Author Interviews, Brigham & Women's - Harvard, Cancer Research, Cost of Health Care, JAMA / 20.10.2021

MedicalResearch.com Interview with: Anita Katharina Wagner, PharmD, MPH, DrPH Associate Professor of Population Medicine Director, Ethics Program, Point32Health (parent company of Harvard Pilgrim Health Care and Tufts Health Plan) Co-Director, HMS Fellowship in Health Policy and Insurance Research Co-Director, Center for Cancer Policy and Program Evaluation (CarPE) Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: The expectation for new cancer drugs is that they help patients live better longer. Increasingly more cancer drugs are approved without documented quality of life or overall survival benefits.   At the same time, cancer drug prices are rising.  We studied use of and spending on selected new cancer drugs among patients with employer-sponsored health insurance. We found that among 37348 patients who received one or more of 44 oral targeted cancer drugs, the proportion of patients who received a drug without documented overall survival benefit increased from 13% in 2011 to 59% in 2018.  By 2018, spending on drugs without documented overall survival benefit accounted for 52% of the $3.5 million spend on the 44 drugs since 2011. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Stroke / 30.09.2021

MedicalResearch.com Interview with: Daniel E. Singer, MD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School of Public Health Division of General Internal Medicine Massachusetts General Hospital Boston, MA, 02114 MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation (AF) raises the risk of ischemic stroke 4-5-fold and this risk is largely reversible by oral anticoagulants (OAC). These facts are part of the core knowledge of internal medicine and the basis of multiple guidelines. They are based on studies of patients with persistent or predominantly “heavy burden” paroxysmal AF completed in the 1990s. More recent studies using cardiac implantable devices (CIEDs: implantable defibrillators, pacemakers, etc) which have the capacity to monitor heart rhythm continuously have found that many older patients have brief, often undiagnosed, episodes of AF. Several of these studies have found that strokes occur during periods of sinus rhythm temporally distant from a preceding episode of AF. This has led to a widespread suspicion that AF is not a direct causal risk factor but a risk “marker” indicating the presence of other truly causal features like a diseased left atrium (atrial myopathy). If the risk marker hypothesis is correct, then long-term anticoagulation is needed even for brief and rare episodes of AF (assuming the patient’ s CHA2DS2-VASc score is high enough). The key problem with prior prospective studies using CIEDs was that only a small number of strokes were observed leading to inadequate statistical power. Our study addressed this power problem by linking the very large Optum electronic health record database which could identify ischemic strokes with the Medtronic CareLink database of long-term, continuous heart rhythm records of patients with CIEDs. We ended up studying 891 individuals who had an ischemic stroke and had 120 days of continuous heart monitoring prior to the stroke. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease, Transplantation / 27.09.2021

MedicalResearch.com Interview with: Joel T. Adler, MD, MPH Department of Surgery, Brigham and Women’s Hospital Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: For patients who require renal replacement therapy for failed kidneys, kidney transplantation increased length of life and improves quality of life.  For many of these patients, their dialysis centers are the source of referral for evaluation for transplantation.  These dialysis centers have a number of publicly-reported quality measures, but they largely focus on the provision of dialysis care and not how often the centers’ patients undergo a kidney transplant.  Because these higher-rated facilities provide better dialysis care, we wanted to know if that benefit also spilled over into higher transplant listing rates. (more…)
Anesthesiology, Author Interviews, Brigham & Women's - Harvard, Opiods, Surgical Research / 21.09.2021

