About 1 in 189 US Americans Identify as Transgender

MedicalResearch.com Interview with:

Halley Crissman, MD, MPH University of Michigan Resident Physician Department of Obstetrics and Gynecology University of Michigan Ann Arbor, Michigan

Dr. Halley Crissman

Halley Crissman, MD, MPH
University of Michigan
Resident Physician
Department of Obstetrics and Gynecology
University of Michigan
Ann Arbor, Michigan

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

Response: There has been very little data on the epidemiology of the transgender population in the U.S., including basic information regarding the proportion of adults that identify as transgender. Transgender is an identity term for individuals whose gender expression and gender identity does not align with culture expectations and gender norms associated with sex assigned at birth.

Our study used data from the Centers for Disease Control and Prevention 2014 Behavioral Risk Factor Surveillance System to estimate the demographic characteristics of the U.S. adult transgender population compared to the non-transgender population. We found that 0.53% of U.S. adults identified as transgender. Transgender individuals were more likely to be non-white and below the poverty line, were less likely to attend college, and were as likely to be married, living in a rural area, and employed, compared to non-transgender individuals.

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Vaccine Nanodiscs Can Trigger More Cancer Fighting Immune Cells

MedicalResearch.com Interview with:

James Moon, PhD John Gideon Searle Assistant Professor University of Michigan Dept. of Pharmaceutical Sciences and Biomedical Engineering Biointerfaces Institute Ann Arbor, MI, 48109

Dr. James Moon

James Moon, PhD
John Gideon Searle Assistant Professor
University of Michigan
Dept. of Pharmaceutical Sciences and Biomedical Engineering
Biointerfaces Institute
Ann Arbor, MI, 48109

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

Response: The field of cancer immunotherapy has recently made a breakthrough with the clinical success of immune checkpoint inhibitors, which work by removing the brakes on immunosuppressed T-cells. However, these approaches generally work by augmenting pre-existing T-cell immunity and benefit only a subset of patients. In addition, because the majority of somatic mutations in cancer cells are unique to each patient, cancer immunotherapy may benefit from a personalized approach.

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Low Carb Meals Reduce Insulin Resistance

MedicalResearch.com Interview with>
Katarina Borer, Ph.D. Professor
Po-Ju Lin,PhD
School of Kinesiology
The University of Michigan
Ann Arbor, MI

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

Response: This study was part of the doctoral dissertation of Po-Ju Lin, who is now a post-doctoral fellow at the University of Rochester. With this study, we wanted to answer three questions:

(1) Is daily carbohydrate load responsible for evening glucose intolerance and post-meal insulin resistance. (Evening glucose intolerance represents well-documented higher glucose and insulin responses in the evening than in the morning when the same quantity of glucose is eaten or infused intravenously) To answer this question we offered two daily meals containing about 800 Kcal and either 30% or 60% of carbohydrates.

(2) Will exercise before the meals improve glucose tolerance (glucose clearance from the blood and insulin response) after eating? (Exercise is a well-known means of increasing glucose uptake by the muscle and of increasing muscle sensitivity to insulin action for a number of hours after exercise). To answer this question we had the subjects exercise for two hours walking on a treadmill at 45% of their maximal aerobic effort one hour before each meal.

(3) Is the upper-intestinal hormone GIP involved in any effects associated with variation in dietary carbohydrate? (GIP or glucose-dependent insulinotropic peptide, stimulates insulin secretion in advance of absorbed glucose).

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Doctors: “I would never want to have a mental health diagnosis on my record”


MedicalResearch.com Interview with:

Katherine J. Gold, MD MSW MS Department of Family Medicine Institute for Healthcare Policy and Innovation; Depression Center University of Michigan

Dr. Katherine Jo Gold

Katherine J. Gold, MD MSW MS
Department of Family Medicine
Institute for Healthcare Policy and Innovation; Depression Center
University of Michigan

With co-authors Louise B. Andrew MD JD; Edward B. Goldman JD; Thomas L. Schwenk MD

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

Response: It is common knowledge that physicians are often hesitant to seek care for mental health concerns. Knowing that female physicians have increased rates of both depression and suicide, we surveyed female physicians who were mothers and who participated in a closed FaceBook group about their mental health, treatment, and opinions about licensing. More than 2100 U.S. physicians responded, representing all specialties and states.

