Author Interviews, Endocrinology, JAMA, Radiology, Surgical Research, UCSF / 28.07.2015

Quan-Yang Duh MD Endocrine surgeon UCSF Medical CenterMedicalResearch.com Interview with: Quan-Yang Duh MD Chief, Section of Endocrine Surgery UCSF Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Quan-Yang Duh: At UCSF we have a monthly Adrenal Conference (involving surgeons, endocrinologists and radiologists) to discuss patients we are consulted for adrenal tumors. About 30% of these are for incidentally discovered adrenal tumors (versus those found because of specific indications such as clinical suspicion or genetic screening). Of these 15-20% has bilateral adrenal tumors. The evaluation of unilateral incidentaloma has been very well studied and many national guidelines have been published with specific management recommendations. So during our monthly adrenal conference, we have a routine "script" for evaluation and recommendations (rule out metastasis by looking for primary cancer elsewhere, rule out pheochromocytoma and Cushing, resect secreting tumors or large tumors, and if no operation recommended repeat scan in 6 months, etc.). This “script” has worked very well for patients with unilateral incidentaloma. However, we were less certain when we made recommendations about bilateral incidentalomas because there was very little literature or guidelines written about it. We had some gut feelings, but we were not sure that we were recommending the right things. We needed more data. That was the main reason for the study. What we found in our study was that although the possible subclinical diseases were the same – hypercortisolism and pheochromocytoma, the probabilities were different. The patients with bilateral incidentalomas were more likely to have subclinical Cushing’s and less likely to have pheochromocytomas than those with unilateral incidentalomas. (more…)
Author Interviews, Education, Electronic Records, PLoS, UCSF / 17.07.2015

Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of MedicineMedicalResearch.com Interview with: Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs).  This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider.  Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now.  Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits.  Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients.  Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations. However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites.  There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites.  There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency.  Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access. (more…)
Author Interviews, Surgical Research, UCSF, Weight Research / 22.06.2015

MedicalResearch.com Interview with: Leslee L. Subak, MD University of California, San Francisco Professor, Departments of Obstetrics, Gynecology & Reproductive Sciences, Urology and Epidemiology & Biostatistics Chief of Gynecology, SF Veterans Affairs Medical Center UCSF Women's Health Clinical Research Center MedicalResearch: What is the background for this study? What are the main findings? Dr. Subak: Urinary incontinence is very common, affecting an estimated 30 million adults in the U.S., and may account for as much as $60 billion in annual medical costs. Incontinence can cause significant distress, limitations in daily functioning, and reduced quality of life. Obesity is an important risk factor, with each 5-unit increase in body mass index – a ratio of someone’s weight divided by the square of their height – above normal weight associated with far higher rates of incontinence.   The prevalence of incontinence has been reported to be as high as 70 percent among severely obese women, and 24 percent among severely obese men (BMI greater than 40, or more than about 100 pounds greater than ideal body weight). Since obesity is a risk factor for incontinence, several studies have examined whether weight loss is a treatment for incontinence among obese people with the condition.  Clinical trials have shown the low calorie diets, behavioral weight reduction, and bariatric surgery are associated with improvement in incontinence in obese women and men through one year, but evidence on the durability of this effect is lacking. We performed this study to examine changes in urinary incontinence and identify factors associated with improvement among women and men in the first 3 years following bariatric surgery. This study included 1987women and men in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study performed at 10 hospitals at 6 clinical centers in the U.S. who underwent bariatric surgery between 2005 and 2009.  The study participants ranged in age from 18 to 78 years old – the median age was 47. The analysis controlled for factors such as age, race, smoking status and recent pregnancy.  Nearly 79 percent of the participants in the study were women with 49% reporting at least weekly incontinence, compared with 2% of men reporting incontinence. Following surgery and large weight loss of 29% for women and 26% for men, substantial improvements in incontinence were observed, with a majority of women and men achieving remission at 3 years post-surgery. The more weight lost, the higher the chances of improvement. While the risk of relapse rose with each gain of about 10 pounds, overall there was substantial improvement for both women and men. People who were older, had severe walking limitations or were recently pregnant showed less improvement. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, Surgical Research, UCSF / 10.06.2015

