NUEDEXTA® (Dextromethorphan and Quinidine) Studied for ALS and MS but Primarily Use in Dementia

MedicalResearch.com Interview with:

Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine, St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto  PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University

Dr. Fralick

Michael Fralick, MD, FRCPC, SM, PhD (Cand)
Clinical Associate, General Internal Medicine
St Michael’s Hospital
Phillipson Scholar, Clinician Scientist Program, University of Toronto
PhD Candidate, IHPME, University of Toronto
Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital, Harvard University

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

Response: This medication is a pill that combines two ingredients: dextromethorphan (the active ingredient in cough syrup) and quinidine (used to increase the concentration of dextromethorphan). The medication was primarily studied and evaluated in patients with amyotrophic lateral sclerosis (ALS)   or (multiple sclerosis) MS, but anecdotal evidence suggested it was being prescribed to patients with dementia. We used data from two nationwide healthcare databases to understand how the medication was being used in routine care.

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Does Zofran (ondansetron) for Nausea & Vomiting Cause Birth Defects?

MedicalResearch.com Interview with:

Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120

Dr. Krista Huybrechts

Krista F. Huybrechts, MS PhD
Associate Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120 

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

Response: Pregnant women often experience nausea and vomiting, particularly during the first trimester.  Early treatment is recommended to relieve symptoms and prevent progression to hyperemesis gravidarum.  Although not formally approved for this indication, ondansetron is the most frequently prescribed treatment for nausea and vomiting in pregnancy in the US: 22% of pregnant women reportedly used ondansetron in the US in 2014. Despite this common use, the available evidence on the fetal safety of ondansetron is limited and conflicting, and the possibility of a doubling in risk of cleft palate and cardiac malformations has been raised.

We therefore evaluated the association between ondansetron exposure during the first trimester of pregnancy, the period of organogenesis, and the risk of congenital malformations in a cohort of 1,816,414,publicly insured pregnancies using the nationwide Medicaid Analytic eXtract data for 2000-2013.  A total of 88,467 women (4.9%) were exposed to ondansetron during the first trimester.  After adjusting for a broad range of potential confounding variables, we found no association with cardiac malformations (RR = 0.99; 95% CI, 0.93 – 1.06)  and congenital malformations overall (RR = 1.01; 95% CI, 0.98 – 1.05). For oral clefts, we found a 24% increase in risk (RR=1.24; 95% CI, 1.03 – 1.48), which corresponds to an absolute risk of 2.7 per 10,000 births (95% CI, 0.2 – 5.2 per 10,000 births).  These findings were consistent across sensitivity analyses, conducted to address potential misclassification and confounding bias. 

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When Asked, Teens Frequently Report Hallucinations, Paranoia or Anxiety with Marijuana Use

MedicalResearch.com Interview with:

Sharon Levy, MD, MPH Director, Adolescent Substance Use and Addiction Program Boston Children's Hospital Associate Professor of Pediatrics Harvard Medical School

Dr. Levy

Sharon Levy, MD, MPH
Director, Adolescent Substance Use and Addiction Program
Boston Children’s Hospital
Associate Professor of Pediatrics
Harvard Medical School 

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

Response: ​For this study we analyzed data that were collected as part of a larger survey study that recruited a sample of adolescents who were coming to the doctor’s office for routine medical care.  We asked them a lot of questions about their health, school, extracurricular activities, plans for the future, substance use patterns and problems associated with use among other things.

The main finding was that among the participants who reported marijuana use in the past year, many of them, more than 40%, said that they had experienced either an hallucination, or paranoia/anxiety related to their use.

Kids who used more frequently and those who met criteria for a substance use disorder were more likely to experience these symptoms, as were those who had symptoms of depression Continue reading

Mediterranean Diet Linked to Lower Long-Term Cardiovascular Events in Women

MedicalResearch.com Interview with:

Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA

Dr. Mora

Samia Mora, MD, MHS
Associate Professor of Medicine
Harvard Medical School
Director, Center for Lipid Metabolomics
Brigham and Women’s Hospital
Boston, MA

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

Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit.

Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors.

Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites.  Continue reading

Mental Health and Substance Abuse Drive Hospitalizations Among Homeless

MedicalResearch.com Interview with:

Dr. Rishi Wadhera, MD  Cardiology Fellow Brigham and Women's Hospital Harvard Medical School.

Dr. Wadhera

Dr. Rishi Wadhera, MD 
Cardiology Fellow
Brigham and Women’s Hospital
Harvard Medical School.

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

Response: In the United States, an estimated half a million people are homeless on any given night. In recent years, policy efforts to improve the health of homeless individuals have intensified, but there is little large-scale, contemporary data on how these efforts have impacted patterns of acute illness in this vulnerable population.

In this study, we examined trends, causes, and outcomes of hospitalizations among homeless individuals in three states – Massachusetts, Florida, and California – from 2007 to 2013. We found that hospitalization rates among homeless adults increased over this period of time.

Strikingly, over one-half of these hospitalizations were for mental illness and substance use disorder. More broadly, homeless adults were hospitalized for a very different set of reasons compared with demographically similar non-homeless adults. In addition, homeless individuals had longer lengths of hospitalization but lower total costs per hospitalization.

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Regular Religious Service Attendance Associated with 50% Lower Divorce Rates

MedicalResearch.com Interview with:

Professor Tyler VanderWeele Ph.D John L. Loeb and Frances Lehman Loeb Professor of Epidemiology Harvard University

Prof. VanderWeele

Professor Tyler VanderWeele Ph.D
John L. Loeb and Frances Lehman Loeb Professor of Epidemiology
Harvard University

MedicalResearch.com: What is the background for this study? What are the key points of the paper?  

Response: Several prior studies have suggested that religious service attendance is associated with lower rates of divorce. However, many of these studies have been with small samples and have not had rigorous study designs. In addition, most studies have focused on women earlier in life and there has been little research on the effects of religious service attendance on divorce later in life. While divorce rates in the United States in general has been falling, it has in fact been increasing for middle-aged groups, doubling between 1990 and 2010.

In our study we found that among women in mid- to late- life, regular religious service attendance was subsequently associated with 50% lower divorce rates over the following 14 years of the study.

We also found that among those who were widowed, religious service attendance was associated with a 49% increase in the likelihood of remarrying over the 14 years of the study.

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Rotating Night Shift Work Adds To Risk of Type II Diabetes

MedicalResearch.com Interview with:

"Night Shift" by Yuchung Chao is licensed under CC BY-ND 3.0Dr. Zhilei Shah PhD
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety
Ministry of Education Key Lab of Environment and Health, School of Public Health
Tongji Medical College, Huazhon
University of Science and Technology
Wuhan,  China

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

Response: Shift work has progressed in response to changes in economic pressure and greater consumer demand for 24-hour services. There are many economic advantages to increased shift work, including higher employment, increased services to customers, and improved trade opportunities. Currently, one in five employees in the U.S. works nonstandard hours in the evening, night, or rotating shifts. However, shift work, especially night shift work, has been associated with a higher risk of chronic diseases, including type 2 diabetes, cardiovascular disease, and several types of cancer.

Compelling evidence has shown that body weight and lifestyle behaviors, such as smoking, diet, and physical activity can influence type 2 diabetes risk. Among shift workers, excess adiposity and increased smoking are frequently and consistently reported, whereas the evidence on physical activity and diet is mixed. Additionally, no previous study has examined the joint associations of rotating night shift work duration and unhealthy lifestyle factors with risk of type 2 diabetes, or evaluated their potential interactions.

Therefore, we prospectively assessed the joint association of rotating night shift work and established type 2 diabetes lifestyle risk factors with risk of type 2 diabetes and quantitatively decomposed the proportions of the joint association to rotating night shift work alone, to lifestyle alone and to their interaction in two large US cohorts.

