Transgender Actors Effective in Teaching Residents to Provide Respectful and Effective Health Care

MedicalResearch.com Interview with:

Richard E. Greene, MD, FACP Medical Director, Bellevue Adult Primary Care Center Assistant Professor, NYU School of Medicine Associate Program Director, Primary Care Residency Program Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

Dr. Greene

Richard E. Greene, MD, FACP
Medical Director, Bellevue Adult Primary Care Center
Assistant Professor, NYU School of Medicine
Associate Program Director, Primary Care Residency Program
Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList
Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies
VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

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

Response: Transgender individuals face complex health disparities and have historically been mistreated and even denied care in medical settings. As a provider in New York City, I saw how this affected my trans patients, resulting in mistrust of the health care system, resulting in negative health outcomes. This sparked my interest in improving medical education to serve the needs of trans patients. It’s important to teach medical students and residents that they are not just treating a set of symptoms, they are working with a individuals with complex lived experiences who deserve compassionate care.

I found with traditional didactic methods, like lectures, learners smiled and nodded in agreement, but when faced with a patient who was transgender, they would stammer and feel uncomfortable with aspects of the cases that were specific to transgender patients, from pronouns to hormones.

Residents should be prepared to treat transgender patients not only with dignity, but also in medically appropriate ways. Without exposure to the transgender community, it’s difficult for providers to decipher their trans patients’ health care needs and contextualize them within a care plan.

In order to provide a low stakes environment for residents to practice these skills, we developed an OSCE focused on a transgender woman with health care needs specific to her transition. The goal of the case was to discuss the patient’s medical concerns while also taking into consideration her goals around her hormone therapy and surgical interests.

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Genetic Cause of Cushing’s Disease Detected

MedicalResearch.com Interview with:

Constantine A. Stratakis, MD, DMSci Section on Endocrinology and Genetics Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Bethesda

Dr. Stratakis

Constantine A. Stratakis, MD, DMSci
Section on Endocrinology and Genetics
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health, Bethesda 

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

Response: The pituitary and adrenal glands operate on a kind of feedback loop.  In response to stress, the pituitary release ACTH (Adrenocorticotropic hormone), which signals the adrenal glands to release cortisol.  Rising cortisol levels then act on the pituitary, to shut down ACTH production. In a previous study, Jacque Drouin of the Institute for Clinical Research in Montreal and colleagues had determined that the CABLES1 protein was a key player in this feedback mechanism, switching off pituitary cell division in cultures exposed to cortisol. Since this feedback mechanism appears to be impaired in many corticotropinomas, we investigated the presence of Cables1 gene mutations and copy number variations in a large group of patients with Cushing’s disease.

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Pembrolizumab – Keytruda- Shows Promise in Subset of Triple Negative Breast Cancer

MedicalResearch.com Interview with:

Sylvia Adams, MD Associate Professor of Medicine Breast Cancer and Cancer Immunotherapy Programs NYU Langone Medical Center Cancer Institute/Clinical Cancer Center New York, NY 10016

Dr. Adams

Sylvia Adams, MD
Associate Professor of Medicine
Breast Cancer and Cancer Immunotherapy Programs
NYU Langone Medical Center
Cancer Institute/Clinical Cancer Center
New York, NY 10016

 

MedicalResearch.com: What is the background for the Keynote-086 trial ? What are the main findings?

Response: This study is the largest immunotherapy study to date presented in metastatic triple negative breast cancer. This phase 2 trial studied the efficacy and safety of pembrolizumab (P) as single agent in a very aggressive disease and had two cohorts, a cohort of previously untreated patients (Cohort B) and a cohort with patients who had received prior chemotherapy lines in the metastatic setting (Cohort A).

The study showed that single agent pembrolizumab can elicit durable responses in a subset of patients. This was found regardless of tumoral PD-L1 expression but appeared to be much more frequent in women without prior chemotherapy treatments in the metastatic setting. Survival is especially promising for patients responding to therapy.

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Herceptin Biosimilar CT-P6 Found Safe and Effective in Early Breast Cancer

MedicalResearch.com Interview with:

Prof Francisco J Esteva MD PhD</strong> Director of the breast medical oncology program at Perlmutter Cancer Center. NYU Langone Medical Center

Prof. Esteva

Prof Francisco J Esteva MD PhD
Director of the breast medical oncology program at Perlmutter Cancer Center.
NYU Langone Medical Center

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

Response: Trastuzumab is a monoclonal antibody directed against the human epidermal growth factor receptor 2 (HER-2). Trastuzumab therapy has been shown to improve survival in patients with early-stage and metastatic her-2 positive breast cancer.

In this study, we compared the safety and efficacy of the trastuzumab originator (Herceptin) to a trastuzumab biosimilar (CT-P6) in patients with stage I-III HER-2 positive breast cancer receiving neoadjuvant chemotherapy. The study was a randomized phase III trial.

We found the pathological complete response rates were similar in both groups. Both antibodies were safe. Pharmacokinetic studies showed similar plasma concentrations for the trastuzumab originator and the proposed biosimilar.