MedicalResearch.com Interview with: Susan Ming Lee, MD, FRCPC, MAS (Clinical Research) Clinical Instructor, Dept. of Anesthesia and Perioperative Care University of California, San Francisco Medical Research: What are the main findings? Dr. Lee: Angiotensin receptor blockers (often referred to as ARBs) are common medications used to treat high blood pressure, heart disease, and kidney disease.  Doctors sometimes stop these medications briefly around the time of surgery, since they are known to cause low blood pressure under general anesthesia.  Doctors may hesitate to restart ARBs after surgery because they are worried about low blood pressure or kidney function.  Prior to our research, there was little information to guide the optimal timing of restarting ARBs after surgery. Medical Research: What are the main findings? Dr. Lee: Our study of over 30,000 veterans shows that nearly one third of veterans admitted to hospital for non-cardiac surgery are not restarted on their usual ARBs within two days of their operation.  This delay in resuming ARBs is associated with increased death rates in the first month after surgery.  In fact, even accounting for factors that might contribute to why doctors would withhold ARB (such as low blood pressure, kidney dysfunction, or other comorbidities), 30-day postoperative mortality was increased approximately 50% in those without resumption of ARBs, and this effect was even greater in younger patients under age 60.  Our findings of reduced rates of infections, pneumonia, heart failure, and kidney failure in those that resumed ARBs soon after surgery suggest that early resumption may also reduce complications after surgery. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Medical Imaging, UCSF / 20.05.2015

Rik Ossenkoppele PhD. Postdoctoral researcher UCSF Memory and Aging CenterMedicalResearch.com Interview with: Rik Ossenkoppele PhD. Postdoctoral researcher UCSF Memory and Aging Center MedicalResearch: What is the background for this study? Dr. Ossenkoppele: Since 2004, several PET tracers have been developed that measure fibrillar amyloid-β plaques, a neuropathological hallmark of Alzheimer’s disease (AD). Through visual assessment by a nuclear medicine physician or quantitative cut-points, the presence or absence of amyloid-β pathology can be determined in the living human brain. The FDA, in support of the clinical application of amyloid imaging, has recently approved three of these PET tracers. A proportion of patients with other types of dementia then Alzheimer’s disease that harbor cerebral amyloid-β pathology, however, potentially limits the clinical utility of amyloid imaging. When ordering clinical amyloid PET scans and correctly interpreting the significance of amyloid PET results, clinicians need to understand the prevalence of amyloid-positivity across different types of dementia. It is also important to be aware of the relationships of amyloid-positivity prevalence and demographic (e.g. age and sex), cognitive and genetic (e.g. presence of the AD-risk allele apolipoprotein E [APOE] ε4) factors. Most amyloid PET studies to date come from single centers with modest sample sizes. We therefore conducted a meta-analysis with individual participant data from 29 cohorts worldwide, including 1359 patients with clinically diagnosed Alzheimer’s disease and 538 patients with non-AD dementia. We also included 1849 healthy controls with amyloid PET data, and an independent sample of 1369 AD patients with autopsy data from the NACC database. MedicalResearch: What are the main findings? Dr. Ossenkoppele: In patients clinically diagnosed with Alzheimer’s disease, the prevalence of amyloid-positivity decreased from 93% at age 50 to 79% at age 90. The drop in amyloid-positivity was most prominent in older Alzheimer’s disease patients who did not carry an APOE ε4 allele (~1/3 of these patients had a negative amyloid PET scan). This most likely reflects a mix of 1) clinical misdiagnoses (i.e. non-AD pathology causing an AD phenotype), 2) false negative PET scans (i.e. abundance of cerebral amyloid pathology that is not detected by PET), and 3) possibly elder patients need less amyloid pathology (sub-threshold levels for PET) to reach the stage of dementia due to age-related reductions in cognitive resilience (“cognitive reserve theory”) or simultaneous presence of multiple pathologies (“double-hit theory”). The relatively high rate of amyloid-negative Alzheimer’s disease patients highlights the necessity of biomarker-informed patient selection for Alzheimer’s disease clinical trials. In most patients clinically diagnosed with non-AD, the prevalence of amyloid-positivity increased with aging and was ~18% higher in APOE ε4 carriers. Presence of amyloid pathology in non-AD dementia may reflect 1) clinical misdiagnosis (i.e. AD pathology is the causative pathology), or 2) comorbid pathologies, where amyloid may be secondary to other pathologies that are actually driving the clinical presentation. Interestingly, patients with a clinical diagnosis of non-AD dementia who harbored cerebral amyloid pathology showed lower Mini-Mental State Examination scores (measure of global cognition), suggesting that amyloid-β is not just an innocent bystander. (more…)
Author Interviews, Biomarkers, UCSF / 10.05.2015

