Most Patients Who Survive Overdose Do Not Receive FDA Approved Medications for Opioid Use Disorder

MedicalResearch.com Interview with:

Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston University School of Medicine Boston MA

Dr. Larochelle


Marc R. Larochelle, MD, MPH

Assistant Professor of Medicine
Boston University School of Medicine
Boston MD 

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

Response: In this study we examined more than 17,000 individuals who survived an opioid overdose in Massachusetts between 2012 and 2014.

We were interested in identifying how many went on to receive one of the three FDA-approved medications for opioid use disorder (MOUD), and whether or not they were associated with mortality.

We found that only 3 in 10 received MOUD and that receipt of buprenorphine and methadone were associated with 40-60% reduction in all-cause and opioid-related mortality.

We found no association between naltrexone and mortality though the confidence of this conclusion is limited by the small number who received naltrexone in this cohort.

Continue reading

Long Term HIV Viral Suppression Reduces But Does Not Eliminate Elevated Cancer Risk

MedicalResearch.com Interview with:

Lesley S. Park, PhD, MPH Instructor, Medicine- Primary Care and Population Health BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

Dr. Lesley Park

Lesley S. Park, PhD, MPH
Instructor, Medicine- Primary Care and Population Health
BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship
Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

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

Response: As the population of persons living with HIV/AIDS is aging, the overall burden of cancer is substantial and increasing; however, we have much to learn about the potential cancer prevention benefits of antiretroviral treatment (ART).

Our study is the first to examine the effects of prolonged periods of viral suppression and potential cancer prevention benefits. While prior randomized clinical trials (RCTs) and observational studies have examined viral suppression and cancer risk, they mostly were limited to small numbers of cancer outcomes or were only focused on few specific cancer types.

Our study demonstrated a benefit of the prevention of cancer development in AIDS-defining cancers (non-Hodgkin lymphoma, Kaposi sarcoma), which was expected, but also in some non-AIDS-defining cancer types (lung, larynx, melanoma, leukemia).  Continue reading

Physician MOC Status Linked To Better Diabetes Performance Measure

MedicalResearch.com Interview with:
Bradley Gray, PhD
Senior Health Services Researcher
American Board of Internal Medicine

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

Response: This study is part of an ongoing effort to improve and validate ABIM’s MOC process through the use of real data that is ongoing here at ABIM.

MedicalResearch.com: What are the main findings? 

Response: The paper examines the association between MOC status and a set of HEDIS process quality measures for internists twenty years past the time they initially certified. An example of one HEDIS performance measure we looked at was percentage of patients with diabetes that had twice annual HbA1c testing. The key findings of the paper are that physicians who maintained their certification had better scores on 5 of 6 HEDIS performance measures than similar physicians who did not maintain their certification.

Continue reading

Lack of Dialysis Access for Undocumented Immigrants Stresses Patients and Providers

MedicalResearch.com Interview with:

Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center

Dr. Cervantes

Lilia Cervantes, M.D.
Internal Medicine, Hospitalist
Denver Health and Hospital Authority
Assistant Professor, Division of General Internal Medicine
Founder, Healthcare Interest Program and Health Equity Lecture Series
at Denver Health
University of Colorado Health Sciences Center

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

Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis.

This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  Continue reading

Amyloid Biomarker Predictive of Mortality in Non-STEMI Heart Attack

MedicalResearch.com Interview with:

Prof. Dr. med. Konstantinos Stellos,MD, FAHA, FESC Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle upon Tyne United Kingdom

Prof. Stellos

Prof. Dr. med. Konstantinos Stellos,MD, FAHA, FESC
Cardiovascular Research Centre, Institute of Genetic Medicine
Newcastle upon Tyne
United Kingdom

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

 

Response: Risk stratification of patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains a major challenge in clinical cardiology. Risk stratification is important to identify patients at high risk, to whom an early coronary intervention with optimal adjunctive medical therapy shall be applied to reduce that risk. Conversely, it is equally important to identify patients at low risk, to whom a potentially hazardous invasive therapy or a multi-drug administration shall be avoided. Current ACC/AHA and ESC guidelines agree in a standardized approach that uses Global Registry of Acute Coronary Events (GRACE) score, a well validated scoring system, to calculate a patient’s risk and guide triage and management decisions.

Amyloid-β (Aβ) 1-40 and 1-42 peptides (Aβ40 and Aβ42), are proteolytic fragments of a larger protein, the amyloid precursor protein (APP) cleaved by β- and γ-secretases, found in typical brain amyloid deposits in Alzheimer’s disease. Many lines of evidence support a role of Aβ40 in cardiovascular disease as a peptide with pro-inflammatory and pro-thrombotic properties. Most cardiovascular risk factors seem to affect APP metabolism and thus, Aβ production and its soluble circulating APP770 isoform are elevated in patients with ACS_ENREF_15, suggesting a role for Aβ40 in the triggering and outcome of ACS in stable CAD patients. Although vascular inflammation is considered as a hallmark in the pathophysiologic pathways of coronary artery disease (CAD) and novel mechanisms are continuously recognized in its pathogenesis, no inflammatory marker is currently recommended for risk stratification of patients with NSTE-ACS individually or as a component of the GRACE score. This may partly explain the moderate discriminative ability of GRACE score in some studies, especially in older patients and those after early percutaneous coronary intervention (PCI).

