Aging, Author Interviews, Exercise - Fitness, JAMA / 25.02.2019

MedicalResearch.com Interview with: Fuzhong Li, Ph.D. Senior Scientist Oregon Research Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: Injurious falls among community-dwelling older adults are a serious public health and cost-bearing problem worldwide.Exercise has been shown to reduce falls and injurious falls among older adults. However, evidence is limited with regard to the type of exercise interventions that are most effective, without exacerbating the risk in some individuals, in reducing injurious falls. This study addresses this knowledge gap in the field of falls prevention. Findings from this study showed that a six-month Tai Ji Quan program reduced the incidence of injurious falls among frail elderly by 53% compared to a regular (multimodal) exercise intervention. The effect of the Tai Ji Quan intervention was shown to be robust, and still evident at follow-up examinations six months after the study. (more…)
Accidents & Violence, Author Interviews, JAMA / 25.02.2019

MedicalResearch.com Interview with: Hannah Decker MD Candidate, Class of 2019 Emory School of Medicine Jeremiah Schuur, MD, MHS FACEP Physician-in-chief for emergency medicine at Lifespan and Chair of the department of Emergency Medicine Brown MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Firearm injury is a leading cause of injury and death in the United States. Many physician groups advocate for evidence-based policies, such as universal background checks, to reduce this morbidity and mortality. We studied contributions of the 25 largest political action committees (PACs) affiliated with physician professional groups during the 2016 election cycle and found that almost all gave more money to political candidates who voted against universal background checks and were endorsed by the NRA. These PACs contributed to more than twice as many incumbent US Senate candidates who voted against an amendment to expand firearm background checks than those who voted for the amendment. In the US House of Representatives, the pattern of giving was similar. These PACs gave $2.8 million more to candidates who did not sponsor a bill to expand background checks than to those who did. Finally, these physician PACs were more than twice as likely to contribute to and gave almost $1.5 million dollars more to candidates rated A by the NRA. (more…)
Author Interviews, JAMA, Karolinski Institute, Pharmacology, Schizophrenia / 24.02.2019

MedicalResearch.com Interview with: Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden  MedicalResearch.com: What is the background for this study? Response: The effectiveness of antipsychotic combination therapy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being. But the evidence for this are weak and antipsychotic polypharmacy is widely used. (more…)
Author Interviews, Genetic Research, JAMA, Prostate Cancer / 24.02.2019

MedicalResearch.com Interview with: Masaki Shiota MD, PhD Department of Urology Graduate School of Medical Sciences Kyushu University Fukuoka , Japan MedicalResearch.com: What is the background for this study? What are the main findings? Response:  3β-hydroxysteroid dehydrogenase-1 encoded by HSD3B1 is a rate-limiting enzyme required for all pathways of dihydrotestosterone synthesis, as well as converts abiraterone into Δ4-abiraterone (D4A), which blocks multiple steroidogenic enzymes and antagonizes the androgen receptor. A mutation (1245A>C) in HSD3B1 is shown to be resistant to proteasomal degradation, causing substantial accumulation of this enzyme and gain-of-function. Although the HSD3B1 (1245C) allele can be acquired by mutation, germ-line single nucleotide polymorphism (SNP; rs1047303) is also known to exist. Then, in this study, we investigated the significance of missense polymorphism in HSD3B1 gene among men treated with primary ADT or abiraterone. The results showed men carrying variant allele showed higher risk of progression in primary androgen-deprivation therapy, but vulnerable to abiraterone treatment. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Surgical Research, Weight Research / 24.02.2019

MedicalResearch.com Interview with: Jagpreet Chhatwal PhD Assistant Professor, Harvard Medical School Senior Scientist, Institute for Technology Assessment Massachusetts General Hospital Chin Hur, MD Associate Professor of Medicine Harvard Medical School       MedicalResearch.com: What is the background for this study? Response: Nonalcoholic steatohepatitis (NASH), a severe form of nonalcoholic fatty liver disease, is one of the leading causes of liver transplantation. Because of increasing prevalence of obesity in the United States, NASH-related cirrhosis cases are expected to increase in the near future. Unfortunately, there are few pharmacological treatments for NASH, and none with proven long-term benefit. Weight loss can be effective in managing NASH but not many patients can lose the sufficient weight necessary to impact NASH and/or maintain long-term weight loss. In contrast, bariatric surgery can provide long-term weight loss and thus potentially reverse liver damage in cirrhosis. However, bariatric surgery is associated with mortality and morbidity associated with the procedure. (more…)
Author Interviews, Health Care Systems, JAMA, Outcomes & Safety, Surgical Research / 22.02.2019