Alan H.B. Wu, PhD, DABCC Professor Laboratory Medicine Chief, Clinical Chemistry Laboratory University of California San Francisco, CAMedicalResearch.com Interview with: Alan H.B. Wu, PhD, DABCC Professor Laboratory Medicine Chief, Clinical Chemistry Laboratory University of California San Francisco, CA Medical Research: What is the background for this study? What are the main findings? Response: Clinical trials are conducted for validation of novel biomarkers.  There is considerable heterogeniety in the quality design and documentation of findings. This can have a major impact on the conclusions rendered. (more…)
Author Interviews, Cost of Health Care, NEJM, Ophthalmology, UCSF / 16.04.2015

Catherine L. Chen M.D., M.P.H. UCSF Dept of AnesthesiaMedicalResearch.com Interview with: Catherine L. Chen M.D., M.P.H. UCSF Dept of Anesthesia Medical Research: What is the background for this study? What are the main findings? Dr. Chen: Cataract surgery is a very common and safe surgery that most older adults have in their 70's or 80's. It usually happens as a same-day surgery and most patients only need eye drops to numb the eye with little or no intravenous sedation for a procedure that on average is only 18 minutes long. Given their age, these patients typically have other concurrent medical problems, so even though multiple research studies and professional societies have concluded that routine preoperative testing is not necessary before cataract surgery, we found that this testing still frequently occurs in these patients. More than half of the patients in our study had at least one preoperative test performed in the month before their surgery. We hypothesized prior to undertaking this study that the older and sicker patients were the ones who were most likely to get preoperative testing. Instead, what we found was that the most important factor that determined whether or not a patient got tested was the ophthalmologist who operated on the patient. This is an important finding because it shows that most patients are not getting extra testing, but the few that do are getting testing because that's the way their ophthalmologist typically prepares his patients for surgery. Most of the time, this testing is not needed and will not affect how well the patient does during and after surgery. (more…)
Author Interviews, JAMA, Surgical Research, UCSF / 07.04.2015

Emily Finlayson, MD, MS Department of Surgery, Division of General Surgery Department of Medicine, Division of Geriatrics Philip R Lee Institute for Health Policy University of California, San Francisco Director, UCSF Center for Surgery in Older AdultsMedicalResearch.com Interview with: Emily Finlayson, MD, MS Department of Surgery, Division of General Surgery Department of Medicine, Division of Geriatrics Philip R Lee Institute for Health Policy University of California, San Francisco Director, UCSF Center for Surgery in Older Adults Medical Research: What is the background for this study? What are the main findings? Dr. Finlayson: In general, the goal of lower extremity revascularization is to preserve the leg so that patients can maintain the ability to ambulate and maintain functional independence.  We evaluated the results of this operation in older nursing home residents in the United States.  We found that over the 3 year study period, over 10,000 nursing home residents underwent this procedure.  Most of them were functionally dependent before surgery, 3/4 were unable to walk, and over half had dementia. After 1 year, half of the residents had died.  Among residents who could not walk before surgery, 89% were dead or non ambulatory 1 year after surgery. (more…)
Author Interviews, Cancer Research, UCSF / 03.04.2015