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Advanced Prostate Cancer: Risk of Mortality with Surgery vs Radiotherapy

MedicalResearch.com Interview with:

Anthony Victor D'Amico, MD, PhD Professor and Chief, Genitourinary Radiation Oncology Harvard Medical School

Dr. D’Amico

Anthony Victor D’Amico, MD, PhD
Professor and Chief,
Genitourinary Radiation Oncology
Harvard Medical School

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

Response: This study investigated whether surgery followed by the use of adjuvant low dose radiation and short course hormonal therapy as compared to high dose radiation and hormonal therapy could provide an equivalent low risk of death from prostate cancer amongst men presenting with aggressive and not infrequently fatal Gleason score 9 or 10 prostate cancer.

It has been shown previously (https://jamanetwork.com/journals/jama/fullarticle/2673969) and validated in the current study that surgery alone in such cases leads to a more then 2.5-fold increase in the risk of death from prostate cancer as compared to high dose radiation and hormonal therapy.  Continue reading

Eat Carbs in the Morning, Fat at Night?

MedicalResearch.com Interview with:
"Compare-the-Use-of-Carbohydrates-and-Lipids-in-Energy-Storage" by Zappys Technology Solutions is licensed under CC BY 2.0Kirsi-Marja Zitting, Ph.D.

Instructor in Medicine, Harvard Medical School
Division of Sleep and Circadian Disorders
Departments of Medicine and Neurology
Brigham and Women’s Hospital
Boston, MA 02115

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

Response: This study is a follow-up study to our previous study where we found that chronic insufficient sleep together with chronic jet lag is associated with adverse changes in metabolism, including increase in blood sugar levels (Buxton et al. Science Translational Medicine, 2012). The present study focuses on the influence of the time of day on metabolism, which has not been investigated in humans independent of the effects of sleep, physical activity and diet.

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Higher BMI Linked to Increased Risk of Younger Colon Cancer

MedicalResearch.com Interview with:

Stuart Po-Hong Liu, MD, MPH

Dr. Po-Hong Liu

Stuart Po-Hong Liu, MD, MPH
Clinical and Translational Epidemiology Unit Massachusetts General Hospital and
Harvard Medical School
Boston

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

Response: Although there were global decreases in overall colorectal cancer (CRC) incidence, CRC rates have increased dramatically in those aged 20 to 49 years in the United States, parts of Europe, and Asia. The etiology and early detection of young-onset becomes an emerging research and clinical priority. Another important fact that is that this emerging public health concern has resulted in updated guidelines from the American Cancer Society advising average-risk screening begin at age 45, rather than 50.

However, up to this point, the etiology of young onset CRC remains largely unknown. Elucidating the role of traditional CRC risk factors in the etiopathogenesis of young-onset CRC is one of the first research agenda. Continue reading

Dysplastic Moles Not Necessarily Precursor to Melanoma But Indicate Increased Risk

MedicalResearch.com Interview with:

Caroline C. Kim, M.D. Associate Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director, Cutaneous Oncology Program Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Kim

Caroline C. Kim, M.D.
Associate Professor, Department of Dermatology
Harvard Medical School
Director, Pigmented Lesion Clinic
Associate Director, Cutaneous Oncology Program
Beth Israel Deaconess Medical Center
Boston, MA 02215

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

Response: Atypical/dysplastic nevi have been identified as risk factors for melanoma, however the majority of melanomas arise as new lesions on the skin.

Unlike other models of dysplasia having a clear trajectory towards cancer as seen in cervical dysplasia, dysplastic nevi are not proven to be obligate precursors for melanoma.  However, there is little evidence to guide the management of biopsied dysplastic nevi with positive margins, with much clinical variation in the management of moderately dysplastic nevi in particular.

In this multi-center national study of 9 U.S. academic centers, we examined outcomes of 467 moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins with at least 3 years of clinical follow-up.  We found that no cases developed into a same-site melanoma with a mean follow-up time of 6.9 years. However, 22.8% of our patients went on to develop a future separate site melanoma.