In this retrospective study, we used data from two independent prospective cohorts, the Heidelberg study (n=1,145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation, n=734) study and determined the clinical prognostic and reclassification value of baseline circulating Aβ40 levels in the prediction of mortality over the GRACE risk score in patients with NSTE-ACS across a median follow-up of 21.9 ( Heidelberg cohort) and 24.9 months (APACE cohort), respectively.

Continue reading

Double-Edge Sword of Drug Epidemic

MedicalResearch.com Interview with:
Christine Marie Durand, M.D
.
Assistant Professor of Medicine
Johns Hopkins Medicine 

MedicalResearch.com: What is the background for this study

Response: Most Americans know that the United States faces an epidemic of deaths due to drug overdose.  And many are also aware that there is a critical shortage of organs available for transplant.  Perhaps less widely known is that today, more than 1 in every 8 deceased organ donors died from a drug overdose.  The objective of our study was to look at the outcomes of patients who received transplants with organs donated after an overdose.

Continue reading

LOUD Outdoor Concerts Lead To Temporary Hearing Loss, esp in Men

Christine Marie Durand, M.D. Assistant Professor of Medicine Johns Hopkins Medicine MedicalResearch.com Interview with:
Dr. Véronique J. C. Kraaijenga
 MD
Department of Otorhinolaryngology–Head and Neck Surgery
Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands


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

Response: During the past two decades, the frequency of hearing loss among young people has increased and going to music concerts, clubs and festivals may part of the reason. Noise-induced hearing loss because of recreational noise exposure is reduced by using earplugs.

Our study evaluated 51 adults who attended an outdoor music festival in Amsterdam, the Netherlands, in September 2015. The study measured music festival visit for 4.5 hours (intervention); temporary hearing loss (outcome).

Continue reading

Since Semi-Automatic Rifles Outlawed, Australia Has Had Zero Mass Shootings

MedicalResearch.com Interview with:

Simon Chapman AO PhD FASSA Hon FFPH (UK) Emeritus Professor in the School Public Health University of Sydney

Prof. Chapman

Simon Chapman AO PhD FASSA Hon FFPH (UK)
Emeritus Professor in the School Public Health
University of Sydney

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

Response: Since major gun law reforms in 1996, Australian has seen zero mass shootings (five or more deaths, not including the perpetrator).The law reforms outlawed semi-automatic rifles, those often favored by mass killers.

In the 18 years prior to the reforms, Australia experienced 13 mass shootings. The National Rifle Association and others have suggested that the 22 year absence of mass shootings may simply reflect that these events are rare and statistically unlikely to occur regardless of any policy.

Continue reading

Hand Osteoarthritis: Hydroxychloroquine No More Effective Than Placebo

MedicalResearch.com Interview with:
Dr Sarah Kingsbury PhD
Osteoarthritis Strategic Lead
Deputy Section Head, Musculoskeletal Medicine and Imaging
Leeds Institute of Rheumatic and Musculoskeletal Medicine
University of Leeds

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

Response: Osteoarthritis of the hand is a painful and disabling condition, estimated to effect up to 31 per cent of people aged over 70. It can stop people from carrying out everyday activities and can limit their quality of life. The first-line pharmacological treatments for hand osteoarthritis, including paracetamol and non-steroidal anti-inflammatory drugs, are often not effective and are associated with side effects. Doctors have used hydroxychloroquine, an established treatment for rheumatoid arthritis, as an off-label alternative, supported by increasing evidence that inflammation is a factor in osteoarthritis. Until now, there has not been a large-scale study into whether using hydroxychloroquine works.

HERO was a 12 month randomised, double-blind, placebo controlled, pragmatic trial, designed with a view to replicate anecdotal reports of hydroxychloroquine use in clinical practice, and  powered to detect a moderate effect equivalent to that for NSAIDs in this population. The study involved 248 patients at 13 NHS hospitals in England: all had the condition for at least 5 years, had changes to the joints in their hands consistent with osteoarthritis and reported moderate to severe pain on at least half of the days in the previous three months to the study commencing.

Participants were randomised 1:1 to either hydroxychloroquine or placebo and followed up at 3 monthly intervals for 12 months. The study found that patients initially reported a small reduction in the severity of pain before the improvement plateaued. However, a similar amount of change was seen in both the group receiving hydroxychloroquine medication and the group taking the placebo.

Continue reading

HOT Tea Raises Risk of Esophageal Cancer

MedicalResearch.com Interview with:
“Hot tea #steam” by Thomas Ricker is licensed under CC BY 2.0Jun / 吕筠

Professor, Department of Epidemiology & Biostatistics
School of Public Health, Peking University Health Science Center
Beijing 100191 

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

Response: Esophageal cancer (EC) remains a global concern because of its increasing incidence and persistently poor survival. It poses a bigger threat to less developed regions and men.

Tea is one of the most common beverages worldwide and usually consumed at elevated temperature. Existing evidence remains inconclusive as to the association between tea consumption and EC risk. Tea consumers, especially in Chinese men, are more likely to smoke and drink alcohol. Tobacco smoking and alcohol consumption, as well as the chemical compounds and adverse thermal effect of high-temperature tea, considerably complicate the association between tea consumption and esophageal cancer risk.

Continue reading