MedicalResearch.com Interview with: Andres Zorrilla Vaca, MD Resident Physician Brigham and Women’s Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: The background for this study was Enhanced Recovery After Surgery, also known as ERAS protocols. They basically consisted of a bundle of interventions that are performed preoperatively, intraoperatively and postoperatively with the aim of enhancing patient recovery and reducing complications. This protocol in our institution started with a thorough preoperative counseling which includes, smoking cessation, pain and analgesia education, ERAS program expectations, pulmonary rehabilitation based on pulmonary function tests and incentive spirometry. On the day of surgery, prolonged fasting is avoided and a carbohydrate loading is given orally 2 hours before surgery. Our protocol also included a standardized multimodal analgesic regimen consisting of tramadol ER 300mg p.o. and gabapentin 300mg p.o., intraoperative acetaminophen 1gm i.v., posterior intercostal nerve blockade with liposomal bupivacaine 266mg prior to incision, intraoperative 30mg ketorolac upon wound closure and scheduled postoperative acetaminophen 1g p.o. q 6hrs and ketorolac 15mg i.v. q 6 hrs, as well as additonal interventions recommended by ERAS Society Guidelines. As a general rule, preoperative sedatives (midazolam) are avoided as premedication and prophylaxis against nausea and vomiting (ondansetron, dexamethasone and scopolamine) is administered. Patients are kept euvolemic by using validated goal-directed fluid therapy algorithms (stroke volume variation and cardiac output) and normothermia is maintained throughout the procedure. (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, Circadian Rhythm, Occupational Health, PNAS, Pulmonary Disease, Sleep Disorders / 11.09.2021

MedicalResearch.com Interview with: Frank Scheer, PhD, MSc Professor and Director of the Medical Chronobiology Program Division of Sleep and Circadian Disorders Brigham and Women’s Hospital Steve Shea, PhD Professor and Director Oregon Institute of Occupational Health Sciences MedicalResearch.com: What is the background for this study? Response: For hundreds of years, people have observed that asthma severity often worsens in the nighttime. As many as 75 percent of people with asthma—20 million people in the U.S.—report experiencing worsening asthma severity at night. One longstanding question has been to what degree the body’s internal circadian clock—as opposed to behaviors, such as sleep and physical activities—contributes to worsening of asthma severity. Our research used long term intensive monitoring throughout two circadian protocols in dim light and without time cues to carefully isolate the influence of the circadian system from the other factors that are behavioral and environmental, including sleep. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, OBGYNE, Pediatrics, Weight Research / 28.08.2021

MedicalResearch.com Interview with: Emily Oken MD MPH Professor, Harvard Medical School Professor in the Department of Population Medicine Associate Director and Advisor, Oliver Wendell Holmes Society. Professor, Department of Nutrition, Harvard School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study of over 11,000 mothers and children, we found that a mothers with higher weight in late pregnancy had children with poorer performance on tests of cognition and behavior in childhood and adolescence. The findings are consistent with results from studies in other populations around the world, as well as animal experiments.  This research suggests that maternal nutrition is important for child health over the long-term, and specifically provides support for mothers to try to achieve healthy weight and nutritional status during pregnancy. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Immunotherapy, Kidney Disease, NEJM / 18.08.2021

MedicalResearch.com Interview with: Toni K. Choueiri, MD Director, Lank Center for Genitourinary Oncology Director, Kidney Cancer Center Jerome and Nancy Kohlberg Chai Professor of Medicine, Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The standard of care for patients diagnosed with locoregional RCC is partial or total nephrectomy. Nearly half of patients will eventually experience disease recurrence following nephrectomy and no standard, globally approved adjuvant therapy options are currently available for this population. The phase 3 KEYNOTE-564 study met its primary objective of demonstrating a statistically significant and clinically meaningful improvement in disease-free survival with pembrolizumab vs placebo as adjuvant therapy for patients with RCC post nephrectomy, supporting pembrolizumab as a potential new standard of care for patients at high risk of disease recurrence following surgery. (more…)
Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Pediatrics, Primary Care / 09.07.2021

MedicalResearch.com Interview with: Lisa Rotenstein, MD, MBA Assistant Medical Director Population Health and Faculty Wellbeing Department of Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Response: Our previous work in JAMA Internal Medicine demonstrated significant differences in time spent on the electronic health record (EHR) by specialty, and specifically showed that primary care clinicians spent significantly more total and after-hours time on the EHR than surgical and medical specialty counterparts. Primary care clinicians spent twice as long as surgical colleagues on notes, and received more than twice as many messages from team-mates, five times as many patient messages, and fifteen times as many prescription messages each day. Given these findings, the heavy administrative burden placed on primary care clinicians, and previous data about burnout among primary care clinicians, we wanted to better understand differences in time spent on the EHR among the different types of primary care clinicians. (more…)
Author Interviews, Brigham & Women's - Harvard, Medical Imaging, Neurological Disorders / 02.07.2021