Almost half of participants reported that at some point since medical school they had met criteria for a mental illness but didn’t seek treatment. Reasons included feeling like they could get through without help (68%), did not have the time (52%), felt a diagnosis would be embarrassing or shameful (45%), did not want to ever have to report to a medical board or hospital (44%), and were afraid colleagues would find out (39%). Overall, 2/3 identified a stigma-related reason for not seeking help.

Almost half reported prior diagnosis or treatment, but just 6% of these women stated they had disclosed this to a state medical board on a licensing application, though states vary on what information they require be disclosed.

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More ICU Use in Hospitals With Worse Quality of Care for Heart Failure or MI

MedicalResearch.com Interview with:

Thomas Valley, MD, MSc Fellow, Pulmonary and Critical Care University of Michigan Ann Arbor, MI 48109-2800

Dr. Thomas Valley

Thomas Valley, MD, MSc
Fellow, Pulmonary and Critical Care
University of Michigan
Ann Arbor, MI 48109-2800

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

Response: Hospitalizations for cardiovascular condition such as acute myocardial infarction (AMI) and heart failure (HF) are incredibly common and costly. Yet, about 20% of hospitalized patients with these conditions receive substandard care. We assessed whether there was an association between the quality of care a hospital provided for AMI or heart failure and how frequently a hospital used the ICU. We found that hospitals with the highest rates of ICU use for AMI or HF delivered worse quality of care and had higher 30-day mortality for these conditions.

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Almost 1/3 of Women in Academic Medicine Report Experiencing Sexual Harassment

MedicalResearch.com Interview with:

Reshma Jagsi, MD, DPhil Department of Radiation Oncology, University of Michigan Ann Arbor, MI 48109

Dr. Reshma Jagsi

Reshma Jagsi, MD, DPhil
Department of Radiation Oncology, University of Michigan
Ann Arbor, MI 48109

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

Dr. Jagsi: There has recently been considerable media attention to certain egregious individual cases of sexual harassment, but it has been less clear whether these cases were isolated and uncommon incidents or whether they are indicative of situations more commonly experienced by academic medical faculty.  An excellent survey study had previously documented that 52% of female faculty in 1995 had experienced harassment, but many of those women had attended medical school when women were only a small minority of the medical students (let alone faculty).  More recent estimates of faculty experiences are necessary to guide ongoing policies to promote gender equity in an era when nearly half of all medical students are women.

We found that in a modern sample of academic medical faculty, 30% of women and 4% of men had experienced harassment in their careers.

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Kidney-on-a-Chip Technology Allows For Faster Drug Safety Analysis

MedicalResearch.com Interview with:

Shuichi Takayama, PhD Professor, Department of Biomedical Engineering & Macromolecular Science and Engineering Associate Director, Michigan Center for Integrative Research in Critical Care Director, Microfluidics in Biomedical Sciences Training Program Biointerfaces Institute University of Michigan

Shuichi Takayama, PhD
Professor, Department of Biomedical Engineering & Macromolecular Science and Engineering
Associate Director, Michigan Center for Integrative Research in Critical Care
Director, Microfluidics in Biomedical Sciences Training Program
Biointerfaces Institute
University of Michigan

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

Dr. Takayama: In this particular study, we tested a once a day vs continuous administration of drug and showed once daily administration is better.  The type of study was something that could not be done well in animals because drug clearance is much faster than humans.  And existing human clinical data has been inconclusive for this particular drug and is too expensive to collect new data specifically for this drug.

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

Dr. Takayama: Miniature human surrogate model that provides better understanding of how to more safely administer drugs.

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

Dr. Takayama: The results highlight the importance of studying drug administration timing/dynamics in addition to the more common static drug concentration level studies. The paper provides a template for study of other drugs and organ models. 

MedicalResearch.com: Is there anything else you would like to add?

Dr. Takayama: Professor Se Joong Kim is a nephrologist and he was key in driving this research. 

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

Citation:

Shuichi Takayama et al. Pharmacokinetic profile that reduces nephrotoxicity of gentamicin in a perfused kidney-on-a-chip. Biofabrication, March 2016

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

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Biomarker Expression Linked to Aggressive Basal Cell Skin Cancer

MedicalResearch.com Interview with:

Alon Kahana, MD, PhD Associate Professor Kellogg Eye Center University of Michigan

Dr. Alon Kahana

Alon Kahana, MD, PhD
Associate Professor
Kellogg Eye Center
University of Michigan

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

Dr. Kahana:
Basal cell carcinoma is the most common cancer – more common than all other cancers combined. Fortunately, it is usually not aggressive, and can be easily treated surgically. However, when it is on the face, or when it has grown to a large size, it can become very disfiguring and even deadly. Basal cell carcinoma is diagnosed histopathologically, yet molecular diagnostics have proven value in a variety of cancers. In order to improve diagnosis and care, we set out to test whether histologically aggressive forms of basal cell carcinoma are associated with increased cell proliferation.