MedicalResearch.com Interview with: Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Hepatitis - Liver Disease, JAMA / 22.02.2019

MedicalResearch.com Interview with: Xuehong Zhang, MD, ScD Assistant Professor in Medicine Harvard Medical School Associate Epidemiologist Brigham and Women's Hospital Boston, MA MedicalResearch.com: What is the background for this study? Response: In the United States., liver cancer incidence is rapidly increasing and over 42,200 new cases were projected to be diagnosed in 2018. The majority of individuals with liver cancer are diagnosed at a late stage, are not eligible for curative therapy, and die within 1 year of diagnosis. Established risk factors for liver cancer are limited to hepatitis B and C virus (HBV/HCV) infections, metabolic disorders, and smoking. Clearly, identification of novel risk factors, particularly those that are modifiable, is urgently needed. Dietary factors have been suspected as important, but only excessive alcohol use and aflatoxin-contaminated foods are considered to be established dietary risk factors for hepatocellular carcinoma (HCC). Consumption of whole grains and dietary fiber, especially cereal fiber, have been associated with lower risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease, which are known predisposing factors for HCC. We thus hypothesized that long-term intake of whole grains and dietary fiber may lower the risk of developing hepatocellular carcinoma (HCC) and tested this hypothesis using data from two large prospective cohort studies, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology / 21.02.2019

MedicalResearch.com Interview with: Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware MedicalResearch.com: What is the background for this study? Response: Human synthetic insulins have been available over-the-counter for nearly a century, and at relatively low cost for around a decade under a Walmart brand name. However, little is known about  the frequency of sale of over-the-counter insulin or the reasons why patients use it. While prescription insulins (insulin analogues) are considered by many to be easier to use and more predictable than the over-the-counter versions, the cost of these insulins has skyrocketed. Our study examined the frequency of sale of over-the-counter insulins and whether patients potentially use over-the-counter insulin as a substitute for expensive prescription insulins. (more…)
Author Interviews, Columbia, Depression, JAMA, OBGYNE, USPSTF / 21.02.2019

MedicalResearch.com Interview with: Dr. Karina Davidson, PhD Professor of Behavioral Medicine (in Medicine and Psychiatry) Executive Director, Center for Behavioral Cardiovascular Health Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Perinatal depression, which includes depression that develops during pregnancy or after childbirth, is one of the most common complications of pregnancy and the postpartum period, affecting as many as 1 in 7 pregnant women. The Task Force found that counseling can help those who are at increased risk of developing perinatal depression, and clinicians should provide or refer pregnant and postpartum individuals who are at increased risk to counseling. Clinicians can determine who might be at increased risk of perinatal depression by looking at someone’s history of depression, current depressive symptoms, socioeconomic risk factors, recent intimate partner violence, and other mental-health related factors. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology, University of Pittsburgh / 19.02.2019

MedicalResearch.com Interview with: Alvaro San-Juan-Rodriguez, PharmD Pharmacoeconomics, Outcomes and Pharmacoanalytics Research Fellow Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Before 2009, etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) were the only tumor necrosis factor (TNF) inhibitors approved by the FDA for rheumatoid arthritis. Subsequently, 3 therapies gained FDA approval: subcutaneous golimumab (Simponi®) in April 2009, certolizumab pegol (Cimzia®) in May 2009, and intravenous golimumab (Simponi Aria®) in July 2013. All 6 agents are brand-name drugs. Our study aimed to evaluate how the prices of existing TNF inhibitors (Enbrel®, Remicade® and Humira®) changed in response to the market entry of new TNF inhibitors.  (more…)
Author Interviews, Inflammation, JAMA, Kidney Disease, Pain Research, Stanford / 16.02.2019