MedicalResearch.com Interview with: Michael Ferguson, PhD Instructor in Neurology | Harvard Medical School Lecturer on Neurospirituality | Harvard Divinity School Center for Brain Circuit Therapeutics Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? Response: Over 80% of the global population consider themselves religious with even more identifying as spiritual, but the neural substrates of spirituality and religiosity remain unresolved. MedicalResearch.com: What are the main findings? Where is this circuit located in the brain? What other effects does this circuit control or influence? Response: We found that brain lesions associated with self-reported spirituality map to a human brain circuit centered on the periaqueductal grey. (more…)
Author Interviews, Brigham & Women's - Harvard, Chocolate, Weight Research / 24.06.2021

MedicalResearch.com Interview with: Frank A. J. L. Scheer, PhD, MSc, Neuroscientist and Marta Garaulet, PhD, Visiting Scientist Division of Sleep and Circadian Disorders Departments of Medicine and Neurology, Brigham and Women's Hospital. MedicalResearch.com: What is the background for this study? Response: We and others have shown that not only “what” but also “when” we eat relates to obesity and weight loss
  • Meal timing can influence circadian rhythms and eating a high energy and high sugar food, such as chocolate, either at night or in the morning may have a different effect on the circadian system, and consequently on body weight and metabolism.
  • Milk chocolate has a name for contributing to weight gain due to its high fat, sugar and caloric content. Chocolate eating habit has been associated with long-term weight gain especially in postmenopausal females who are particularly vulnerable to weight gain.
(more…)
Author Interviews, Brigham & Women's - Harvard, Primary Care, Surgical Research, Weight Research / 10.06.2021

MedicalResearch.com Interview with: Alexander Turchin, MD, MS Director of Informatics Research Division of Endocrinology, Diabetes and Hypertension Associate Professor of Medicine, Harvard Medical School Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Response: There is an epidemic of obesity in the U.S.: over 40% of adults are obese. Obesity causes numerous complications, ranging from heart attacks to cancer. Bariatric surgery is one of the most effective ways to treat obesity, but very few patients utilize it; it is unclear why.  (more…)
Author Interviews, Brigham & Women's - Harvard, Journal Clinical Oncology, Prostate Cancer, Radiation Therapy / 04.06.2021

MedicalResearch.com Interview with: Anthony D'Amico, MD, PhD Professor and Chief of Genitourinary Radiation Oncology Brigham and Women's Hospital and Dana-Farber Cancer Institute MedicalResearch.com: What is the background for this study? Response: 3 randomized trials published in Sept, 2020 in the Lancet and Lancet Oncology concluded that delivering radiation therapy (RT) after surgery for prostate cancer   when the PSA rises signaling recurrence (i.e. early salvage RT) as opposed to when the PSA is undetectable (i.e. adjuvant RT) did not compromise subsequent cancer progression. However these trials may have missed the benefit of adjuvant RT because a minority of men (9 to 17% of the study cohorts) were found to have adverse factors at prostatectomy which are associated with cancer progression and death from prostate cancer. Specifically, men with adverse pathology at prostatectomy comprise the vast majority of men who go on to die from prostate cancer and therefore have the most to gain from adjuvant RT. Yet, given the results of the 3 randomized trials many physicians are no longer offering adjuvant RT, even in men with adverse pathology at surgery. (more…)
Author Interviews, Brigham & Women's - Harvard, Clots - Coagulation, Hematology, Neurological Disorders, Pain Research / 22.05.2021

MedicalResearch.com Interview with: Daniel Chasman, PhD Pamela Rist, ScD, Yanjun Guo, MD, PhD Division of Preventative Medicine Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been speculation in the field about relationships between coagulation and migraine susceptibility for some time, but previous research has been largely inconclusive. In this study, we leveraged Mendelian randomization, a mode of genetic analysis that can support or refute potential causal effects on a health outcome, to examine whether hemostatic factors may contribute to risk of MA. (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, Race/Ethnic Diversity / 09.05.2021

