MedicalResearch.com Interview with: S. Yousuf Zafar, MD, MHS
Assistant Professor of Medicine
Duke Cancer Institute
twitter: @yzafar
MedicalResearch.com: What are the main findings of the study?Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan.
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MedicalResearch.com Interview with:Janet L. Stanford, MPH, PhD Full Member, Research Professor
Co-Head, Program in Prostate Cancer Research
Fred Hutchinson Cancer Research Center
1100 Fairview Ave. N. M4-B874
Seattle, WA 98109-1024
MedicalResearch.com: What are the main findings of the study?Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease. In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day. The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients.
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MedicalResearch.com Interview with:Vanja Douglas, MD
Sara & Evan Williams Foundation
Endowed Neurohospitalist Chair
Assistant Professor of Clinical Neurology
UCSF Department of Neurology
Neurology Clerkship Director
Editor in Chief, The NeurohospitalistMedicalResearch.com: What are the main findings of the study?Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient's risk of developing delirium during that hospitalization.
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MedicalResearch.com Interview with:Saul Blecker, MD, MHS
Assistant Professor
Department of Population Health
NYU School of Medicine
227 East 30th St., #648
New York, NY 10016
MedicalResearch.com: What are the main findings of the study?Dr. Blecker:We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends.
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MedicalResearch.com Interview with:Ruifeng Cao, MD,PhD
Postdoctoral Fellow
Laboratory of Nahum Sonenberg
McGill University
Department of Biochemistry
Montreal, QC H3A 1A3, Canada
MedicalResearch.com: What are the main findings of the study?Answer: Circadian (~24h) timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria. In mammals, including humans, a circadian clock in the brain drives daily rhythms in sleep and wakefulness, feeding and metabolism, and many other essential processes. We studied how protein synthesis, which is a fundamental process underlying many biological activities, is controlled in the brain clock in mice and identified a protein that functions as a clock repressor. By removing the repressor protein, the clock function is improved.
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MedicalResearch.com Interview with:Leora I. Horwitz, MD, MHSSection of General Internal Medicine, Department of Medicine,
Yale School of Medicine,
Center for Outcomes Research and Evaluation,
Yale–New Haven Hospital, New Haven, Connecticut
MedicalResearch.com: What are the main findings of the study?Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
40% of patients could not understand or explain the reason they were in the hospital in the first place;
A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
Only 44% accurately recalled details of their appointments.
In other words, we didn't do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home.
We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients - that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients - we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn't even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn't find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies.
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MedicalResearch.com Interview with:
Sandra Ryeom, PhD,
Assistant professor of Cancer Biology,
Perelman School of Medicine, University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases.
MedicalResearch.com: Were any of the findings unexpected?Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling was all unexpected.
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MedicalResearch.com Interview with: Rakesh M. Suri MD, D.Phil.
Mayo Clinic College of Medicine, Rochester, Minnesota
MedicalResearch.com: What might clinicians “take home” from this study?
Answers:
a. The contemporary outcomes of surgical correction of mitral regurgitation are excellent based upon results observed in this large multinational, multi-institutional study, Mitral valve surgery now has a low peri-operative risk of death or complications, and a very high likelihood of saving a patient’s own heart valve (>90% - repair); thereby avoiding the need for replacement with an artificial valve substitute.
b. All patients with severe degenerative mitral regurgitation are at risk for heart failure and/or death when surgical correction is delayed. A safe period of “watchful waiting” in those with severe mitral regurgitation due to flail leaflets, even in the absence of traditional Class I triggers for surgery (symptoms or left ventricular dilation/dysfunction) does not exist.
c. Prompt mitral valve surgery within months following the diagnosis of severe degenerative mitral regurgitation, even in those without symptoms, is associated with important and sustained long term benefits including a 40% decrease in death and 60% less heart failure risk, sustained many years following surgical intervention
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MedicalResearch.com Interview with:Marina Klein, MD, MSc, FRCP(C)
Associate Professor of Medicine
McGill University Health Centre
Division of Infectious Diseases and Chronic Viral Illness Service
3650 Saint Urbain
Montreal, Quebec H2X 2P4
Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis MedicalResearch.com: What are the main findings of the study?Dr. Klein: We showed that people with HIV and hepatitis C infection who smoked marijuana did not tend to progress more rapidly to liver fibrosis, liver cirrhosis or end-stage liver disease, even with increasing numbers of joints smoked per week. Previous studies that reported that marijuana was harmful to the liver were likely biased because they did not ensure that marijuana smoking occurred before the development of liver problems.