MedicalResearch.com Interview with: Alan Nelson, MPAS, PhD Division of Primary Care and Population Health, Department of Medicine Stanford University School of Medicine Stanford, California  MedicalResearch.com: What is the background for this study?   Response: The past research literature has provided relatively little information on the appropriate level of concern regarding non-steroidal anti-inflammatory drugs (NSAIDs) and kidney disease risk among younger, apparently healthy patients. Clinicians are generally most concerned about the effects of these medications on the kidneys among patients with existing renal impairment and persons at risk for it, especially older patients. Given that NSAID use appears to be high and rising in the US, we were interested in developing evidence on this topic in a population of working-age adults. (more…)
Author Interviews, Emory, JAMA, Prostate Cancer, Radiation Therapy / 15.02.2019

MedicalResearch.com Interview with: Deborah Watkins Bruner RN, PhD, FAAN Senior Vice President of Research Emory University Professor and Robert W. Woodruff Chair in Nursing Nell Hodgson Woodruff School of Nursing Professor, Department of Radiation Oncology Emory University School of Medicine MedicalResearch.com: What is the background for this study? Response: In a randomized clinical trial entitled, “Quality of Life in Patients With Low-Risk Prostate Cancer Treated With Hypofractionated vs Conventional Radiotherapy” the NRG Oncology Group previously demonstrated that men with low risk prostate cancer had  similar 5-year disease- free survival of about 85%  when treated with either conventional radiotherapy  (C-RT) of 73.8 Gy in 41 fractions over 8.2 weeks, or with  hypofractionated radiotherapy (H-RT) of 70 Gy in 28 fractions over 5.6  weeks. However, late physician reported side effects of mild bowel and bladder symptoms were increased in patients treated  with H-RT and raised questions if the H-RT arm is acceptable to patients. The current study asked the patient’s directly about their bowel, bladder, sexual function, anxiety, depression and general quality of life using valid patient reported questionnaires. These questionnaires have been found to be more accurate for reporting patient symptoms than physician report alone. (more…)
Author Interviews, Dermatology, JAMA, Johns Hopkins, Microbiome / 15.02.2019

MedicalResearch.com Interview with: Luis Garza, MD-PhD Associate Professor Department of Dermatology Johns Hopkins School of Medicine Baltimore, MD 21287 MedicalResearch.com: What is the background for this study? What are the main findings?  Do you think these findings would be similar with other antibiotics (oral or topical) or with isotretinoin for acne? Response: We prescribe antibiotics frequently for acne. We certainly know it affects our normal and abnormal bacteria on our skin. But we don’t fully understand how well or not people recover from antibiotics.  (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 15.02.2019

MedicalResearch.com Interview with: JOÃO L. CAVALCANTE, MD, FASE, FACC, FSCCT, FSCMR Director, Cardiac MRI and Structural CT Labs Director, Cardiovascular Imaging Research Core Lab Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis, MN, 55407 MIHO FUKUI MD Division of Cardiovascular Diseases, Department of Internal Medicine, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota MedicalResearch.com: What is the background for this study? Response: Recent study by Généreux et al (1), using the Placement of Aortic Transcatheter Valves (PARTNER) 2A and 2B data, provided the first framework of a staging system for severe aortic stenosis (AS) that quantifies the extent of structural and functional cardiac change associated with AS and importantly its association with 1-year mortality in patients receiving either surgical or transcatheter AVR (TAVR):
  • Stage 0: No other cardiac damage;
  • Stage 1: LV damage as defined by presence of LV hypertrophy, severe LV diastolic, or LV systolic dysfunction;
  • Stage 2: Left atrium or mitral valve damage or dysfunction;
  • Stage 3: Pulmonary artery vasculature or tricuspid valve damage or dysfunction; and
  • Stage 4: right ventricular damage.
(more…)
Author Interviews, JAMA, Prostate Cancer, Radiation Therapy / 12.02.2019

MedicalResearch.com Interview with: Amar U. Kishan, MD Assistant Professor Department of Radiation Oncology University of California, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Typical external beam radiation courses range up to 8-9 weeks in length (39-45 treatments). There are data that shorter courses, delivering a higher dose per day, may be just as effective. Stereotactic body radiotherapy (SBRT) really pushes this concept by condensing the treatment to just four to five treatments, with a high dose per day. Here, we present the pooled results of the outcomes of 2142 men with low and intermediate risk prostate cancer and a median of 6.9 years of followup. We demonstrate a very favorable efficacy and safety profile. Specifically, the rates of recurrences were 4.5% and 10.2% for low and intermediate risk disease at 7 years, and rates of late severe toxicity were 2.4% for urinary toxicity and 0.4% for gastrointestinal toxicity. (more…)
Author Interviews, CDC, JAMA, Opiods / 12.02.2019