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MidLife PSA Can Risk-Stratify Prostate Cancer in African American Men

MedicalResearch.com Interview with:

Mark Preston, MD, MPH Associate Surgeon, Brigham and Women's Hospital Assistant Professor of Surgery, Harvard Medical School Brigham and Women's Hospital Department of Surgery, Urology Boston, MA

Dr. Preston

Mark Preston, MD, MPH
Associate Surgeon, Brigham and Women’s Hospital
Assistant Professor of Surgery, Harvard Medical School
Brigham and Women’s Hospital
Department of Surgery, Urology
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Black men are at significantly increased risk of developing and dying from prostate cancer. Unfortunately, there is limited research on screening strategies in this high-risk population. In this original investigation, we studied how baseline PSA levels measured in midlife predict later risk of aggressive prostate cancer in a population of black men. This study used stored blood samples and over a decade of follow-up in the Southern Community Cohort Study, an on-going cohort study with the highest representation of black men in the U.S.

We demonstrated that PSA levels in midlife very strongly predict future aggressive prostate cancer. Our data identify subgroups of black men who have widely divergent long-term risk of aggressive prostate cancer based on baseline PSA during midlife. We suggest that these groups could benefit from screening intervals tailored to their actual magnitude of disease risk.

These important findings build on our previous work on baseline PSA and subsequent risk of lethal prostate cancer in mainly white men, which was published in the Journal of Clinical Oncology in August 2016. 

MedicalResearch.com: What should readers take away from your report? 

Response: One strategy for improving PSA screening is to do an earlier measurement of PSA during midlife (aged 40-55). PSA levels during midlife have been shown by our group and others to strongly predict long-term risk of prostate cancer, particularly risk of aggressive disease, in now both black and white men.

This baseline PSA level during midlife can be used to risk-stratify PSA screening, targeting higher risk men for screening in order to diagnosis and treat them early while an opportunity exists for cure.  In addition, men at low risk could safely be screened less frequently. As a result, much of the benefit of PSA screening on prostate cancer mortality could be maintained, while overdiagnosis and overtreatment would be reduced.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Prospective studies of a risk stratified screening program should be conducted.  We are also studying ways to further improve risk prediction and to explore biologic mechanisms why a midlife PSA is so predictive.

Disclosures. I have no disclosures. Disclosures for other authors are listed in the manuscript.

Citation:

Eur Urol. 2018 Sep 17. pii: S0302-2838(18)30627-4. doi: 10.1016/j.eururo.2018.08.032. [Epub ahead of print]

Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men.

Preston MA1, Gerke T2, Carlsson SV3, Signorello L4, Sjoberg DD5, Markt SC6, Kibel AS7, Trinh QD7, Steinwandel M8, Blot W9, Vickers AJ5, Lilja H10, Mucci LA6, Wilson KM11.

Oct 14, 2018 @ 12:36 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Cutting Out Bacon, Sausage and Hot Dogs May Reduce Risk of Breast Cancer

MedicalResearch.com Interview with:
"bacon&eggs" by ilaria is licensed under CC BY 2.0
Maryam Farvid, Ph.D., Research Scientist  

Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA 02115

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

Response: Prior prospective studies on red and processed meat consumption with risk of breast cancer have produced inconsistent results.

Current meta-analysis of 15 prospective studies shows that women who eat a high amount of processed meat each day may have a higher risk of breast cancer than those who don’t eat or have a low intake in their diet.  Continue reading

Gene Variants Can Alter Glucose Absorption and Cardiometabolic Risks

MedicalResearch.com Interview with:

Scott David Solomon, MD Director, Noninvasive Cardiology Professor, Harvard Medical School Brigham and Women's Hospital

Dr. Solomon

Scott David Solomon, MD
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Brigham and Women’s Hospital 

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

Response: The sodium glucose transport proteins are known to be important in regulating uptake of glucose. SGLT-1 is predominantly located in the gut and is responsible for uptake of glucose and galactose in the small intestine. Individuals born with severe mutations of this gene have severe malabsorption syndrome.