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May Be No Benefit To Statins For Primary Prevention in Older Adults

MedicalResearch.com Interview with:
Benjamin Han, MD, MPH
Assistant professor
Departments of Medicine-Division of Geriatric Medicine and Palliative Care, and Population Health
NYU Langone Medical Center

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

Response: There are an increasing number of older adults being prescribed statins for primary prevention, but the evidence for the benefit for older adults is unclear.

Our study finds that in the ALLHAT-LLT clinical trial, there were no benefits in either all-cause mortality or cardiovascular outcomes for older adults who did not have any evidence of cardiovascular disease at baseline.

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E-cigarette Smoke Increases Bladder Cancer Risk

MedicalResearch.com Interview with:

Moon-shong Tang, Ph</strong>D Professor of Environmental Medicine, Pathology and Medicine New York University School of Medicine Tuxedo Park, New York 10987

Dr. Moon-shong Tang

Moon-shong Tang, PhD
Professor of Environmental Medicine, Pathology and Medicine
New York University Langone School of Medicine
Tuxedo Park, New York 10987

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

Response: E-cigarettes (E-cigs) are designed to deliver the stimulant nicotine through aerosols, commonly referred as vapors. Nicotine is dissolved in organic solvents such as glycerin and propylene glycol. The nicotine is then aerosolized by controlled electric heating. E-cigs do not use tobacco leaves and E-cig smoke does not involve the burning process. Hence, E-cig smoke (ECS) contains only nicotine and the gas phase of the solvent. Because ECS contains neither carcinogens nor allergens or odors from the tobacco burning process, E-cigs have been promoted as an invention that can deliver a TS ‘high’ without TS negative effects. The population of E-cig users is rapidly rising, particularly in young adults. It has been estimated that 16% of high school students are E-cig smokers. Therefore, the health effects of E-cig smoke, particularly its carcinogenicity, deserve careful scrutiny.

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Strong Evidence That Antipsychotics Are Effective For Acute Psychosis and Prevent Relapse

MedicalResearch.com Interview with:

Donald C. Goff, MD Marvin Stern Professor Vice Chair for Research Department of Psychiatry NYU Langone Medical Center

Dr. Goff

Donald C. Goff, MD
Marvin Stern Professor
Vice Chair for Research
Department of Psychiatry
NYU Langone Medical Center

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

Response: Since their introduction in the 1950’s antipsychotic drugs have been an integral part of the treatment of schizophrenia. However, over the past decade concerns have been raised about whether these drugs might negatively affect the long-term course of the illness—either by causing supersensitivity of dopamine receptors, which might make patients more prone to psychosis and relapse, or by direct toxic effects on the brain.

To address these concerns, we convened a panel of international experts to review the evidence supporting these concerns, including findings from clinical studies, brain imaging studies, post-mortem examination of the brains of people treated with these drugs, and studies in which these drugs were administered to animals.

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No Magic Age To Stop Performing Screening Mammograms

MedicalResearch.com Interview with:
Cindy S. Lee, MD

Department of Radiology and Biomedical Imaging
University of California, San Francisco, San Francisco
Now with Department of Radiology
NYU Langone Medical Center, Garden City, New York

MedicalResearch.com: What led you and colleagues to conduct this study?

Response: I am a breast imager. I see patients who come in for their screening mammograms and I get asked, a lot, if patients aged 75 years and older should continue screening, because of their age. There is not enough evidence out there to determine how breast cancer screening benefits women older than 75. In fact, all previously randomized trials of screening mammography excluded people older than 75 years.

Unfortunately, age is the biggest risk factor for breast cancer, so as patients get older, they have higher risks of developing breast cancer. It is therefore important to know how well screening mammography works in these patients.

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Radiation Exposure in the Pediatric Patient: What Every Orthopaedist Should Know

MedicalResearch.com Interview with:
Ayesha Rahman, MD

Chief Orthopaedic Surgery Resident
NYU Langone Medical Center.

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

Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow.

Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.

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Deep Brain Stimulation Can Be Effective For Severe Tourette Syndrome

MedicalResearch.com Interview with:

Alon Y. Mogilner, M.D., Ph.D. Associate Professor of Neurosurgery and Anesthesiology Director, Center for Neuromodulation Department of Neurosurgery NYU Langone Medical Center New York, NY 10016

Alon Mogilner

Alon Y. Mogilner, M.D., Ph.D.
Associate Professor of Neurosurgery and Anesthesiology
Director, Center for Neuromodulation
Department of Neurosurgery
NYU Langone Medical Center
New York, NY 10016

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

Response: The study was a review of our series of patients with Tourette’s syndrome who had failed all other treatments and who underwent deep brain stimulation (DBS), and the study demonstrated that the procedure was safe and effective in relieving their tics.

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

Response:  Deep brain stimulation can be an effective treatment in patients with severe Tourette’s syndrome.

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

Response: Further studies should be done to confirm which patients are most likely to benefit.

Disclosure: I have received consulting fees from Medtronic, the company who makes the implants.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Richard S. Dowd, Michael Pourfar, Alon Y. Mogilner. Deep brain stimulation for Tourette syndrome: a single-center series. Journal of Neurosurgery, 2017; 1 DOI: 10.3171/2016.10.JNS161573

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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