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MedicalResearch.com: Interview with Alice Chen-Plotkin, MD
Assistant Professor
Department of Neurology
University of Pennsylvania School of Medicine
MedicalResearch.com: What are the main findings of the study?Answer: Parkinson's disease (PD) is an incurable neurodegenerative disease. Many neurons die, but the neurons that make dopamine (dopaminergic neurons) are particularly vulnerable. We think that the disease actually starts well before the time when people show clinical symptoms. We were therefore interested in finding proteins from the blood that correlated with better or worse dopaminergic neuron integrity. Since it's hard to access the dopaminergic neurons directly, we looked at a tracer that labels the ends of the dopaminergic neurons in people who do not have Parkinson's disease but are at high risk for developing it, and we also looked at the age at onset of PD in people who are already symptomatic. Screening just under 100 different proteins from the blood, we found that higher plasma levels of apolipoprotein A1 (ApoA1) were correlated with better tracer uptake in the people who did not yet have PD, and with older ages at onset in the people who already had PD. These data suggest that plasma ApoA1 may be a marker for PD risk, with higher levels being relatively protective.
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MedicalResearch.com Interview with: Kornelia Polyak, MD, PhD
Professor of Medicine
Dana-Farber Cancer Institute
Harvard Medical School
Boston, MA 02215
MedicalResearch.com: What are the main findings of the study?Dr. Polyak: We found that when comparing normal breast tissue of women who have not had children (nulliparous) and those who had children in their early 20s, the largest changes are in breast epithelial progenitors. The frequency of these cells is lower in parous women (women who had children) and the properties are also altered in a way that they are less likely to proliferate. Women with high risk of breast cancer, such as BRCA1 and BRCA2 mutation carriers, have very high frequency of these cells, and also parous women who did get cancer have more than those who did not. These results indicate that the frequency of these cells may predict breast cancer risk.
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MedicalResearch.com Interview with:
Dr. Wen-Ya Ko, Ph.D.Postdoctoral Fellow, First author of the paper
Department of Genetics
School of Medicine
University of Pennsylvania
426 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104-6145
Dr. Sarah Tishkoff, Ph.D., Senior author of the paper
David and Lyn Silfen University Professor
Departments of Genetics and Biology
School of Medicine
School of Arts and Sciences
University of Pennsylvania
MedicalResearch.com: What are the main findings of the study? Answer: In humans the APOL1 gene codes for Apolipoprotein L1, a major component of the trypanolytic factor in serum. The APOL1 gene harbors two risk alleles (G1 and G2) associated with chronic kidney disease (CKD) among individuals of recent African ancestry. We studied APOL1 across genetically and geographically diverse ethnic groups in Africa. We have discovered a number of novel variants at the APOL1 functional domains that are required to lyse trypanosome parasites inside human blood vessels.
We further identified signatures of natural selection influencing the pattern of variation on chromosomes carrying some of these variants. In particular, we have identified a haplotype (a cluster of genetic variants linked along a short region of a chromosome), termed G3, that has evolved adaptively in the Fulani population who have been practicing cattle herding which has been historically documented as early as in the medieval ages (but which could have begun thousands of years earlier). Many of the novel variants discovered in this study are candidates to play a role conferring protection against trypanosomiasis and/or to play a role in susceptibility of CKD in humans.
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MedicalResearch.com Interview with: Simon Maltais MD PhD
Vanderbilt University Medical Center
Division of Cardiovascular Surgery
1215 21st Ave S, MCE 5th Flr
Nashville, TN 37232-8808.