Trevor G. Bivona MD PhD Assistant Professor, Hematology and Oncology UCSFMedicalResearch.com Interview with: Trever G. Bivona MD PhD Assistant Professor, Hematology and Oncology UCSF Medical Research: What is the background for this study? What are the main findings? Dr. Bivona: Resistance to targeted cancer therapy remains a problem in the treatment of cancer patients.  These targeted drugs are often effective at shrinking the tumor, but do so incompletely.  This incomplete response results in residual disease that is drug resistant and eventually grows to cause relapse that is lethal in patients.  We investigated the mechanisms underlying this residual disease state in lung cancers treated with the EGFR targeted therapy Tarceva.  We discovered that the tumor cells survival initial EGFR targeted therapy treatment by activating a signaling pathway called NF-kappa B.  This NF-kappa B pathway then promotes tumor cell survival, residual disease, and eventual relapse in the lung cancer models we studied. (more…)
Author Interviews, JAMA, Melanoma, Technology, UCSF / 01.04.2015

Maria L. Wei, M.D., Ph.D. Associate Professor of Dermatology Director, Melanoma Surveillance Clinic Multidisciplinary Melanoma Program University of California, San Francisco Staff Physician Veterans Affairs Medical Center, San FranciscoMedicalResearch.com Interview with: Maria L. Wei, M.D., Ph.D. Associate Professor of Dermatology Director, Melanoma Surveillance Clinic Multidisciplinary Melanoma Program University of California, San Francisco Staff Physician Veterans Affairs Medical Center, San Francisco Medical Research: What is the background for this study? Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
Author Interviews, JAMA, Mental Health Research, UCSF / 12.02.2015

Carol Mathews UCSF Professor, Psychiatry UCSF School of MedicineMedicalResearch.com Interview with: Carol Mathews Professor, Psychiatry UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Mathews: The background for this study is that, as a part of ongoing genetic studies of Tourette Syndrome, the Tourette Syndrome Association International Genetics Collaborative (TSAICG) has collected a wealth of information about commonly co-occurring psychiatric disorders in individuals with Tourette Syndrome and their families, providing us with an opportunity to explore questions about Tourette Syndrome that are relevant to individuals with Tourette Syndrome, their families, and their treating clinicians. (more…)
Author Interviews, Mental Health Research, UCSF / 09.02.2015

Ezequiel Morsella, Ph.D. Associate Professor of Neuroscience Department of Psychology San Francisco State University Assistant Adjunct Professor Department of Neurology University of California, San Francisco Boardmember, Scientific Advisory Board Institute of Cognitive Neurology (INECO), Buenos AiresMedicalResearch.com Interview with: Ezequiel Morsella, Ph.D. Associate Professor of Neuroscience Department of Psychology San Francisco State University Assistant Adjunct Professor Department of Neurology University of California, San Francisco Boardmember, Scientific Advisory Board Institute of Cognitive Neurology (INECO), Buenos Aires Medical Research: What is the background for this study? What are the main findings? Dr. Morsella: Previous studies have demonstrated that, under certain experimental conditions, conscious processes in the brain can function in a way that resembles reflexes.  In past research, a single ‘high-level’ thought (e.g., the name of a visually-presented object) was triggered involuntarily by external stimuli. The current research is the first to trigger, not one, but two high-level unintentional conscious thoughts. In this experiment, participants were presented with an object (e.g., the picture of a star) and instructed to not subvocalize (i.e., name in one’s head but not aloud) the name of the object nor count the number of letters comprising the name of the object.  On many trials, participants experienced both cognitions (e.g., “STAR” and “4”), even though these thoughts were against the intentions of the participant. Thus, this is the first demonstration of external control of two thoughts in the stream of consciousness. This research is based in part on the pioneering investigations of Wegner, of Gollwitzer, and of Ach. (more…)
Author Interviews, JAMA, Pediatrics, UCSF / 06.01.2015