We looked at genetic variants that lead to reduced function of the protein, but not complete loss of function, in a large cohort of individuals in the NIH funded Atherosclerosis Risk in Communities Study. We found that those with mutations in the gene had reduced glucose uptake, as measured by an oral glucose tolerance test, as well as less obesity, diabetes, heart failure and death.

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Insufficient Sleep in Adolescence May Be A Driver of Risky Behaviors

MedicalResearch.com Interview with:

Matthew D. Weaver, PhD Instructor in Medicine · Harvard Medical School Associate Epidemiologist · Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston, MA 02215

Dr. Weaver

Matthew D. Weaver, PhD
Instructor in Medicine · Harvard Medical School
Associate Epidemiologist · Division of Sleep and Circadian Disorders
Brigham and Women’s Hospital
Boston, MA 02215

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

Response: We were interested whether high school students who tended to sleep less than 8 hours per night reported more risk-taking behaviors compared to high school students who slept at least 8 hours per night on a school night. We utilized a nationally representative dataset from the CDC of surveys that were completed by high school students between 2007 and 2015. Over that time, approximately 67,000 students were surveyed. Students were asked about the hours of sleep that they obtained on an average school night. They were also asked how often, in the month prior to the survey, they engaged in a number of risk-taking behaviors. Some behaviors were related to driving, like driving without a seatbelt or driving drunk, while others were related to using alcohol, doing drugs, or being involved in a fight. They were also asked about their mood, including whether they felt sad or hopeless, considered suicide, and whether they had attempted suicide. 

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Genetic Risk Score Improves Ability To Predict Diabetics at Risk of Coronary Disease

MedicalResearch.com Interview with:

Mario Luca Morieri

Dr. Morieri

Mario Luca Morieri MD
Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center
Department of Medicine, Harvard Medical School, Boston, MA

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

Response: Coronary artery disease (CAD) is one of the most important complications of diabetes.

Similarly to other complex disorders, CAD is influenced by both environmental and genetic factors. Over the last decade, our understanding of the genetic factors contributing to CAD has dramatically improved and hundreds of new genetic markers associated with increased cardiovascular risk have been identified.

In this study, we showed that combining these genetic markers into a single score (a so called genetic risk score) can improve our ability to the identify those patients with type 2 diabetes who are at higher risk of experiencing a coronary event. 

MedicalResearch.com: What should readers take away from your report? 

Response: One take-away message is that the genetic markers associated with CAD in persons without diabetes have a similar effect in people with diabetes. Another is that prediction of increased risk of CAD in people with diabetes can be improved with the combination of genetic markers with “classic” known markers of CAD such as high cholesterol and high blood pressure. Improving cardiovascular risk prediction will allow physicians to focus their effort on people at higher risk, making the allocation of health-care resources more efficient. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We were able to replicate our findings (from the ACCORD trial) in another study including diabetic patients with similar characteristics (the ORIGIN trial). However, to improve the generalizability of the genetic risk score, its performance should be tested in populations with different clinical characteristics. With the detailed information provided in the paper, other researchers should be able to do this. Also, the genetic score reported in our paper applies to Whites as it was derived from genetic markers discovered in that ethnic group. It would be important to build a similar genetic risk score for people of different ancestry using genetic markers specific to those populations.

MedicalResearch.com: Is there anything else you would like to add? 

Response: We showed in the paper that the identification of an increasing number of genetic markers of CAD risk over the last 8 years has resulted into a progressive improvement in the performance of genetic risk scores for prediction of CAD risk. Thus, if new genetic markers of CAD continue to be identified over the next few years, the usefulness of these genetic scores may continue to increase. 

Citation:

Genetic Tools for Coronary Risk Assessment in Type 2 Diabetes: A Cohort Study From the ACCORD Clinical Trial

Mario Luca Morieri, He Gao, Marie Pigeyre, Hetal S. Shah, Jennifer Sjaarda, Christine Mendonca,Timothy Hastings, Patinut Buranasupkajorn, Alison A. Motsinger-Reif, Daniel M. Rotroff, Ronald J. Sigal,Santica M. Marcovina, Peter Kraft, John B. Buse, Michael J. Wagner, Hertzel C. Gerstein, Josyf C. Mychaleckyj, Guillaume Parè and Alessandro Doria

Diabetes Care 2018 Sep; dc180709.https://doi.org/10.2337/dc18-0709

Sep 29, 2018 @ 6:39 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

What Types of Health Care Records Are Breached?