MedicalResearch.com: What did your study evaluate and why is this important?Answer: We performed a rigorous, retrospective review of the Scientific Registry of Transplant Recipients (SRTR) data base to evaluate donor, recipient, and technical characteristics associated with graft survival in patients undergoing mechanical circulatory support (MCS) device explantation at the time of heart transplantation surgery.
Donor and recipient characteristics has been well described in the medical literature for routine heart transplantation, however these characteristics in patients who were supported with a long term MCS device at the time of heart transplant was not known. Additionally, due to chronic donor heart shortages, an increasing number of patients with advanced heart failure are being bridged with MSC devices until a suitable donor heart can be obtained.
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MedicalResearch.com Interview with: Caroline Franck, MSc
Dvisions of Cardiology and Clinical Epidemiology
McGill University, Montreal, Quebec, Canada
MedicalResearch.com: What are the main findings of the study?Answer: We found that, although subsidies are needed to protect farmers from production risks, the current allocation of payments encourages the sustained overproduction of a handful of grains and oilseeds. Overproduction contributes to making the end products cheaper, which are then processed into energy-dense and high-fat/sugar foods. Obesity should be treated as a systems problem, in which farm production plays an important role.
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MedicalResearch.com Interview with: Prasad Adusumilli MD, FACS
Associate Member, Thoracic Surgery
Memorial Sloan-Kettering Cancer Center
New York
MedicalResearch.com: What are the main findings of the study?Answer: The current standard of care of for early-stage lung adenocarcinoma, the common form of lung cancer is curative-intent surgery either by limited resection, LR (removal of tumor with clear margins) or lobectomy, LO (removal of one-third to one-half of the lung harboring the tumor). Although lung-sparing LR is preferable, there is a reported incidence of 30-40% of recurrences within the same lung. The causative factor/s for these local recurrences is not known.
In our study, we analyzed recurrence patterns and pathological features in patients who underwent 476 LO and 258 LR performed at the Memorial Sloan-Kettering Cancer Center, New York. We investigated the morphological patterns in pathology specimens utilizing the recently proposed International Association for the Study of Lung Cancer / European Respiratory Society / American Thoracic Society (IASLC/ERS/ATS) classification. We noticed that presence of micropapillary morphology was associated with three times higher recurrences in patients undergoing LR compared to LO, these recurrences were lower when there is an adequate margin (2 cm) resected beyond the tumor. In patients undergoing LO, the recurrences were 75% less.
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MedicalResearch.com Interview with Frederic D. Bushman, Ph.D.
Professor, Department of Microbiology
Department of Microbiology
Perelman School of Medicine
University of Pennsylvania
426A Johnson Pavilion 3610 Hamilton Walk
Philadelphia, PA 19104
MedicalResearch.com: What are the main findings of the study?Dr. Bushman: Viral populations in the human gut are huge, and some of the viruses change rapidly over time.
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MedicalResearch.com Interview with Edna B. Foa, PhDDepartment of Psychiatry, University of Pennsylvania, Philadelphia
MedicalResearch.com: What are the main findings of the study?Dr. Foa:Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment. Six months after treatment discontinuation, participants who received prolonged exposure therapy for PTSD drank less than those who did not receive prolonged exposure. Participants who received a combined treatment of prolonged exposure and naltrexone had the lowest drinking level after six-month treatment discontinuation. The main message of the study is that simultaneous treatment of alcohol dependence and PTSD yield superior outcome than each treatment alone. Importantly, the findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators. In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts that common view that trauma-focuses therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use. (more…)
MedicalResearch.com Interview with:Carol S. North, MD, MPE
The Nancy and Ray L. Hunt Chair in Crisis Psychiatry
Director, Program in Trauma and Disaster,
VA North Texas Health Care System
4500 S. Lancaster Rd., Dallas, TX 75216
Professor of Psychiatry and Surgery/Division of Emergency Medicine
UT Southwestern Medical Center
6363 Forest Park Rd. Dallas, TX 75390-8828
MedicalResearch.com: What are the main findings of the study?Answer: In post-disaster settings, a systematic framework of case identification, triage, and mental health interventions can guide overall mental health response and should be integrated into emergency medicine and trauma care responses.