MedicalResearch.com Interview with: Justin Salciccioli, MBBS, MA Research Fellow in Medicine Elliot Israel, MD Professor of Medicine, Harvard Medical School Pulmonary and Critical Care, Rheumatology, Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Response: Asthma attacks account for almost 50% of the cost of asthma care, which costs $80 billion each year in the United States. Asthma is more severe in African-American/Black and Hispanic/Latinx patients, with these groups having double the rates of attacks and hospitalizations as the general population. The PREPARE study is an ongoing national clinical trial for African American/Black and Hispanic/Latinx adults with moderate-to-severe asthma from different U.S. cities in which reporting of asthma control and asthma exacerbations was monitored entirely remotely. With the arrival of the Covid19 pandemic, several studies suggested that asthma exacerbations may have decreased during the pandemic. However, multiple reports have suggested people were avoiding health services because of the pandemic, making it difficult to tell whether exacerbations truly decreased or whether people were simply avoiding their doctors. This is the first study done to assess asthma exacerbations before and during the pandemic that is unlikely to be impacted by patient healthcare avoidance. (more…)
Author Interviews, Brigham & Women's - Harvard, Colon Cancer, Gastrointestinal Disease, Sugar / 06.05.2021

MedicalResearch.com Interview with: Jinhee Hur, PhD Research Fellow Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? Response: Early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis) is rapidly rising in the US since the mid-1980s, with an unclear understanding of its etiology and contributors to the rise. Sugar-sweetened beverages (SSBs) exert adverse metabolic repercussions throughout the life course, including insulin resistance and inflammation. Higher SSB intake can induce obesity, which has been linked to risk of EO-CRC. A recent experimental study also suggests that high fructose corn syrup, a primary sweetener in SSBs, may promote colon tumor growth, independent of metabolic dysregulation. In the US, SSB consumption has dramatically increased during the 2nd half of the 20th century, and adolescents and young adults have been the heaviest SSB drinkers across all age groups. Thus, we expect SSBs may be an emerging risk factor for EO-CRC and likely contribute to the rising incidence of EO-CRC. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Colon Cancer, Radiation Therapy / 04.05.2021

MedicalResearch.com Interview with: James Donald Byrne, Ph.D., M.D. Department of Radiation Oncology Massachusetts General Hospital Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: Radiation therapy is used as a treatment for more than half of all cancer patients and can be highly effective at shrinking tumors and killing cancer cells. But radiation treatment can also damage healthy tissue, including tissue in the mouth and gastrointestinal tract. This tissue injury can lead to oral mucositis, esophagitis, and proctitis — painful and sometimes debilitating tissue damage. It’s estimated that these injuries occur in over 200,000 patients in the U.S. each year. Our goal was to develop personalized shields that blocked radiation from affecting healthy GI tissue. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, NEJM / 22.04.2021

MedicalResearch.com Interview with: Aditya Bardia MD, MPH Director, Breast Cancer Research Program, Attending Physician, Massachusetts General Hospital Harvard Medical School  MedicalResearch.com: What is the background for this study? Response: Triple negative breast cancer (TNBC) represents an aggressive subtype of breast cancer associated with guarded prognosis. For patients with pre-treated metastatic TNBC, standard chemotherapy is associated with low response rate (5-10%) and poor progression-free survival (2-3 months), highlighting need for better therapies. Sacituzumab govitecan is an antibody drug conjugate (ADC) which  combines SN-38, an active metabolite of irinotecan, with an antibody against Trop-2, an antigen overexpressed in majority of triple negative breast cancer. (more…)
AACR, Author Interviews, Brigham & Women's - Harvard, Cancer Research, Nutrition, Prostate Cancer / 10.04.2021