Yvonne Wu MD Professor of Clinical Neurology and Pediatrics UCSF School of MedicineMedicalResearch.com Interview with: Yvonne Wu MD Professor of Clinical Neurology and Pediatrics UCSF School of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Wu: Newborn infants commonly have elevated bilirubin levels, manifested as jaundice, because the body's mechanisms for breaking down bilirubin have not yet fully matured.  Although high bilirubin levels are almost always well tolerated, extremely high bilirubin levels may lead to brain injury, or kernicterus, which in turn can cause a very severe form of cerebral palsy.  When bilirubin levels are extremely high, or when bilirubin levels remain high despite phototherapy, it is recommended that an exchange transfusion be performed to prevent brain injury and cerebral palsy.  The American Academy of Pediatrics (AAP) has published recommendations on when an exchange transfusion should be performed, based on bilirubin level, age of infant and other clinical factors.  However, no previous study had examined the actual risk of cerebral palsy in infants whose bilirubin levels exceeded the exchange transfusion thresholds. Among 500,000 newborns born at Kaiser Permanente Northern California over a 17-year period, we found 1833 who had at least one bilirubin level above the AAP exchange transfusion level.  There were only 3 cases of cerebral palsy due to kernicterus in this group, even though only 42 (2.3%) of them had received exchange transfusions.  All 3 infants had bilirubin levels at least 5 mg/dL above the AAP exchange transfusion threshold and all 3 infants had 2 or more other risk factors for brain damage, including prematurity, sepsis, hypoxia and the hereditary blood disorder G6PD deficiency.  We did not identify any cases of kernicterus among otherwise well term babies, even at bilirubin levels that exceeded the AAP exchange transfusion threshold. (more…)
Author Interviews, JAMA, Mental Health Research, UCSF / 06.01.2015

Dr. Georges Naasan MD Neurologist, Clinical Instructor UCSF Memory and Aging CenterMedicalResearch.com Interview with: Dr. Georges Naasan MD Neurologist, Clinical Instructor UCSF Memory and Aging Center Medical Research: What is the background for this study? What are the main findings? Dr. Naasan: Degenerative diseases of the brain can lead to dysfunction in judgment, emotional processing, social decorum and self-awareness. In turn, such dysfunctions may result in criminal behavior that appears for the first time in middle-aged adults or even later in life. We studied 2397 patients from the Memory and Aging Center at UCSF and found 204 (8.5%) that had a criminal behavior as part of their illness. The large majority of these patients were patients with a specific type of neurodegenerative disease called behavioral variant of frontotemporal dementia, followed by a group of people with a disease called semantic variant of primary progressive aphasia. People with Alzheimer's disease, a disease that does not usually interrupt the functions mentioned above, were the least likely to exhibit criminal behavior. The common manifestation of criminal behaviors in people with the behavioral variant frontotemporal dementia included theft, sexual advances trespassing and public urination in contrast to people with Alzheimer's disease who, when such behaviors were present, primarily committed traffic violations often secondary to cognitive impairment. (more…)
Author Interviews, Dermatology, JAMA, Melanoma, Occupational Health, UCSF / 18.12.2014

Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San FranciscoMedicalResearch.com Interview with: Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San Francisco Medical Research: What is the background for this study? Dr. Sanlorenzo: We recently performed a meta-analysis and found an increased risk of melanoma in pilots and cabin crew. One of the possible occupational hazards responsible for this risk is UV radiation. Medical Research: What are the main findings? Dr. Sanlorenzo: We performed UV measurements in airplane cockpits during flight and we found that windshields blocked UV-B but allowed UV-A transmission. We compared the UV-A dose in airplanes with the UV-A dose in tanning beds, whose use is a known risk factor for melanoma. Pilots flying for 56.6 minutes at 30,000 feet received the same amount of UV-A carcinogenic effective radiation of a 20-minute tanning beds session. (more…)
Author Interviews, Outcomes & Safety, PLoS, UCSF / 06.12.2014