MedicalResearch.com Interview with:

Thomas McCoy, M.D. Assistant Professor of Psychiatry Massachusetts General Hospital Psychiatry Massachusetts General Hospital

Dr. McCoy

Thomas McCoy, M.D.
Assistant Professor of Psychiatry
Massachusetts General Hospital
Psychiatry
Massachusetts General Hospital

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

 Response: Big data has the potential to transform how we care for patients but comes with risks of big breaches. My co-author and I use health records in our research and we wanted to better understand the risks that these data might pose to our patients.

MedicalResearch.com:? What are the main findings? 

Response: The majority of breaches are of health care providers whereas the majority of breached records are from health plans. The three largest breaches account for the over half of records breached.

MedicalResearch.com: What should readers take away from your report?

Response: This study doesn’t speak to any particular solution; rather, it speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: This study speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers; however, much is left to be learned about the specific mechanisms and consequences of these events.

MedicalResearch.com: Is there anything else you would like to add?

Response: Large healthcare datasets present a means of transformational discovery but also come with real risks of large scale disclosure. 

Disclosures: Dr. McCoy reports unrelated grants from The Stanley Center at The Broad Institute, Brain and Behavior Research Foundation, and Telefonica Alpha. Dr. Perlis reports unrelated grants from the National Human Genome Research Institute, National Institute of Mental Health, and Telefonica Alpha; serves on the scientific advisory board for Perfect Health, Genomind, and Psy Therapeutics; and consults to RID Ventures. Dr. Perlis is an editor of JAMA Network Open.

Citation:

McCoy TH, Perlis RH. Temporal Trends and Characteristics of Reportable Health Data Breaches, 2010-2017. JAMA. 2018;320(12):1282–1284. doi:10.1001/jama.2018.9222

 

Sep 28, 2018 @ 11:22 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Cardiac Stimulant Found in Some OTC Supplements

MedicalResearch.com Interview with:

Pieter Cohen, M.D. Associate Professor of Medicine Cambridge Health Alliance Assistant Professor of Medicine Harvard Medical School

Dr. Cohen

Pieter Cohen, M.D.
Associate Professor of Medicine
Cambridge Health Alliance
Assistant Professor of Medicine
Harvard Medical School

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

Response: Dietary supplements lead to an estimated 23,000 emergency department visits each year in the United States (US), and weight loss and sports supplements contribute to a disproportionately large number of these emergency department visits. It is not known which ingredients in weight loss and sports supplements pose the greatest risk to consumers, but there are stimulants found in botanical remedies that might pose risks.

In the current study, we investigated the presence and quantity of higenamine a stimulant found in botanicals and available in sports and weight loss supplements sold in the US.

Continue reading

Combination Brand Name Drugs Cost Medicare Millions More Than Separate Generic Pills

MedicalResearch.com Interview with:

Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital

Dr. Sacks

Chana A. Sacks, MD, MPH
Program On Regulation, Therapeutics, And Law (PORTAL)
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital

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

Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications.

Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products.

For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen.

The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. Continue reading

Why Do So Few Women Enter or Complete Surgical Residency?

MedicalResearch.com Interview with:

Erika L. Rangel, MD,MS Instructor, Harvard Medical School Trauma, Burn and Surgical Critical Care Department of Surgery, Center for Surgery and Public Health  Brigham and Women’s Hospital  Harvard T. H. Chan School of Public Health Boston, Massachusetts

Dr. Rangel

Erika L. Rangel, MD,MS
Instructor, Harvard Medical School
Trauma, Burn and Surgical Critical Care
Department of Surgery, Center for Surgery and Public Health
Brigham and Women’s Hospital
Harvard T. H. Chan School of Public Health
Boston, Massachusetts

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

Response: Although women make up half of medical student graduates in 2018, they only comprise a third of applicants to general surgery. Studies suggest that lifestyle concerns and perceptions of conflict between career and family obligations dissuade students from the field.