Furthermore, we tested whether expression of the epigenetic regulator Ezh2 is associated with higher-grade carcinoma and/or with increased proliferation. The breakthrough discovery is that expression of Ezh2 correlates with high proliferation and with aggressive histologic features, suggesting that epigenetic regulators can be used both as markers of disease severity and targets of novel therapy. Continue reading

Many Seniors Carry Superbugs Home From the Hospital

MedicalResearch.com Interview with:
Lona Mody, MD, MS
Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center
Division of Geriatric and Palliative Medicine, University of Michigan Medical School,
School of Public Health
University of Michigan, Ann Arbor

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

Dr. Mody: Hand hygiene is considered to be the most important strategy to prevent infections and spread of drug resistant organisms. Surprisingly, all strategies and efforts have predominantly involved healthcare workers and that too mainly in acute care hospitals.  We are now facing a tsunami of an aging population in our hospitals, post-acute care facilities and long-term care facilities.  Hand hygiene falls off when patients are hospitalized compared to when they are at home.  So, we were very interested, first, in hand colonization in older patients who have recently been transferred from the acute care hospital to a post-acute care (PAC) facility for rehabilitation or other medical care before fully returning home. We were also interested in evaluating whether these organisms persisted.

MedicalResearch.com: What are the main findings?

Dr. Mody: We recruited and followed 357 patients (54.9 percent female with an average age of 76 years). The dominant hands of patients were swabbed at baseline when they were first enrolled in a post-acute care facility, at day 14 and then monthly for up to 180 days or until discharge.

The study found:

  • To our surprise, nearly one-quarter (86 of 357) of patients had at least one multi-drug resistant organism on their hands when they were transferred from the hospital to the post-acute care facility
  • During follow-up, 34.2 percent of patients’ hands (122 of 357) were colonized with a resistant organism and 10.1 percent of patients (36 of 357) newly acquired one or more resistant organisms.
  • Overall, 67.2 percent of colonized patients (82 of 122) remained colonized at discharge from PAC.

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Many Breast Cancer Patients Overestimate Risk of Recurrence and Spread

MedicalResearch.com Interview with:

Sarah T. Hawley PhD MPH Professor of Medicine University of Michigan

Dr. Sarah Hawley

Sarah T. Hawley PhD MPH
Professor of Medicine
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Dr. Hawley: Research has shown that breast cancer patients do not have a good understanding of their risk of distant recurrence, and and that the fear of cancer spreading is one of the biggest concerns that patients have. The research that has been done shows that most patients over-esimate this risk, and think they have a bigger chance of the cancer coming back than they actually have. There has been relatively little done to investigate the association between patient over-estimation of risk and patient reported outcomes, specifically their quality of life. We therefore conducted our study to understand the extent of overestimation of risk in a population-based sample of breast cancer patients with very favorable prognosis (DCIS, low risk invasive breast cancer) using a numeric (number based) and descriptive (general understanding) measure, and to understand the association between over-estimation and quality of life.

The main findings are that almost 40% of our sample of patients over-estimated their risk; 33% using a numeric measure and 15% using a descriptive measure. There was no clear “type” of patient who overestimated her risk of distant recurrence, though women with lower education more over overestimated numerically than those with higher education.

Both numeric and descriptive over-estimation was associated with reduced quality of life outcomes, especially with frequency of worry about recurrence, however over estimating descriptively mattered the most. Women who overestimated their risk both numerically and descriptively had a nearly 10 fold odds of frequent worry compared to women who understood their risk.

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PET Scans May Be Overused To Detect Recurrent Lung Cancer

MedicalResearch.com Interview with:

Mark A. Healy, MD Department of Surgery Center for Healthcare Outcomes & Policy, University of Michigan Ann Arbor, MI

Dr. Mark Healy

Mark A. Healy, MD
Department of Surgery
Center for Healthcare Outcomes & Policy, University of Michigan
Ann Arbor, MI  

Medical Research: What is the background for this study? What are the main findings?

