Antibiotic Failure in Community Acquired Pneumonia Surprisingly Common

MedicalResearch.com Interview with:

Dr. James A. McKinnell, MD LA BioMed Assistant Professor of Medicine David Geffen School of Medicine at UCLA

Dr. McKinnell

Dr. James A. McKinnell, MD
LA BioMed
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA

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

Response: Pneumonia is the leading cause of death from infectious disease in the United States. We conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society America, published in 2007, provide some direction about prescribing antibiotics for community-acquired pneumonia. But large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure. Antibiotic failure for community-acquired pneumonia is associated with substantial morbidity and mortality and results in significant medical expenditures.

We examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia. We defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.

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Brain Triggers For Eating Differ in Obese Men vs Women

MedicalResearch.com Interview with:

Arpana Gupta, Ph.D. Assistant Professor G. Oppenheimer Center for Neurobiology of Stress and Resilience Ingestive Behavior and Obesity Program Vatche and Tamar Manoukin Division of Digestive Diseases David Geffen School of Medicine, UCLA

Dr. Gupta

Arpana Gupta, Ph.D.
Assistant Professor
G. Oppenheimer Center for Neurobiology of Stress and Resilience
Ingestive Behavior and Obesity Program
Vatche and Tamar Manoukin Division of Digestive Diseases
David Geffen School of Medicine, UCLA

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

Response: Past studies have demonstrated how an imbalance in the processing of rewarding and salient stimuli results in maladaptive or excessive eating behaviors. However, stress and drug use are known to affect how sex and sex hormones modulate responses of the dopamine system involved in reward, and are thought to underlie sex differences in the pathophysiology of drug addiction and treatment response. These results suggest similar sex effects on the mesolimbic reward system may also be at play in obesity.

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Restrictions on Pharmaceutical Detailing Linked To Increase in Generic Drug Prescription

MedicalResearch.com Interview with:

Ian Larkin, PhD</strong> Assistant Professor of Strategy UCLA Anderson School of Management

Dr. Ian Larkin

Ian Larkin, PhD
Assistant Professor of Strategy
UCLA Anderson School of Management

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

Response: The study examined whether restrictions put in by medical centers on salesperson visits to physicians, known as “detailing,” affected subsequent physician prescribing behavior. Detailing represents the most prominent form of pharmaceutical marketing. Detailing visits allow the sharing of scientific information, but they also often involve small gifts for physicians and their staff, such as meals.

Pharmaceutical companies incur far greater expenditures on detailing visits than they do on direct-to-consumer marketing, or even on research and development of new drugs. Specifically, the study examined detailing restrictions put into place by 19 academic medical centers (AMCs) in five states in the U.S. It compared changes in prescribing by thousands of AMC physicians whose practices limited typical elements of detailing visits, such as provisions of meals and educational gifts, to a carefully matched control group of similar physicians practicing in the same geographic regions but not subject to such detailing restrictions.

The study, which included more than 25,000 physicians and all 262 drugs in eight major drug classes — from statins to sleep aids to antidepressants, representing more than $60 billion in aggregate sales in the United States — was, to date, by far the most comprehensive to examine the impact of detailing restrictions. The comprehensive and quasi-experimental methodology, which compared prescribing behavior before and after implementation of policies, and which included a large matched control group of physicians not subject to policy changes, was an important innovation relative to prior research. The study used prescription data from CVS Caremark, one of the largest pharmacy benefit managers in the United States.

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Hospital Based Primary Care Practices Provide More Low Value Services

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Natural Scientist in Health Policy RAND Corporation 1776 Main St, Santa Monica, CA 90401

Dr. John Mafi

John N. Mafi, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine and Health Services Research
UCLA David Geffen School of Medicine
Los Angeles, CA 90024
Affiliated Natural Scientist in Health Policy
RAND Corporation
1776 Main St, Santa Monica, CA 90401

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

Response: Between 10-30% of healthcare costs are due to low value care, or patient care that provides little to no benefit to patients, and can sometimes cause harm (e.g., radiation exposure from diagnostic imaging tests). In this study, we found that hospital-based primary care practice provide more low value care than community-based primary care practices across the United States. Understanding where and why low value care occurs is going to be essential if we want to get serious about eliminating it.

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Thyroid Hormone Medication Should Not Be Taken With Cow’s Milk

MedicalResearch.com Interview with:
Deborah Chon MD
Endocrinology fellow
UCLA David Geffen School of Medicine 

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

Response: Our study shows that drinking cow’s milk concurrently with oral levothyroxine significantly reduces the absorption of the medication.