After entering surgical residencies, women residents have higher rates of attrition (25% vs 15%) and cite uncontrollable lifestyle as a predominant factor in leaving the field. Surgeons face reproductive challenges including stigma against pregnancy during training, higher rates of infertility, need for assisted reproduction, and increased rates of pregnancy complications. However, until recently, studies capturing the viewpoints of women who begin families during training have been limited. Single-institution experiences have described mixed experiences surrounding maternity leave duration, call responsibilities, attitudes of coworkers and faculty, and the presence of postpartum support.

Earlier this year, our group presented findings of the first national study of perspectives of surgical residents who had undergone pregnancy during training. A 2017 survey was distributed to women surgical residents and surgeons through the Association of Program Directors in Surgery, the Association of Women Surgeons and through social media via twitter and Facebook. Responses were solicited from those who had at least one pregnancy during their surgical training.

39% of respondents had seriously considered leaving surgical residency, and 30% reported they would discourage a female medical student from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training (JAMA Surg 2018; July 1; 153(7):644-652).

These findings suggested the challenges surrounding pregnancy and childrearing during training may have a significant impact on the decision to pursue or maintain a career in surgery. The current study provides an in-depth analysis of cultural and structural factors within residency programs that influence professional dissatisfaction.

We found that women who faced stigma related to their pregnancies, who had no formal maternity leave at their programs, and who altered subspecialty training plans due to perceived challenges balancing motherhood with the originally chosen subspecialty were most likely to be unhappy with their career or residency. Continue reading

When It Comes to LDL-C, “You Really Can’t Be Too Low”

MedicalResearch.com Interview with:

Marc S. Sabatine, MD, MPH  Chairman | TIMI Study Group  Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine Brigham and Women's Hospital  Professor of Medicine | Harvard Medical School

Dr. Marc Sabatine

Marc S. Sabatine, MD, MPH
Chairman | TIMI Study Group
Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine
Brigham and Women’s Hospital
Professor of Medicine | Harvard Medical School

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

Response: Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor for cardiovascular disease.

The initial statin trials studied patients with high levels of LDL-C, and showed a benefit by lowering LDL-C.

We and others did studies in patients with so-called “average” levels of LDL-C (120-130 mg/dL), and also showed clinical benefit with lowering.

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Sexual Minorities More Likely To Be Unemployed and Uninsured

MedicalResearch.com Interview with:

Brittany M. Charlton, ScD, Assistant Professor Harvard Medical School Harvard T.H. Chan School of Public Health Boston Children's Hospital Boston, MA

Dr. Charlton

Brittany M. Charlton, ScD, Assistant Professor
Harvard Medical School
Harvard T.H. Chan School of Public Health
Boston Children’s Hospital
Boston, MA

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

Response: Research has shown that nearly half of all sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience employment discrimination in their lifetime, which may lead to many other disparities, including health insurance coverage, healthcare access, and ultimately health-related quality of life (e.g., pain, anxiety).

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Changing One Gene in One Gut Bacteria Altered Metabolism and Weight Gain (in mice)

MedicalResearch.com Interview with:

A. Sloan Devlin, PhD Assistant Professor Department of Biological Chemistry and Molecular Pharmacology Harvard Medical School

Dr. Devlin

A. Sloan Devlin, PhD
Assistant Professor
Department of Biological Chemistry and Molecular Pharmacology
Harvard Medical School

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

Response: It is known that the microbiome, the collection of bacteria that live in and on our bodies, influences the development of metabolic diseases including diabetes and obesity. The ways in which the microbiome affects host metabolism, however, are poorly understood. One reason for this lack of understanding is because the gastrointestinal tract contains hundreds of species of bacteria producing many different kinds of metabolites. Untangling the effects of these bacteria and the molecules they make is a significant challenge.