MedicalResearch.com Interview with: Dr. Anna Plym PhD Postdoctoral Research Fellow Brigham and Women's Hospital Harvard T.H. Chan School of Public Health  MedicalResearch.com: What is the background for this study? What are the main elements of the healthy lifestyle? Response: Prostate cancer is the most heritable of all cancers, with genetic factors accounting for a large proportion of cases. Although we do not currently know about all the genetic factors contributing, a recent study identified 269 genetic markers for prostate cancer, validated in multiple independent populations (Conti et al., Nature Genetics 2021, Plym et al, JNCI, 2021: https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djab058/6207974). Based on a polygenic risk score derived from these 269 markers, we observed that men with a high polygenic risk score have over a 50% risk of developing prostate cancer within their lifetime. With this excess risk in mind, we were interested in possible ways in which the genetic risk of prostate could be attenuated. An increasing number of studies have suggested that lifestyle factors can affect the risk of lethal prostate cancer – however, these studies have seldom incorporated genetic factors. We know from other diseases that a healthy lifestyle is of benefit for individuals at high genetic risk, and we hypothesized that this would be the case for prostate cancer as well. In this study, we examined a healthy lifestyle score for lethal prostate cancer consisting of six components: healthy weight (BMI < 30), not smoking (never smoked or quit > 10 years ago), vigorous physical exercise (3 or more hours per week), high intake of tomatoes or tomato-based products (7 servings or more per week), high intake of fatty fish (1 or more serving per week) and low intake of processed meat (less than 3 servings/week of beef or pork hot dogs, bacon, salami, bologna, or other processed meat sandwiches) (Kenfield et al, JCO, 2016).  (more…)
Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus / 25.03.2021

MedicalResearch.com Interview with: Hesam Dashti, PhD Brigham and Women's Hospital, Harvard Medical School Senior Computational Scientist The Broad Institute of MIT and Harvard  MedicalResearch.com: What is the background for this study? What parameters does the SARS2 score take into consideration? Response: While complex models have been developed for predicting the severity of COVID-19 from the medical history, laboratory, and imaging results of patients, simplified models with similar accuracy would be more practical for individualizing the decision making, especially when detailed medical history of patients is not readily available. In this study, we developed the SARS2 risk equations for estimating risk of hospitalization of patients with COVID-19 and also the risk of mortality among hospitalized patients. The “SARS2” risk equations are named for their input variables: Sex, Age, Race, Socioeconomic and Smoking status. To develop and validate the models, we used the electronic records from 12,347 patients who tested positive for COVID-19 at the Mass General Brigham medical centers in Massachusetts between 02/26/2020 and 07/14/2020 to construct derivation and validation cohorts for estimating 1) risk of hospitalization within 30 days of COVID-19 positive PCR test, and 2) for the hospitalized patients, risk of mortality within approximately 3 months. (more…)
Author Interviews, Brigham & Women's - Harvard, Endocrinology, Insomnia, Menopause, Sleep Disorders, Weight Research / 23.03.2021

MedicalResearch.com Interview with: Leilah K. Grant, PhD Postdoctoral Research Fellow in Medicine Brigham and Women’s Hospital Harvard Medical School  MedicalResearch.com: What is the background for this study? Response: The prevalence of obesity increases in women around the age of menopause which increases the risk of diseases like diabetes and heart disease. Changes in hormones, like estrogen, are thought to contribute to weight gain during menopause, but other common symptoms of menopause such as sleep interruption may also play a role. While short sleep is known to adversely affect metabolism, little is known about the metabolic consequences of the type of sleep disruption most common in menopausal women – increased nighttime awakenings (i.e., sleep interruption) caused by hot flashes, but no change in overall sleep duration. We therefore did this study to see how an experimental model menopause-related sleep interruption would affect metabolic outcomes that may contribute to weight gain.  (more…)
Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus / 17.03.2021