MedicalResearch.com Interview with: Gery Guy, PhD, MPH Injury Center CDC MedicalResearch.com: What is the background for this study? Response: This study examined opioid prescribing at the national and county-level in 2015 and 2017. During 2015 to 2017, the amount of opioids prescribed decreased 20.1% in the United States. The amount of opioids prescribed per person varies substantially at the county-level. The average amount of opioids prescribed in the highest quartile of counties was nearly 6 times the amount in the lowest quartile. Reductions in opioid prescribing could be related to policies and strategies aimed at reducing inappropriate prescribing, increased awareness of the risks associated with opioids, and release of the CDC Guideline for Prescribing Opioids for Chronic Pain. (more…)
Author Interviews, Genetic Research, JAMA, Race/Ethnic Diversity, Stroke / 11.02.2019

MedicalResearch.com Interview with: Sandro Marini, MD Research Fellow Jonathan Rosand Laboratory Massachusetts General Hospital Boston, MA 02114 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The epsilon(ε) 4 allele of the Apolipoprotein E (APOE) gene increases risk for Alzheimer’s disease (AD) and intracerebral hemorrhage (ICH). In both diseases, it is believed to increase risk through the deposition of beta-amyloid within the brain and blood vessels, respectively. The effect of APOE ε4 on both AD and ICH risk changes across populations, for unclear reasons. In our study, we confirmed the role of APOE ε4 for ICH risk in whites and found that the risk-increasing effect of the 4 allele is demonstrable in Hispanics only when balancing out the effect of hypertension. (more…)
Author Interviews, Dermatology, JAMA, Kidney Disease, Melanoma, Transplantation / 11.02.2019

MedicalResearch.com Interview with "Kidney Model 9" by GreenFlames09 is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Donal J. Sexton, MD, PhD Department of Nephrology and Kidney Transplantation Beaumont Hospital Royal College of Surgeons in Ireland Dublin, Ireland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Patients who receive a kidney transplant as treatment for end stage kidney disease are at risk of malignancy due to immunosuppression. In contrast to other solid organ transplant types, when kidney transplants fail it is possible for recipients to return to dialysis. Immunosuppression is usually reduced or completely stopped when  the allograft fails due to the risk of infection on dialysis. We decided to investigate what the trajectory of risk for non-melanoma skin cancer and invasive cancers overall (composite group) looked like for patients who have received multiple consecutive kidney transplants with intervening periods of graft failure. We compared cancer risk during periods of allograft failure and periods of functioning kidney transplants.   (more…)
Author Interviews, Health Care Systems, JAMA, Stroke, University Texas / 11.02.2019

MedicalResearch.com Interview with: Amrou Sarraj, MD, Associate Professor Department of Neurology McGovern Medical School The University of Texas Health Science Center at Houston. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Secondary analyses of trials showing efficacy and safety of thrombectomy within 6-8 hours of stroke onset showed that patients who were transferred to centers performing thrombectomy from another hospital had worse outcomes than patients who presented directly to the thrombectomy centers. We wanted to assess if the thrombectomy outcomes differ between transferred patients and patients directly coming to the thrombectomy centers when patients are selected with advanced perfusion imaging. We found that thrombectomy outcome rates were similar between patients who presented directly vs transferred from another hospital, including functional independence and safety outcomes.  (more…)
Author Interviews, Diabetes, JAMA, Metabolic Syndrome, Stroke / 10.02.2019