Dr. Healy: In our study, we found high overall use of PET as a primary study for recurrence detection in lung and esophageal cancers, with substantial hospital-based variation in the use of PET. Despite this, there was not a significant difference in survival for patients across high and low PET use hospitals.

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Paid Sick Leave May Help Cancer Patient Retain Jobs

4/23/13 Studio head shot portrait of Christine Veenstra for Hem/Oncol.

Dr. Veenstra

MedicalResearch.com Interview with:
Christine Veenstra MD

Clinical Lecturer, Internal Medicine
Medical Oncology
University of Michigan
Ann Arbor, MI  48109-5343

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

Dr. Veenstra: Patients with cancer face many costs and incur financial burden as they go through diagnosis and treatment. For working patients, cancer diagnosis and treatment may come with the additional burden of time away from work, lost income, and even long-term job loss. Although 40% of US workers do not have access to paid sick leave, we hypothesized that availability of paid sick leave could reduce the need to take unpaid time away from work during cancer treatment and might therefore be associated with job retention and reduced personal financial burden.

In a survey of over 1300 patients with Stage III colorectal cancer, we found that only 55% of those who were employed at the time of their cancer diagnosis retained their jobs. Working patients with paid sick leave were nearly twice as likely to retain their jobs compared with working patients who did not have paid sick leave. This held true even when controlling for income, education and health insurance. Furthermore, working patients without paid sick reported significantly higher personal financial burden than those who had paid sick leave available.

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Traditional Self-Rated Health Questions Not As Reliable in Blacks and in Whites

Shervin Assari, MD, MPH Postdoctoral Research Fellow Center for Research on Ethnicity, Culture, and Health (CRECH) Department of Health Behavior and Health Education University of Michigan School of Public Health University of Michigan Ann Arbor, MI

Dr. Shervin Assari

MedicalResearch.com Interview with:
Shervin Assari, MD, MPH
Faculty, research investigator
Department of Psychiatry and
Center for Research on Ethnicity, Culture, and Health
University of Michigan School of Public Health
University of Michigan
Ann Arbor, MI 

Medical Research: What is the background for this study? What are the main findings?

Dr. Assari: Literature has consistently shown that a single question that asks individuals to rate their health strongly predicts risk of mortality net of traditional risk factors. Our study shows that self rated health that very well predicts risk of death over a 25 year for Whites does not have any predictive value for Blacks. The results are important because Blacks have a worse self rated health and also shorter life expectancy in the United States, but those 2 health problems have weaker link among Blacks as Whites.

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Urine Biomarker Can Predict Chronic Kidney Disease Progression

MedicalResearch.com Interview with:
Wenjun Ju, Ph.D., M.S.
Research Assistant Professor, Internal Medicine
Matthias Kretzler, M.D.
Professor, Internal Medicine, Nephrology
Research Professor, Computational Medicine and Biology
University of Michigan Health System 

Medical Research: What is the background for this study? What are the main findings?

Response: Chronic kidney disease (CKD) is a global health issue that affects approximately 15% of the global population.. While not all patients with CKD will progress to end-stage kidney disease (ESKD), those that do tend to advance quickly and require dialysis or kidney transplant. They are also at an increased risk of death from cardiovascular disease.

According to the International Society of Nephrology, treatment of CKD, including medical management, dialysis and kidney transplant, is very costly.  In the U.S. alone, therapy for CKD is likely to exceed $48 billion per year, and the ESKD program consumes 6.7 percent of the total Medicare budget to care for less than 1 percent of the covered population. In China, the disease will cost the economy the equivalent of $558 billion in the U.S. over the next decade.

Early identification of patients that are more likely to experience end-stage kidney disease is an urgent, unmet clinical need. Currently, kidney biopsy is required to determine diagnosis and prognosis of kidney disease. This procedure is costly, carries a low, but significant health risk, and has limited ability to predict the future course of kidney disease.

Together with the European Renal cDNA Bank and the Peking University Institute of Nephrology, the University of Michigan team identified epidermal growth factor (EGF) as a promising candidate for prediction of kidney function loss while analyzing transcriptomic data derived from kidney tissue biopsies of CKD patients across Europe and the U.S. We then validated the findings in urine samples from more than 940 patients in North America, Europe and China, and found that a decrease in urinary EGF protein concentration is an early sign of diminishing kidney function and pinpoints the at-risk patient population.