MedicalResearch.com Interview with: Benjamin E. Gewurz MD, PhD Broad Institute of MIT and Harvard, Cambridge, Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Department of Microbiology, Harvard Medical School Boston, MABenjamin E. Gewurz MD, PhD Broad Institute of MIT and Harvard, Cambridge, Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Department of Microbiology, Harvard Medical School Boston, MA  MedicalResearch.com: What is the background for this study? Response: When the Covid-19 virus infects cells, it takes over and redirects our cells resources towards the projection of virus building blocks and new viruses.  Building blocks include large amounts of RNAs that encode for the viral proteins, much as the mRNA vaccines direct our bodies to make the spike protein. We wondered how the virus changes cell metabolism in order to support the synthesis of vast amounts of viral RNAs within hours of infection. (more…)
Author Interviews, Brigham & Women's - Harvard, Kidney Disease, Transplantation / 12.03.2021

MedicalResearch.com Interview with: Jamil R. Azzi MD Associate Professor of Medicine, Harvard Medical School Medical Director, Vascularized Composite Allotransplantation Associate Director, Kidney and Pancreas Transplantation Director, Kidney Transplant Fellowship Engineering in Medicine, Brigham and Women’s Hospital Renal Division, Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Would you explain what is meant by an exosome?  Response: Kidney transplant recipients are always at risk of developing rejection where the immune system recognizes the transplanted kidney as “foreign body” and attacks it. The risk is up to 20% the first year after transplant and many more develop chronic rejection which ultimately leads to kidney failure. Currently, most clinicians monitor for kidney rejection by measuring serum creatinine and urine protein. However, creatinine is neither sensitive nor specific for rejection. On the other hand, performing kidney biopsies to make accurate diagnosis of rejection is invasive and has many complications. In our study, when clinicians decided on performing biopsies based on the clinical informations they have including changes in serum creatinine, the biopsies did not show rejection in almost 70% of the cases. Furthermore, serum creatinine can remain stable while the patient may be undergoing a rejection (subclinical rejection). In fact, some centers currently perform routine biopsies at different time points for all their patients regardless of creatinine despite the high risks, costs and inconveniences of doing biopsies. Out of this frustration with the current tools, we have been working on novel technologies to diagnose rejection through the urine. The idea started from the bench as we were studying exosomes, those are tiny vesicles (less than 100 nm in size) released by all cells. We were interested on how immune cells communicate via those vesicles so we developed assays to identify them. We then showed that if immune cells are invading the kidney during rejection, vesicles derived from those immune cells are found in the urine. This gave us the idea of developing a urine test based on these findings. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Stem Cells / 05.03.2021

MedicalResearch.com Interview with: Khalid Shah, MS, PhD Vice Chair of Research, Department of Neurosurgery Director, Center for Stem Cell Therapeutics and Imaging Director, Center for Excellence in Biomedicine Brigham and Women's Hospital Associate Professor, Harvard Medical School Principal Faculty, Harvard Stem Cell Institute  MedicalResearch.com: What is the background for this study? Response: Approximately 15-to-30 percent of patients with metastatic breast cancer have brain metastasis (BM), with basal-like breast cancer (BLBC) metastasizing to the brain most frequently. The prognosis for BLBC-BM patients is poor, as the blood-brain barrier prevents most therapeutics from reaching the brain. Testing candidate therapies in clinical trials is also challenging because animal models that mimic BM are limited. In this study we engineered a bimodal tumor-suppressing and killing molecule that can be delivered to the brain by stem cells and tested them in mouse models of brain metastases that mimic clinical setting. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, COVID -19 Coronavirus, Electronic Records, JAMA, Technology / 04.03.2021

MedicalResearch.com Interview with: Carlo Giovanni Traverso, MB, BChir, PhD Associate Physician, Brigham and Women's Hospital Assistant Professor, Peter R. Chai, MD, MMS Emergency Medicine Physician and Medical Toxicologist Harvard Medical School Brigham and Women's Hospital Department of Medicine   Dr-Spot-HealthCare-Assistant.jpgMedicalResearch.com: What is the background for this study? What are some of the functions that Dr. Spot can facilitate? Response: During the COVID-19 pandemic, we wanted to consider innovative methods to provide additional social distance for physicians evaluating low acuity individuals who may have COVID-19 disease in the emergency department. While other health systems had instituted processes like evaluating patients from outside of emergency department rooms or calling patients to obtain a history, we considered the use of a mobile robotic system in collaboration with Boston Dynamics to provide telemedicine triage on an agile platform that could be navigated around a busy emergency department. Dr. Spot was built with a camera system to help an operator navigate it through an emergency department into a patient room where an on-board tablet would permit face-to-face triage and assessment of individuals. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Nature / 04.02.2021

