Interviews, Education, NYU/NYMC, Pediatrics, Pediatrics, Social Issues / 05.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21333" align="alignleft" width="112"]Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Dr. Alan Mendelsohn[/caption] Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Adriana Weisleder, PhD [caption id="attachment_21334" align="alignleft" width="100"]Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center Dr. Adriana Weislander[/caption] Research scientist, Department of Pediatrics NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise. The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals. The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.
Author Interviews, Education, Flu - Influenza, Vaccine Studies / 30.12.2015

[caption id="attachment_20371" align="alignleft" width="199"]Mubdiul Ali Imtiaz, MD Department of Internal Medicine Rutgers University, New Jersey Medical School Newark, NJ 07103. Dr.  Mubdiul Ali Imtiaz[/caption] MedicalResearch.com Interview with: Mubdiul Ali Imtiaz, MD Department of Internal Medicine Rutgers University, New Jersey Medical School Newark, NJ 07103 Medical Research: What is the background for this study? Response: Resident physicians (RPs) were defined to be all individuals enrolled in a graduate medical education training program in a healthcare setting. There were 611 resident physicians enrolled in 47 post-graduate residency and fellowship programs at RU-NJMS during the 2013-2014 academic year. Influenza immunization was strongly recommended, but not mandatory for Resident physicians during 2013-2014. A link to the online survey using a standardized, anonymous, self-administered questionnaire was emailed by the program-chiefs to their respective RPs to collect demographic characteristics, influenza immunization status during the 2013-2014 and the previous season, and reasons for non-vaccination. Medical Research: What are the main findings? Response: The overall self-reported immunization rate of  Resident physicians in 2013-2014 was 76.7%. The immunization rate did not differ by the location of medical school attended (P= 0.55) or sex (P= 0.69). Among the respondents, 95.8% had influenza vaccination in the past and 83.1% received influenza vaccine during 2012-2013 flu season. History of influenza vaccination ever and in 2012-2013 were both significantly associated with receiving the vaccine during the 2013-2014 season (P<0.01 for both). The most common reason for not being vaccinated (38.6%) was “lack of time to get immunized” (see Figure 1). The most common cited motivating factors to be vaccinated during the next influenza season among the NVRPs were “making vaccinations in the workplace at convenient locations and times” (43.2%), “availability of mobile flu vaccination carts in hospital floors” (40.9%), and “establishing mandatory flu vaccination for employment” (36.4%).
AHA Journals, Author Interviews, Education, Heart Disease, Stroke / 23.12.2015

MedicalResearch.com Interview with: Carole Decker, RN, PhD, CPHQ, FAHA Director, Cardiovascular Outcomes Research Saint Luke's Mid America Heart Institute Kansas City, MO 64111 Medical Research: What is the background for this study? What are the main findings? Dr. Decker: Stroke is the leading cause of disability and the fifth leading cause of death. The utilization of thrombolytic therapy is the national standard of care for acute ischemic stroke (AIS) treatment resulting in improved outcomes at 90 days and yet only 7% of patients with AIS receive a thrombolytic. The American College of Emergency Physicians emphasizes the importance of using a shared medical decision-making model with AIS patients and their caregivers to discuss benefits and risks of treatment. The recommended door-to-needle (emergency door to thrombolytic administration) is 60 minutes to achieve the optimal patient outcomes which can be problematic in that conversation on benefits and risks occurs in a hurried emergency setting. Multiple risk models to identify individualized benefits and risks of thrombolytic therapy have been developed but few are used prospectively and are not used at the point of care. Our team created ePRISM (Personalized Risk Information Services Manager), a Web-based tool, to generate personalized documents with patient-specific outcomes based on validated risks models. To support knowledge transfer and creation of a shared decision-making tool, our multidisciplinary team conducted qualitative interviews to define the information needs and preferred presentation format for stroke survivors, caregivers, and clinicians considering thrombolytic treatment.
Author Interviews, Cost of Health Care, Education, JAMA / 16.12.2015

[caption id="attachment_20140" align="alignleft" width="200"]Lorette A. Stammen, MD Department of Educational Development and Research Faculty of Health, Medicine, and Life Sciences Maastricht University, Maastricht The Netherlands Dr. Stammen[/caption] MedicalResearch.com Interview with: Lorette A. Stammen, MD Department of Educational Development and Research Faculty of Health, Medicine, and Life Sciences Maastricht University, Maastricht The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Stammen: Research indicated that we can improve the quality of care and reduce the health care costs by eliminating health care waste. Health care waste are health care services that are not beneficial to patients. There are many ways to reduce health care waste, like through insurance and government policies modification,  but we were especially interested in how the medical expertise of physicians could improve high-value, cost-conscious care. We conducted a systematic review with the aim of understanding how training programs cause learning among physicians, residents and medical students. We analyzed 79 articles using realist review method and found three important factors that facilitate the learning of physicians (in training).
  • First, educational programs should focus on knowledge transmission. Knowledge that is essential entails knowledge regarding prices and general health economics, scientific evidence, and patient preferences.
  • Besides knowledge, the second factor of training for high-value, cost-conscious care is reflective practice. Reflective practice for example using feedback and asking reflective questions, by peers, colleagues and supervisors to reflect on decisions made in daily practice.
  • The third element of training programs should address an supportive environment in which physicians, residents and medical students learn. A supportive environment is important to cultivate the importance of high-value, cost-conscious care on multiple levels in the health care system. Since physicians are a part of a health care team their training programs should incorporate the training of health care professionals.
  • Furthermore, it is important that role models demonstrate high-value cost-conscious care.
Author Interviews, Depression, Education, JAMA / 09.12.2015