MedicalResearch.com Interview with: David Spence M.D., FRCPC, FAHA Professor of Neurology and Clinical Pharmacology Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University London, ON Canada MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The motivation for the study was the chair of the committee that advises the Ontario Drug Benefit which medications to pay for said the IRIS results were not relevant to clinical practice. This because the Insulin Resistance Intervention after Stroke (IRIS) trial reported effects of pioglitazone in patients with stroke or TIA and insulin resistance assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score for insulin resistance.1 ( However, few clinicians measure a HOMA-iR score, so the clinical impact of that trial was limited. In this study we analyzed the effect of pioglitazone in stroke/TIA patients with prediabetes, which is commonly assessed by clinicians. Prediabetes was defined by the American Diabetes Association: a glycosylated hemoglobin (A1C) of  5.7% to <6.5% (we did not do glucose tolerance tests).  We analyzed primarily the results for patients with 80% adherence, but also did  an intention-to-treat (ITT) analysis.  The reason for focusing on patients with good adherence was that pioglitazone cannot be taken by about 10-20% of patients, because of fluid retention and weight gain (mainly due  to fluid retention).  (The reasoning was that third party payers would not need to pay for the medication in patients who do not take it.) In stroke/TIA patients with good adherence, the benefits of pioglitazone were greater than in the original IRIS trial. We found a 40% reduction of stroke/MI, a 33% reduction of stroke, and an 80% reduction of new-onset diabetes, over 5 years.  Pioglitazone also improved blood pressure, triglycerides and HDL-cholesterol. As expected, pioglitazone was somewhat less beneficial in the ITT analysis. Fluid retention can usually be managed by reducing the dose of pioglitazone; even small doses still have a beneficial effect . Also, amiloride has been shown to reduce fluid retention with pioglitazone.
  1. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP, Jr., Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O'Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Winder TR and Investigators IT. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016;374:1321-31. 
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Author Interviews, JAMA, MRI, Rheumatology / 07.02.2019

MedicalResearch.com Interview with: Signe Møller-Bisgaard MD, PhD Rigshospitalet Center for Rheumatology and Spine Diseases Copenhagen Center for Arthritis Research  MedicalResearch.com: What is the background for this study?  Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression. In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.  (more…)
Anesthesiology, Author Interviews, JAMA, Surgical Research / 07.02.2019

MedicalResearch.com Interview with: Michael Avidan, MBBCh, FCA SA Dr. Seymour and Rose T. Brown Professor of Anesthesiology Chief of the Division of Clinical and Translational Research Director of the Infrastructure of Quality Improvement, Research and Informatics Washington University School of Medicine St Louis, MO  MedicalResearch.com: What is the background for this study? Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death. Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery. Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery. (more…)
Author Interviews, Brain Injury, Exercise - Fitness, JAMA, Pediatrics / 07.02.2019

MedicalResearch.com Interview with: John J. Leddy, MD Clinical Professor Department of Orthopaedics Jacobs School of Medicine & Biomedical Sciences University of Buffalo MedicalResearch.com: What is the background for this study? Response: Sport-related concussion (SRC) is a significant public health problem without an effective treatment. Recent International Guidelines have questioned the efficacy of recommending complete rest to treat concussion and have called for prospective studies to evaluate early active treatments for sport-related concussion.  (more…)
Author Interviews, Diabetes, Education, JAMA, Pediatrics / 06.02.2019

MedicalResearch.com Interview with: Niels Skipper PhD Associate Professor, Department of Economics and Business Economics Aarhus University MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is unclear if there is an association between type 1 diabetes and school performance in children. Some studies have found type 1 diabetes to be associated with worse performance, while others have found no differences. However, most of the existing literature are based on smaller, non-random samples of children with diabetes. In this study we used data on all public school children in the country of Denmark, involving more than 600,000 schoolchildren where approximately 2,000 had a confirmed diagnosis of type 1 diabetes. The children were tested in math and reading using a nationally standardized testing procedure, and we found no difference in the obtain test scores between children with diabetes compared to children without diabetes.  (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Health Care Systems, Hospital Acquired, JAMA, Urinary Tract Infections / 06.02.2019

MedicalResearch.com Interview with: Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015. Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown. Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example. We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals. (more…)
Author Interviews, JAMA, Ophthalmology, Pediatrics, STD, USPSTF / 05.02.2019

MedicalResearch.com Interview with: Michael Silverstein, M.D., M.P.H. Professor of Pediatrics Director of the Division of General Academic Pediatrics Vice chair of research for the Department of Pediatrics Boston University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gonococcal ophthalmia neonatorum, or GON, is a severe infection of the eye that can occur in babies born to women who have gonorrhea. If left untreated, GON can cause serious problems, including blindness, that can appear as soon as 24 hours after delivery. Fortunately, there are effective treatments available that can prevent GON in newborns. The U.S. Preventive Services Task Force reviewed the most current research on the benefits and harms of ocular prophylaxis—which is applying antibiotic ointment to the babies’ eyes at birth—to prevent GON. We found that, if applied within 24 hours after birth, the ointment is very effective at preventing gonococcal ophthalmia neonatorum and the problems it causes. Therefore, we are recommending that clinicians provide this preventive service for all newborns.  (more…)
Author Interviews, JAMA, Thyroid, Thyroid Disease / 04.02.2019