MedicalResearch.com Interview with: Dr. Hugo Aerts, PhD Dana-Farber Cancer Institute Associate Professor, Brigham and Women's Hospital Harvard Medical School Director, Program for Artificial Intelligence in Medicine Brigham And Women's Hospital  MedicalResearch.com: Deep convolutional neural networks to predict cardiovascular risk from computed tomography  Response: Cardiovascular disease is the most common preventable cause of death in Europe and the United States. Effective lifestyle and pharmacological prevention is available, but identifying those who would benefit most remains an ongoing challenge. Hence, efforts are needed to further improve cardiovascular risk prediction and stratification on an individual basis. One of the strongest known predictors for adverse cardiovascular events is coronary artery calcification, which can be quantified on computed tomography (CT). The CT coronary calcium score is a measure of the burden of coronary atherosclerosis and is one of the most widely accepted measures of cardiovascular risk. Recent strides in artificial intelligence, deep learning in particular, have shown its viability in several medical applications such as medical diagnostic and imaging, risk management, or virtual assistants. A major advantage is that deep learning can automate complex assessments that previously could only be done by radiologists, but now is feasible at scale with a higher speed and lower cost. This makes deep learning a promising technology for automating cardiovascular event prediction from imaging. However, before clinical introduction can be considered, generalizability of these systems needs to be demonstrated as they need to be able to predict cardiovascular events of asymptomatic and symptomatic individuals across multiple clinical scenarios, and work robustly on data from multiple institutions. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, COVID -19 Coronavirus, Prostate, Prostate Cancer, Surgical Research, Urology / 01.02.2021

MedicalResearch.com Interview with: David-Dan Nguyen Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital MPH (Health Policy) Student | Harvard T.H. Chan School of Public Health Medical Student | McGill University MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic has forced hospitals to delay the definitive treatment of cancers via surgery or radiation therapy. While previous evidence has shown that delaying the treatment of low-risk prostate cancer is not associated with worse outcomes, treatment delays for intermediate-risk and high-risk prostate cancer are more controversial. As such, we sought to determine if delays for these disease states negatively impacted oncological outcomes. (more…)
Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus, Heart Disease, JACC / 11.01.2021

MedicalResearch.com Interview with: Rishi K. Wadhera, MD, MPP, MPhil Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center Associate Program Director, Cardiovascular Medicine Fellowship Assistant Professor of Medicine, Harvard Medical School  MedicalResearch.com: What is the background for this study? Response: The direct toll of the novel coronavirus disease 2019 (COVID-19) in the U.S. has been substantial, but concerns have also arisen about the indirect effects of the pandemic on higher-risk patients with chronic medical conditions, such as cardiovascular disease. Hospitalizations for acute cardiovascular conditions, including myocardial infarction, heart failure, and stroke precipitously declined during the early phase of the pandemic. These patterns have raised concern that patients may be avoiding hospitals due to fear of contracting SARS-CoV-2, and that some have died from cardiovascular conditions without seeking medical care. In addition, there has been growing concern about the the effects of health-care system strain and the deferral of semi-elective procedures on patients with cardiovascular conditions. (more…)
Author Interviews, Brain Injury, Brigham & Women's - Harvard / 03.01.2021