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610MedicalResearch.com Interview with: Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco

MedicalResearch: What is the background for this study? What are the main findings? Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms. (more…)
Breast Cancer, UCSF / 04.12.2014

Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA 94115MedicalResearch.com Interview with: Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA  94115 MedicalResearch: What is the background for this study? What are the main findings? Dr. Price: Screening mammography recommendations for the 40 - 49 age group is very controversial. 2009 USPTF guidelines emphasized taking patient context into account when making decisions for these young women. Recent publications have suggested risk-based screening strategies.  Family history and breast density are important are easily accessible risk factors. Had we been using this risk-based approach to screening mammography at our institution, we would have missed more than 3Ž4 of the screen detected breast cancers in the 40-49 age group, thereby foregoing most of the survival benefit from screening mammography. (more…)
Author Interviews, OBGYNE, Race/Ethnic Diversity, UCSF / 12.11.2014

Paula Braveman, MD, MPH Director, Center on Social Disparities in Health Professor, Family and Community Medicine University of California San Francisco San Francisco, CA 94118MedicalResearch.com Interview with: Paula Braveman, MD, MPH Director, Center on Social Disparities in Health Professor, Family and Community Medicine University of California San Francisco San Francisco, CA 94118 Medical Research: What are the main findings of the study? Dr. Braveman: There were a couple of striking findings from this study of preterm birth (PTB) among non-Latino White and Black women born in the U.S.. First, we found that women who were poor or socioeconomically disadvantaged in other ways (who had not or whose parents had not graduated from high school or who lived in neighborhoods (census tracts) with highly concentrated (25% or more of residents) poverty) had similarly high preterm birth rates.  In addition, we found that while preterm birth rates among White women consistently improved as their socioeconomic status (SES) improved, higher-SES Black women generally did no better –and sometimes did worse—than lower-SES Black women. (more…)
Author Interviews, Brain Injury, Cognitive Issues, JAMA, UCSF / 27.10.2014

Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San FranciscoMedicalResearch.com Interview with: Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San Francisco Medical Research: What are the main findings of the study? Dr. Gardner: We found that people who experience a  traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma. (more…)
Author Interviews, Outcomes & Safety, UCSF / 23.10.2014

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610 MedicalResearch.com: Interview Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610 Medical Research: What is the background for this study? Dr. Drew: Physiologic monitors used in hospital intensive care units (ICUs) are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue.” Alarm fatigue occurs when clinicians are desensitized by numerous alarms, many of which are false or clinically irrelevant. As a result, the cacophony of alarm sounds becomes “background noise” that is perceived as the normal working environment in the ICU. Importantly, alarms may be silenced at the central station without checking the patient or permanently disabled by clinicians who find the constant audible or textual messages bothersome. Disabling alarms creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. To date, there has not been a comprehensive investigation of the frequency, types, and accuracy of physiologic monitor alarms collected in a “real-world” ICU setting. For this reason, nurse and engineer scientists in the ECG Monitoring Research Laboratory at the University of California, San Francisco (UCSF) designed a study to provide complete data on monitor alarms. (more…)
Author Interviews, Melanoma, UCSF / 17.10.2014

Martina Sanlorenzo, MD Department of Dermatology Mt. Zion Cancer Research Bldg. San Francisco, CA 94143-0808MedicalResearch.com Interview with: Martina Sanlorenzo, MD Department of Dermatology Mt. Zion Cancer Research Bldg. San Francisco, CA 94143-0808 Medical Research: What are the main findings of the study? Dr. Sanlorenzo: In the treatment of BRAF mutant melanoma, the combination of BRAF inhibitor and MEK inhibitor has a better cutaneous safety profile compared with BRAF inhibitor monotherapy. Combination regimen shows fewer cutaneous adverse events and longer cutaneous adverse event-free interval. In particular, the development of squamous cell carcinoma or keratoacanthoma was significantly less frequent. (more…)
Author Interviews, JAMA, Lipids, UCSF / 15.10.2014