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MedicalResearch.com Interview with: Virender Rehan, MD
Professor of Pediatrics
Chief, Division of Neonatology
Director, Neonatal Intensive Care Unit
Director, Neonatal-Perinatal Fellowship Training Program
Co-Director Perinatal Research Center
Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA
Torrance, CA, 90502
MedicalResearch.com: What are the main findings of the study?Dr. Rehan: The main findings of the study include the likelihood of transmission of asthma to third generation offspring following maternal smoking during pregnancy even when child’s mother didn’t smoke. And these effects seem to be more profound in the upper airways of males compared to that in females.
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MedicalResearch.com Interview with: Dr. R.T. van Domburg
Clinical epidemiologist, Associate Professor
Erasmus Medical Center
Department of Cardiology Ba561
‘s-Gravendijkwal 230 3015 CE Rotterdam
MedicalResearch.com: What are the main findings of your study?Answer: We collected data from the first patients who underwent coronary angioplasty in the early 1980s and followed them for 25 to 30 years.
We found that patients who were able to quit smoking in the year following their PCI lived on average more than two years longer than those who continued to smoke.
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MedicalResearch.com Interview with:Bruce Y. Lee, MD MBA
Associate Professor of International Health
Director of Operations Research
International Vaccine Access Center (IVAC)
Johns Hopkins Bloomberg School of Public Health
855 N. Wolfe Street Suite 600
Baltimore, MD 21205
MedicalResearch.com: What are the main findings of the study?Dr. Lee: Vancomycin resistant enterococci (VRE) is every hospital’s problem. A VRE outbreak in one hospital, even if the hospital is relatively small or distant, can readily spread to other hospitals in a region because patients leaving one hospital often will go to other hospitals either directly or after an intervening stay at home. These patients can then carry VRE with them to other hospitals. Therefore, as long a single hospital has a problem with VRE or any other healthcare associated infection, all other hospitals are at risk. Conquering VRE then requires cooperation among hospitals.
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MedicalResearch.com Interview with Dr. Brian Haas MD
Department of Diagnostic Radiology,Yale University School of Medicine, New Haven, CT
MedicalResearch.com: What are the main findings of the study?Dr. Haas: We found that tomosynthesis helped to reduce the number of women who undergo a screening mammogram and are called back for additional imaging and testing. Specifically, the greatest reductions in patients being called back were seen in younger patients and those with dense breasts. Tomosynthesis is analogous to a 3D mammogram, and improves contrast of cancers against the background breast parenchyma.
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MedicalResearch.com Interview with: Xiaolu Yang, Ph.D.
Professor of Cancer Biology at the Perelman School of Medicine
University of Pennsylvania
and the Abramson Family Cancer Research Institute,
MedicalResearch.com: What are the main findings of the study?Dr. Yang: TAp73 is a structural homologue of the preeminent tumor suppressor p53, but its role in tumorigenesis has been unclear. In this study, we show that TAp73 supports the proliferation of tumor cells. Mechanistically, TAp73 activates the expression of glucose-6-phosphate dehydrogenase (G6PD), a rate-limiting enzyme in the pentose phosphate pathway. This function of TAp73 is required for maintaining a robust biosynthesis and anti-oxidant defense in tumor cells. These finding connects TAp73 to oncogenic growth and suggest that G6PD may be a valuable target for tumor therapy.
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MedicalResearch.com Interview with:
Jon C. Tilburt, MD, MPH
Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
Biomedical Ethics Program, Mayo Clinic
Knowledge & Evaluation Research Unit, Mayo Clinic
Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery
Division of Health Care Policy and Research, Mayo Clinic
What did you set out to find, what was your objective in this study?