MedicalResearch.com Interview with: Nitin Joshi, Ph.D. Engineering in Medicine/Department of Medicine Brigham and Women's Hospital   Dr. Jeffrey M Karp Ph.D Principal Investigator Professor of Medicine at Brigham and Women’s Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? Would you explain what is meant by the blood brain barrier? How will nanoparticles facilitate transport of drugs into the brain? Response: Over the past few decades, researchers have identified promising therapeutic agents that can target the biological pathways involved in brain diseases. Unfortunately, clinical translation of these therapeutics is limited by their inability to cross the blood brain barrier (BBB) and enter the brain at therapeutically effective levels. The BBB is a highly selective semipermeable border of cells that prevents molecules in the circulating blood from non-selectively crossing into the brain tissue. We have developed a simple targeted nanoparticle platform that can stably encapsulate therapeutic agents and enable their therapeutically effective delivery into the brain. In this work, we have demonstrated the utility of this platform for the treatment of traumatic brain injury (TBI), which is a leading cause of death and disability in children and young adults, with millions of people suffering TBI each year in accidents, sports, and military conflicts. Following primary injury, which is a result of the mechanical impact to the brain, secondary injury gradually occurs over months to years and can lead to neurological dysfunctions, including Alzheimer’s and Parkinson’s diseases. After TBI, the BBB is physically breached for a short time and previous approaches to achieve therapeutically effective transport of drugs across the BBB have been severely limited to utilizing this very short window. However, the extent to which the BBB is physically breached in TBI varies greatly across the patient population. Therefore, current approaches are applicable to only a subset of injuries with substantially breached BBB. Moreover, BBB can self-repair within a few hours to weeks post-injury to restore its integrity. Hence, physical breaching of BBB offers a limited window for therapeutic interventions, which is not ideal as the secondary injury can last months to years and may require repeated dosing over long term. The nanoparticle platform developed in this work can enable therapeutically effective delivery of drugs into the brain, irrespective of the state of the BBB. We achieved this by precise engineering of the surface properties of nanoparticles, which maximized their transport across the BBB. The therapeutic used in this study was a small interfering RNA (siRNA) molecule designed to inhibit the expression of the tau protein, which is believed to play a key role in neurodegeneration. Poly(lactic-co-glycolic acid), or PLGA, a biodegradable and biocompatible polymer used in several existing products approved by the U.S. Food and Drug Administration was used as the base material for nanoparticles. We systematically engineered and studied the surface properties of the nanoparticles to maximize their penetration across the intact, undamaged BBB in healthy mice. This led to the identification of a unique nanoparticle design that maximized the transport of the encapsulated siRNA across the intact BBB and also significantly improved the uptake by the brain cells.  (more…)
Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus, JAMA, Social Issues / 23.12.2020

MedicalResearch.com Interview with: Kenneth Freedberg, MD Director, Medical Practice Evaluation Center Massachusetts General Hospital Professor of Medicine at Harvard Medical School Study senior author Jessie Gaeta, MD Chief Medical Officer Boston Health Care for the Homeless Program Assistant Professor of Medicine Boston University School of Medicine Travis P. Baggett, MD, MPH Faculty clinician-investigator MGH Division of General Internal Medicine Assistant Professor of Medicine Harvard Medical School MedicalResearch.com: What are the main findings?  Dr. Baggett: We found that two strategies are crucial for addressing COVID-19 among people staying in homeless shelters: 1) Proactively identifying and testing people with symptoms, and 2) Providing a dedicated, medically supervised, non-hospital space for isolation and management of people with mild to moderate COVID. Together these two strategies would reduce infections, hospitalizations, and health care costs compared to not doing them. During a pandemic surge, like we are seeing now, it makes sense to add periodic universal testing of all shelter residents, even those without symptoms. (more…)
Annals Internal Medicine, Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus, Education / 23.12.2020

MedicalResearch.com Interview with: Elena Losina, PhD Robert W. Lovett Professor of Orthopedic Surgery Harvard Medical School Director, Policy and Innovation eValuations in Orthopedic Treatments (PIVOT) Center Co-Director, Orthopedic and Arthritis Center for Outcomes Research Department of Orthopedic Surgery Brigham and Women’s HospitalBoston, MA, 02115 MedicalResearch.com: What is the background for this study? Response: Since the pandemic began, there have been over 320,000 COVID-19 cases and 80 deaths at over 1,700 colleges, highlighting the consequences of different mitigation strategies, and as colleges are closing the fall semester and preparing for the spring semester, figuring out what worked what did not, in term of COVID-19 mitigation, is critical to minimize the impact of COVID-19 on college campuses during the spring semeste.  (more…)