Levothyroxine is used for the physiologic replacement of thyroid hormone in patients with hypothyroidism and for serum TSH suppression in patients with thyroid cancer. It is the mostly commonly prescribed medication in the United States as of 2014. Frequent dose adjustments of levothyroxine have been shown to be a costly burden to the national healthcare system.

Previous studies have shown that certain foods and medication, such as calcium supplements, can interfere with levothyroxine absorption. However, this is the first study to demonstrate that ingesting cow?s milk, a common breakfast staple, affects oral levothyroxine absorption.

To determine the possible effect of cow’s milk ingestion, we measured levothyroxine absorption in humans with and without concurrent milk consumption. Pharmacokinetic studies were conducted in healthy adults without allergies to milk or levothyroxine, and who were not pregnant nor using oral contraceptives. All subjects had no history of known thyroid disease and normal thyroid hormone function at baseline. Following an overnight fast, serum total thyroxine T4 (TT4) concentrations were measured at baseline and at 1, 2, 4, and 6 hours after ingestion of 1,000 ?g of oral levothyroxine alone or when co-administered with 12 oz. of milk (2% fat). There was a four-week washout period between the two study visits.

Ten subjects (mean age 33.7?10.2 years, 60% male) completed the study. The serum total T4 absorption over six hours, calculated as area under the curve (AUC), was significantly lower when taking cow?s milk concurrently with levothyroxine compared levothyroxine alone (mean?SD: 67.26?12.13 vs. 73.48?16.96; p = 0.02). Also, peak serum TT4 concentrations were significantly lower in those who ingested levothyroxine concurrently with milk, compared to taking levothyroxine alone (p=0.04).
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Curcumin Gel May Speed Healing of Scalds and Burns

MedicalResearch.com Interview with:

Madalene Heng MD, FRACP, FACD, FAAD</strong> Professor of Medicine/Dermatology UCLA School of Medicine

Dr. Madalene Heng

Madalene Heng MD, FRACP, FACD, FAAD
Professor of Medicine/Dermatology
UCLA School of Medicine

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

Response: Curcumin, the active ingredient in the spice, turmeric, is an excellent anti-inflammatory agent with unique healing properties.

However, this is only observed with our preparation of topical curcumin but not with oral curcumin. This is because curcumin is not absorbed and does not cross cell membranes – low bioavailability.

The biochemical basis for the efficacy of topical curcumin is based on the fact that it is a phosphorylase kinase inhibitor. Phosphorylase kinase is an enzyme released by injured tissue 5 mins following injury, and is responsible for activating the transcription activator (NF-kB), resulting in turning on over 200 genes responsible for inflammation, and scarring among others, resulting in redness, swelling, pain, and eventually scarring. By blocking phosphorylase kinase activity early in the injury pathway, topical curcumin (curcumin gel) results in rapid healing with minimal or no scarring following many types of healing, including burns and scalds. The unique healing properties are also due to the fact that curcumin induces cell death (apoptosis) to damaged cells, resulting in the “space” for replacement by new healthy cells, resulting in normal appearing skin following burns and scalds.

The salutary result depends on when the curcumin gel is applied – the earlier the better. We observed that when curcumin gel was applied within 4 days to second degree burns- hourly applications, tapering after the patient is improved – we observed rapid healing within 5 days, with the skin returning to normal within 6 weeks to 2 months without redness or visible scarring. Minor burns and scalds heal even more rapidly. Pain was improved within hours.

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

Response: If the readers happen to have curcumin gel (Psoria-Gold) in their first aid kit, they should apply curcumin gel multiple times as soon as possible. Within the first hour, they should apply it every 5-10 mins, tapering off when the pain and swelling is improved. If they do this, it is possible that blistering may be aborted. The scarring is also minimal. The curcumin gel should be applied twice daily until the skin returns to normal (no redness, swelling, pigmentation etc) and no visible scarring is seen.

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Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine, Ronald Reagan UCLA Medical Center Los Angeles, CA

Dr. John N. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA

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

Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.

We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.

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Only a Quarter of Medical Grand Round Speakers Are Women

MedicalResearch.com Interview with:
Julie R. Boiko, MD, MS
Resident Physician, PGY1
Department of Pediatrics
University of California, San Francisco

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

Response: Grand rounds is an over 100-year-old tradition in US medical school clinical departments of recurring, expert-delivered lectures to update physicians and physicians-in-training on recent advances in relevant medicine. We wanted to determine whether gender representation of speakers at grand rounds aligns with the gender distribution of people typically represented in grand rounds audiences — faculty, residents, and medical students — by clinical specialty according to national academic medical trainee and workforce statistics.