In this study, we decided to concentrate on a group of metabolites found in the human gut called bile acids. When we eat a meal, these compounds are released into the gastrointestinal tract where they act as detergents that aid in digestion. Once these molecules reach the lower gastrointestinal tract, the gut bacteria residing there chemically modify these compounds, producing a pool of over 50 different bile acids total.

Imbalances in this bile acid pool are thought to influence the progression of diet-induced obesity. However, it is unclear which specific bile acids are responsible for either beneficial or detrimental effects on host metabolism. We set out to address this question by first identifying a selective type of bacterial enzyme called a bile salt hydrolase, then by genetically deleting this enzyme from a common gut bacterium and investigating how this change affected host metabolism.

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Opioid Prescription Rates Higher in South, Appalachia and Rural West

MedicalResearch.com Interview with:

Dr. Lyndsey Rolheiser MD Postdoctoral Research Fellow at Harvard Center for Population Studies Cambridge, Massachusetts

Dr. Rolheiser

Dr. Lyndsey Rolheiser PhD
Postdoctoral Research Fellow at Harvard Center for Population Studies
Cambridge, Massachusetts

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

Response: The opioid crisis was declared a “public health emergency” in 2017. Opioid related overdoses and prescribing rates have increased dramatically over the past decade and previous literature has identified a relationship between high-dose prescriptions and overdose deaths. Thus, understanding the variation and trends in the opioid prescribing rate is crucial in understanding the nature of the opioid epidemic. Opioid prescribing data is publicly available at the county and state level.

County level data represents an administrative boundary that lacks political representation and accountability. In contrast, the congressional district represents a geography that has both of these characteristics. Further, knowing the congressional district level rates allows for policy makers and researchers to observe the variation that exists within states.

The main findings are high prescribing rate districts are concentrated in the South, Appalachia and the rural West. Low-rate districts are concentrated in urban centers.

MedicalResearch.com: What should readers take away from your report?

Response: There is a great deal of variation across congressional districts, but there are also very clear geographical patterns. In terms of policy, this paper highlights the importance of constructing and disseminating crucial public health data at a politically relevant boundary.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our hope is that the estimates we have created can be used within health related public policy research.

Citation: Lyndsey A. Rolheiser, Jack Cordes, BSPH, S.V. Subramanian. Opioid Prescribing Rates by Congressional Districts, United States, 2016. American Journal of Public Health, 2018; e1 DOI: 10.2105/AJPH.2018.304532

Jul 22, 2018 @ 11:46 am

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Medical Notes Using Speech Recognition: Less Than Perfect

MedicalResearch.com Interview with:

Li Zhou, MD, PhD, FACMI Associate Professor of Medicine Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital, Harvard Medical School Somerville, MA 02145

Dr. Li Zhou

Li Zhou, MD, PhD, FACMI
Associate Professor of Medicine
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital, Harvard Medical School
Somerville, MA 02145

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

Response: Documentation is one of the most time-consuming and costly aspects of electronic health record (EHR) use.

Speech recognition (SR) technology, the automatic translation of voice to text, has been increasingly adopted to help clinicians complete their documentation in an efficient and cost-effective manner. One way in which SR can assist this process is commonly known as “back-end” SR, in which the clinician dictates into the telephone, the recorded audio is automatically transcribed to text by an speech recognition engine, and the text is edited by a professional medical transcriptionist and sent back to the EHR for the clinician to review and sign.

In this study, we analyzed errors at different processing stages of clinical documents collected from 2 health care institutions using the same back-end SR vendor. We defined a comprehensive schema to systematically classify and analyze these errors, focusing particularly on clinically significant errors (errors that could plausibly affect a patient’s future care). We found an average of 7 errors per 100 words in raw  speech recognition transcriptions, and about 6% of those errors were clinically significant. 96.3% of the raw speech recognition transcriptions evaluated contained at least one error, and 63.6% had at least one clinically significant error. However, the rate of errors fell significantly after review by a medical transcriptionist, and it fell further still after the clinician reviewed the edited transcript.

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