MedicalResearch.com Interview with: Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc. Assistant Clinical Investigator/Assistant Professor Metabolic Disease Branch/NIDDK/NIH Bethesda, MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: People with intermediate- and high-risk differentiated thyroid cancer (DTC) are treated with surgical removal of the thyroid gland and radioactive iodine therapy.  After surgery and initial treatment, the thyroid hormone levothyroxine is used for long-term management not only to replace appropriate physiologic thyroid hormones post-surgery, but also to suppress thyrotropin (TSH) release from the pituitary gland at supraphysiologic doses. The current recommended American Thyroid Association TSH suppression goal in patients with a high-risk differentiated thyroid cancer presenting with distant metastases is less than 0.1mIU/ml, and between 0.1-0.5 mIU/ml for patients with intermediate-risk DTC presenting with local metastases to the neck lymph nodes. This TSH goal is much lower than physiologic TSH level, which ranges between 0.4-4.1 mIU/ml, depending on the measurement method and person’s age. TSH suppression is used because some preclinical evidence suggests that TSH can stimulate growth of cancer cells.  However, several preclinical studies show that thyroid hormones may also stimulate cancer growth. In addition, too much levothyroxine, leading to TSH suppression, may cause side effects such as abnormal heart rhythms and decreased bone mass. In this study, based on a large multicenter database analysis, we found that continuous TSH suppression with levothyroxine was not associated with better progression-free survival and overall survival in patients with either intermediate- and high-risk differentiated thyroid cancer. The patients were followed for an average of 7 years after surgical thyroid cancer removal and radioactive iodine therapy.  (more…)
Antibiotic Resistance, Asthma, Author Interviews, JAMA / 04.02.2019

MedicalResearch.com Interview with: Mihaela S Stefan, MD, PhD FACP Research Scientist, Institute for Healthcare Delivery and Population Science Associate Professor, UMMS-Baystate Director of Perioperative Clinic and Medical Consultation Program Academic Hospitalist Director Quality Assessment, Division of Healthcare Quality Springfield MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death. We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. (more…)
Author Interviews, Education, JAMA, Pediatrics / 03.02.2019

MedicalResearch.com Interview with: Sheri Madigan, Ph.D, R.Psych Canada Research Chair in Determinants of Child Development Assistant Professor, Department of Psychology Alberta Children's Hospital Research Institute University of Calgary MedicalResearch.com: What is the background for this study? What are the main findings? Response: Parents are reporting that screen time is one of their major concerns, so we wanted to find out more about how large of a role screen time was playing on children’s developmental outcomes. We were especially interested in the long-term impact of screens, which is why we followed children over time, from ages 2 to 5 and repeatedly assessed both screen time use and children’s achievement of developmental milestones. There are three main findings:
  1. Our study revealed that on average children were viewing screens for 2.4, 3.6 and 1.6 hours per day at two, three and five years of age, respectively. This means that the majority of the participants in our sample are exceeding the American Academy of Pediatrics’ guideline.
  2. We found statistically significant, albeit small effects suggesting that greater amounts of screen time at two and three years predict poorer child outcomes at three and five years, respectively. Thus, screen time has a lasting influence on children’s development.
  3. The opposite pattern was not observed. That is, we did not find evidence that children showing poor performance in terms of achieving developmental milestones were more likely to be place in front of screens to help cope with their potentially challenging behaviors.
(more…)
Author Interviews, JAMA, Opiods / 02.02.2019

MedicalResearch.com Interview with: "Opioids" by KSRE Photo is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Dr. Qiushi Chen (first author) and Jagpreet Chhatwal PhD Assistant Professor, Harvard Medical School Senior Scientist, Institute for Technology Assessment Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Opioid overdose epidemic is a national public health emergency — in 2017, more than 49,000 people died from overdose. Our study shows that under current conditions, the number of deaths is projected to increase to 81,700 by 2025. Efforts to curb the epidemic by reducing the incidence of prescription opioid misuse — the primary focus of current interventions — will have a modest effect of 3-5% reduction in overdose deaths. (more…)