We chose to focus on grand rounds speakers as visible representations of women in academic medicine. This is important because, despite women and men entering medicine at comparable rates, women are much more likely to depart academic medical careers. As current and recent medical students, we considered that consistent exposure to successful female role models in grand rounds speaking venues may positively reinforce women trainees’ desires to continue in academic medical careers.

We found that the people at the podiums do not resemble the people in the audience. Only 26% of grand rounds speakers are women. Even accounting that some clinical specialties contain few women faculty and residents, grand rounds speakers in most specialties we studied were statistically less likely to be women as compared to faculty and residents. Across the specialties, grand rounds speakers are 44% less likely than medical students, 39% less likely than residents, and 21% less likely than faculty to be women.

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Testosterone Improves Anemia and Bone Strength, Worsens Coronary Plaque and Has No Effect on Memory

MedicalResearch.com Interview with:

Ronald S. Swerdloff, MD Chief of the Division of Endocrinology, Department of Medicine and Director of a World Health Organization Collaborative Center in Reproduction a Mellon Foundation Center for Contraceptive Development and a NIH Contraceptive Clinical Trial Center Director of the Harbor-UCLA Reproductive Program LA BioMed Lead Researcher David Geffen School of Medicine UCLA Health

Dr. Ronald Swerdloff

Ronald S. Swerdloff, MD
Chief of the Division of Endocrinology, Department of Medicine and
Director of a World Health Organization Collaborative Center in Reproduction
a Mellon Foundation Center for Contraceptive Development and a
NIH Contraceptive Clinical Trial Center
Director of the Harbor-UCLA Reproductive Program
LA BioMed Lead Researcher
David Geffen School of Medicine
UCLA Health

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

Response: While we have long known that testosterone levels decrease as men age, very little was known about the effects of testosterone treatment in older men with low testosterone until last year.

Our team of researchers from LA BioMed and 12 other medical centers in the U.S., in partnership with the National Institute on Aging, conducted a coordinated group of seven trials known as The Testosterone Trials (TTrials). We studied the effects of testosterone treatment for one year as compared to placebo for men 65 and older with low testosterone. The TTrials are now the largest trials to examine the efficacy of testosterone treatment in men 65 and older whose testosterone levels are low due seemingly to age alone.

The first published research from the TTrials last year reported on some of the benefits to testosterone treatment. We have now published four additional studies in the Journal of the American Medical Association (JAMA) and JAMA Internal Medicine that found additional benefits and one potential drawback.

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E-Cigs Linked To Adverse Cardiac Effects

MedicalResearch.com Interview with:

Holly R. Middlekauff, MD Professor UCLA Division of Cardiology David Geffen School of Medicine UCLA

Dr. Holly Middlekauff

Holly R. Middlekauff, MD
Professor
UCLA Division of Cardiology
David Geffen School of Medicine
UCLA

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

Response: E-cigarettes are the fastest rising tobacco product in the US today, but almost nothing is known about their cardiovascular effects. Rather than wait decades for epidemiological data in e-cigarette users to become available, we reasoned that investigations into the known mechanisms by which tobacco cigarettes increase heart disease would provide insights into the health risks of e-cigarettes.

We focused on 2 critical mechanisms:
1) cardiac adrenaline activity, and
2) oxidative stress, measured in chronic e-cigarrete users compared to matched, healthy controls.

The major findings were that, compared to healthy controls, e-cig users had increased cardiac adrenaline activity (measured by a technique called “heart rate variability”). Furthermore, compared to healthy controls, the e-cig users had increased susceptibility to oxidative stress.

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More Than Moderate Alcohol Not Good For The Heart

MedicalResearch.com Interview with:

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco

Dr. Gregory M Marcus

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS
Director of Clinical Research
Division of Cardiology
Endowed Professor of Atrial Fibrillation Research
University of California, San Francisco

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

Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption.

In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships.
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Patients Who Understand Their Medical Condition Less Likely To Opt For Aggressive Care

MedicalResearch.com Interview with:

Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California

Dr. Joseph A. Ladapo

Joseph A. Ladapo, MD, PhD
David Geffen School of Medicine at UCLA
Department of Medicine, Division of General Internal Medicine and Health Services Research
Los Angeles, California

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

Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive.

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