MedicalResearch.comInterview with: Mary Malloy, M.D. Co-director of the Adult Lipid Clinic and the director of the Pediatric Lipid Clinic UCSF Medical Center Medical Research: What are the main findings of the study? Dr. Malloy: We studied an individual whom we found to be homozygous for a rare loss of function mutation in apolipoprotein E. Because apolipoprotein E is necessary for clearance of lipoproteins from plasma, he has very high levels of cholesterol and triglycerides in blood, and unusual and very severe xanthomas. He had no evidence of neurocognitive or retinal defects. (more…)
Author Interviews, Kidney Stones, NEJM, Radiology, UCSF / 17.09.2014

Rebecca Smith-Bindman, MD Professor in the Departments of Radiology; Epidemiology and Biostatistics; and Obstetrics, Gynecology and Reproductive Medicine UCSF San Francisco Calif.MedicalResearch.com Interview with: Rebecca Smith-Bindman, MD Professor in the Departments of Radiology; Epidemiology and Biostatistics; and Obstetrics, Gynecology and Reproductive Medicine UCSF San Francisco Calif. Medical Research: What are the main findings of the study? Dr. Smith-Bindman: New technology is rapidly developed in medicine, and its important to understand how that technology should be used to improve patient health outcomes. Sometimes the technology is far better than existing technology and it should replace the earlier technology, and sometimes it is not and therefore should not be used. In this clinical scenario – I e. patients who present to an emergency department with abdomen or back pain thought to possibly reflect kidney stones, ultrasound is a simpler, less expensive , and more readily available test in the emergency department setting and therefore if it is equal to CT with respect to patient outcomes, it should be used as the first test in these patients. Currently, CT is the test widely used for patients with suspected kidney stones. We assessed a large number of patients with suspected kidney stones seen at one of 15 large academic emergency medicine departments across the country. Patients were assigned to point of care ultrasound performed by an ED physician, radiology ultrasound or radiology CT. We assessed a broad range of patient centered outcomes and found each of the three tests we studied were equivalent in terms of these outcomes including complications related to missed diagnoses, related serious adverse events, time spent in the emergency department and repeated ED visits and hospitalizations. However, the exposure to ionizing radiation was around half as high in patients who underwent ultrasound as their first test, and thus ultrasound should be used as the first imaging test in patients with suspected nephrolithiasis. (more…)
Author Interviews, JAMA, Pediatrics, Tobacco, UCSF / 12.03.2014

Lauren Dutra, ScD Postdoctoral Scholar, UCSF School of Medicine Cardiovascular Research Institute San Francisco, CA 94143MedicalResearch.com Interview with: Lauren Dutra, ScD Postdoctoral Scholar, UCSF School of Medicine Cardiovascular Research Institute San Francisco, CA 94143 MedicalResearch.com: What are the main findings of the study? Answer: Middle and high school students who used e-cigarettes were more likely to smoke tobacco cigarettes. They were also more likely to progress from experimenting with tobacco cigarettes to becoming regular smokers. Teen smokers who used e-cigarettes were more likely to be planning to quit in the next year and less likely to have abstained from smoking recently, compared to smokers who had never used e-cigarettes. They were also more likely to be heavier smokers (smoke more cigarettes per day) than those who had never tried e-cigarettes, that being said there are eliquids available that have no nicotine content whatsoever and these are therefore a much healthier option, you can see a wide variety of these at Gourmet E-Liquid. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, Heart Disease, UCSF / 25.02.2014