MedicalResearch.com Interview with: [caption id="attachment_19872" align="alignleft" width="200"]Dr. Douglas A. Mata, Harvard Medical School Dr. Douglas A. Mata Harvard Medical School[/caption] Douglas A. Mata, M.D., M.P.H. Anatomic and Clinical Pathology Resident Physician, Brigham & Women’s Hospital Clinical Fellow, Harvard Medical School Boston, MA 02115 Marco A. Ramos, M.Phil., M.S.Ed. History of Science and Medicine M.D./Ph.D. Candidate, Yale School of Medicine New Haven, CT 06511 Medical Research: What is the background for your study? Dr. Mata: Training to be a doctor is clearly stressful, but the prevalence of depression among trainees is not well known. They may get especially depressed during their grueling years of residency, when young physicians are learning their craft by working long hours and taking care of critically ill patients. Coming up with a reliable estimate of the prevalence of depression among graduate medical trainees would help us identify causes of resident depression and begin to treat or prevent it. We thus aimed to find answers to two questions:
  • First, what percentage of new doctors might be depressed?
  • Second, how much has that changed over time?
Medical Research: What are the main findings? Dr. Mata: We set out to find every study ever published on this subject. We analyzed 50 years of research on depression in resident physicians. We collected and combined data from 54 studies conducted around the world, and found that a startling 29% of physicians in training have signs of depression. We also detected a small but significant increase in the prevalence of depression over the five decades the study covered. Mr. Ramos: Twenty-nine percent is a concrete number you can hang your hat on, so to speak. But this number alone doesn’t capture the extent of the problem. We conducted additional studies that revealed that up to 43% of residents have depressive symptoms.
Author Interviews, Education, JAMA / 09.12.2015

[caption id="attachment_19809" align="alignleft" width="150"]Henry Sondheimer, MD Senior director of student affairs American Association of Medical Colleges Dr. Sondheimer[/caption] MedicalResearch.com Interview with: Henry Sondheimer, MD Senior director of student affairs American Association of Medical Colleges Medical Research: What is the background for this study? What are the main findings? Dr. Sondheimer: The background for this study in JAMA's Med Ed issue of December 8th is that a group of the medical schools' deans asked us (AAMC staff) in 2014 whether there was a differential in placement of African-American, Hispanic, and Native American graduates into Graduate Medical Education at the time of their graduation from medical school. In fact, as shown in this short paper, there is a difference with more current graduates from the under-represented in medicine graduates not beginning their GME immediately post-graduation. However, over time this difference diminishes substantially but does not disappear completely.
Author Interviews, Education, Electronic Records, JAMA / 08.12.2015

[caption id="attachment_19902" align="alignleft" width="200"]David Ouyang MD Department of Internal Medicine Stanford University School of Medicine Stanford, California Dr. David Ouyang[/caption] MedicalResearch.com Interview with: David Ouyang MD Department of Internal Medicine Stanford University School of Medicine Stanford, California Medical Research: What is the background for this study? What are the main findings? Dr. Ouyang: In American teaching hospitals, trainee resident physicians are an integral part of the medical team in performing procedures, writing notes, and coordinating care. As more care is being facilitated by electronic medical record (EMR) systems, we are just now finally able to understand how much residents work and how residents spend their time. In our study, we examined the types and timing of electronic actions performed on the EMR system by residents and found that residents spend about a third (36%) of their day in front of the computer and frequently perform many simultaneous tasks across the charts of multiple patients. Additionally, residents often do work long hours, with a median of 69.2 hours per week when on the inpatient medicine service.
Author Interviews, Diabetes, Diabetes Care, Education, Gender Differences / 27.11.2015

MedicalResearch.com Interview with: Marlene Øhrberg Krag , MD, MIH Department of Public Health University of Copenhagen, Denmark Medical Research: What is the background for this study? Dr. Krag: In this follow-up study we wanted to assess whether there was any difference in longterm treatment outcome of personally tailored diabetes care when comparing men and women. The "Diabetes Care in General Practice" trial included people with newly diagnosed type 2 diabetes. Patients were randomized to receive 6 years of either routine care or personally tailored care with regular follow-up, individualized treatment goal setting and continuing education of the participant general practitioners. Medical Research: What are the main findings? Dr. Krag: Following up the patients for 13 years after 6 years of intervention a significant reduction in all cause mortality and diabetes related death was seen for women but not men. This difference could not be explained by intermediate outcomes like HgbA1c alone, and is suggested to be based on a complex of biological, social and cultural issues of gender . Women accept disease and implement disease management more easily than men, whereas men may feel challenged by diabetes, demanding daily consideration and lifestyle changes. Furthermore the study provided attention and support, which the women reported they lack and this could provide an incentive to treatment adherence.
AHA Journals, Author Interviews, Duke, Education, Gender Differences, Heart Disease / 10.11.2015

[caption id="attachment_19201" align="alignleft" width="160"]Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine Dr. Douglas[/caption] MedicalResearch.com Interview with: Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Douglas: The impetus for our study was the concern that cardiology as a profession might be enhanced by greater diversity. By not attracting women in larger numbers (9% of FACCs are female), our fellowships have incomplete access to the talent pool of outstanding residents, and we do not have a diverse group of clinicians to care for our increasingly diverse patient population, or of researchers to explore potentially important health care disparities. Our findings were twofold: first, job descriptions for men and women cardiologists are dramatically different. Men are much more likely to do invasive procedures while women are more likely to see patients and perform imaging/noninvasive tests.  While there were slightly more women working part time than men this was still rare, and the difference in number of days worked was just 6, across an entire year. The second finding was that there was a significant difference in compensation. Unadjusted, this was over $110, 000 per year; after very robust adjustment using over 100  personal, practice, job description and productivity measures, the difference was $37, 000 per year, or over a million dollars across a career. A separate independent economic analysis of wage differentials yield a similar difference of $32,000 per year.