We wanted to know physicians perceived roles and responsibilities in addressing health care costs as well as their enthusiasm for proposed strategies to contain health care spending.
Who did you study and what did you look at?
Practicing US physicians under age 65, we randomly selected 3900 physicians representing all specialties and mailed them an 8-page survey entitled “Physicians, Health Care Costs, and Society.” We received 2,556 completed surveys (65% response rate).
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MedicalResearch.com Interview with:Susan Matulevicius, MD, MSCS
Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
MedicalResearch.com: What are the main findings of the study?Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care.
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MedicalResearch.com Interview with Dr. Vinay Prasad, MD
Medical Oncology Branch, National Cancer Institute
National Institutes of Health, 10 Center Dr 10/12N226, Bethesda, MD20892.
MedicalResearch.com: What are the main findings of the study?Dr. Prasad:We reviewed all original articles in the New England Journal of Medicine over ten years. 1344 articles tested some medical practice-- which is a screening or diagnostic test, medication, procedure or surgery. Only 27% or 363 articles tested current medical practice. And of these articles 146 (40%) contradicted current standard of care, constituting a medical reversal.
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MedicalResearch.com Interview with: Ru-Rong Ji, PhD
Professor, Chief of Pain Research
Department of Anesthesiology and Neurobiology
Duke University Medical Center
Durham, NC 27710
Neuroprotectin/Protectin D1 protects neuropathic pain in mice after nerve trauma
MedicalResearch.com: What are the main findings of the study?Answer: We found the pro-resolution lipid mediator protectin D1 (PD1), derived from the fish oil DHA, can effectively prevent nerve injury-induced neuropathic pain. This treatment can also prevent nerve injury-induced neuroinflammation in the spinal cord (such as glial activation and expression of cytokines and chemokines, e.g., IL-1b, CCL2). These cytokines and chemokines are known to elicit pain.
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MedicalResearch.com Interview with: Nisa M. Maruthur, MD, MHS
Assistant Professor of Medicine & Epidemiology
The Johns Hopkins University
Early Response to Preventive Strategies in the Diabetes Prevention Program
MedicalResearch.com: What are the main findings of the study?Dr. Maruther: For patients engaged in a lifestyle intervention to prevent diabetes, weight loss early on (at 6 months) is an extremely strong predictor of whether they will develop diabetes down the road. Even in the setting of substantial weight loss (>10%) at 6 months, it is still beneficial to lower fasting glucose. These results are unique in that we previously understood that weight loss over time (years) is important to prevent diabetes, but now we know the impact of early weight loss on longer-term diabetes risk.
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MedicalResearch.com Interview with: Ru-Rong Ji, PhD
Professor, Chief of Pain Research
Department of Anesthesiology and Neurobiology
Duke University Medical Center
Box DUMC 3094, Durham , NC 27710
MedicalResearch.com: What are the main findings of the study?Answer: We found the pro-resolution lipid mediator protectin D1 (PD1), derived from the fish oil DHA, can effectively prevent nerve injury-induced neuropathic pain. This treatment can also prevent nerve injury-induced neuroinflammation in the spinal cord (such as glial activation and expression of cytokines and chemokines, e.g., IL-1b, CCL2). These cytokines and chemokines are known to elicit pain.
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MedicalResearch.com Interview with Dr. Frank Sellke, MD
Chief of cardiothoracic surgery and co-director of the Cardiovascular Institute at Rhode Island, The Miriam and Newport hospitals
MedicalResearch.com: What are the main findings of the study?Dr. Sellke: The main findings of the study are that outcomes of repair of an ascending aortic dissection are improved under a full moon compared to other phases of the moon. This was with regard to both mortality and length of hospital stay. Interestingly, there was no correlation with season of the year.
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MedicalResearch.com Interview with:
S. Yousuf Zafar, MD, MHS
Assistant Professor of Medicine
Duke Cancer Institute
twitter: @yzafar
MedicalResearch.com: What are the main findings of the study?
Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan.
(more…)