Dhruv S. Kazi, MD, MSc, MS Assistant Adjunct Professor Division of Cardiology San Francisco General Hospital Department of Medicine, and Department of Epidemiology and Biostatistics University of California San FranciscoMedicalResearch.com Interview with: Dhruv S. Kazi, MD, MSc, MS Assistant Adjunct Professor Division of Cardiology San Francisco General Hospital Department of Medicine, and Department of Epidemiology and Biostatistics University of California San Francisco MedicalResearch.com: What is the background of your study? Dr. Kazi: When we first asked the research question -what is the role of genotyping among patients receiving a stent for ACS, we quickly realized that there were no RCTs that had directly compared ticagrelor with prasugrel. But in our opinion, that was precisely the reason to build a model and systematically synthesize the available literature. There are nearly half a million PCIs for ACS in the US each year, and each time, the physician and patients have to examine the trade-offs between the various alternatives. What our model does is that it explicates the trade-offs - makes them transparent, and quantifies them.  So patients and physicians can make an informed decision on what is the optimal therapy for them. (more…)
Author Interviews, Compliance, Connective Tissue Disease, UCSF / 25.11.2013

Dr. Jinoos Yazdany MD, MPH Assistant Professor in Residence UCSF School of MedicineMedicalResearch.com Interview with: Dr. Jinoos Yazdany MD, MPH Assistant Professor in Residence UCSF School of Medicine MedicalResearch.com: What are the main findings of the study? Answer: For almost all of the drugs we examined, we found that less than half of patients adhered to treatment.  For some drugs, less than one-third of individuals were adherent. The average medication possession ratios were low across all drugs. We found that several factors played an important part in adherence.  Younger individuals were less likely to adhere to treatment for several drugs, and we also found racial/ethnic differences, with Black, Hispanic and Native populations having lower adherence.  We also found geographic variation in adherence, with individuals in the Northeast being the most likely to adhere to treatment. (more…)
Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF / 29.08.2013

MedicalResearch.com Interview with: Dr. Marc Jaffe, MD Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group Associate Clinical Professor of Medicine, UCSF Endocrinology and Internal Medicine Kaiser South San Francisco Medical Center 1200 El Camino Real South San Francisco, California 94080 MedicalResearch.com:    What are the main findings of the study? Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates. If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period. (more…)
Author Interviews, Mental Health Research, UCSF / 23.08.2013

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 NeurohospitalistVanja 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 Neurohospitalist MedicalResearch.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. (more…)
Author Interviews, Nature, UCSF, Vitamin C / 02.07.2013

Interview with: Miguel Ramalho-Santos, Ph.D. University of California - San Francisco stem-cell scientist,MedicalResearch.com  Interview with: Miguel Ramalho-Santos, Ph.D. University of California - San Francisco stem-cell scientist, Vitamin C induces Tet-dependent DNA demethylation and a blastocyst-like state in ES cells MedicalResearch.com: What are the main findings of the study? Answer: We found that Vitamin C has a profound effect in the regulation of gene activity in cultured mouse embryonic stem cells. Vitamin C specifically enhances the action of enzymes called Tet's, which remove certain chemical modifications to DNA (methylation). In this way, Vitamin C makes cultured mouse embryonic stem cells behave more like the early cells in the embryo that they represent. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Mental Health Research, UCSF / 26.04.2013

MedicalResearch.com eInterview with Dr. David Perry UCSF School of Medicine Clinical Fellow in Neurology 675 Nelson Rising Lane San Francisco CA 94158 MedicalResearch.com: What are the main findings of the study? Dr. Perry: We described two patients with clinical syndromes and brain imaging patterns that are consistent with Alzheimer’s disease. Both were found to have mutations in GRN, which are typically associated with inherited frontotemporal dementia. They both showed evidence of underlying Alzheimer’s pathology, in one case through autopsy confirmation (demonstrating Alzheimer’s disease in addition to TDP-43 pathology), and in the other case from a positive amyloid PET scan. (more…)