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Adults With Cerebral Palsy Risk Multiple Chronic Diseases

Mark D. Peterson, Ph.D., M.S. University of Michigan, Medicine Department of Physical Medicine and Rehabilitation Ann Arbor, MI

Dr. Peterson

MedicalResearch.com Interview with:
Mark D. Peterson, Ph.D., M.S
.
University of Michigan, Medicine
Department of Physical Medicine and Rehabilitation
Ann Arbor, MI 

Medical Research: What is the background for this study? What are the main findings?

Dr. Peterson: Cerebral palsy (CP) is a neurodevelopmental condition caused by a disturbance to the developing fetal or infant brain. While the incidence of CP has remained stable in recent years, the mortality rate of children with Cerebral palsy has declined, suggesting that adults with Cerebral palsy represent a growing population whose healthcare needs are poorly understood.  More than half of children with Cerebral palsy are independently mobile at 8 years of age; however, a large proportion lose mobility in adulthood. These declines are attributed to pain, fatigue, and muscle weakness, and result in chronic inactivity and accelerated aging. Despite this, there have been virtually no specific surveillance efforts or even epidemiologic studies to examine the prevalence of lifestyle-related chronic diseases in adults with Cerebral palsy. Therefore, the purpose of this study was to examine estimates of chronic conditions in a large, U.S. population-representative sample of adults with CP (n=1,015 fromthe Medical Expenditure Panel Survey (MEPS) (2002-2010). We demonstrated that adults with cerebral palsy had significantly greater estimates of chronic diseases, including diabetes, asthma, hypertension and other heart conditions, stroke, emphysema, joint pain, and arthritis as compared with adults without Cerebral palsy.

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For Medicare Patients, Dabigatran Offers Significant Cost Savings Over Warfarin

Geoffrey Barnes, MD, MSc Clinical Lecturer Cardiovascular Medicine and Vascular Medicine University of Michigan Health System

Dr. Barnes

MedicalResearch.com Interview with:
Geoffrey Barnes, MD, MSc
Clinical Lecturer
Cardiovascular Medicine and Vascular Medicine
University of Michigan Health System

Medical Research: What is the background for this study?

Dr. Barnes: Although warfarin has been the primary anticoagulant used for stroke prevention in atrial fibrillation for over 60 years, four new direct oral anticoagulants (DOACs) have been introduced into the market since 2010. Dabigatran, which directly inhibits thrombin, was found to have better prevention of ischemic stroke and a significant reduction in hemorrhagic stroke (bleeding strokes) for patients with atrial fibrillation at intermediate and high risk of stroke.  Prior cost-effectiveness studies have shown that dabigatran is cost-effective from both the societal and payer (usually Medicare) perspectives.  However, none of those studies looked at the patient’s out-of-pocket costs and the impact of prescription drug coverage

Medical Research: What are the main findings?

Dr. Barnes: We found that patients with prescription drug coverage (Medicare Part D) had significant cost savings when choosing dabigatran over warfarin.  This is primarily because of the reduction in both types of stroke as well not needing to have frequent blood draws, as are required by warfarin.  However, when patients do not have prescription drug coverage, the costs for dabigatran are quite high.  Continue reading

PET/CT May Yield False Positive Findings in Early Stage Melanoma

MedicalResearch.com Interview with:
Benjamin Y. Scheier, MD
Division of Hematology/Oncology
Department of Internal Medicine
University of Michigan, Ann Arbor

Medical Research: What is the background for this study? What are the main findings?

Dr. Scheier: Existing data suggests that PET/CT has use in the detection of metastases from multiple primary tumor types. However, PET/CT lacks data supporting its use in staging asymptomatic patients with early-stage melanoma, may inconsistently impact treatment decisions, and carries a false-positive finding risk that may detract from its use. To evaluate an evolving practice, this study aims to assess the use of PET/CT in detecting occult metastases in SLN-positive melanoma prior to resection. In this retrospective evaluation of patients with melanoma and clinically silent regional lymph nodes treated at the University of Michigan, only 7% had PET/CT findings that ultimately identified metastatic melanoma and precluded LND. Of the 46 patients who underwent a preoperative PET/CT, 15 (33%) had intense uptake distant from the primary tumor and local lymph node basin. Nine of those 15 patients (60%) had abnormalities biopsied prior to LND. Three of the 9 biopsies yielded metastatic melanoma, a false-positive rate of 67% for PET/CT in identifying distant metastases in asymptomatic patients.

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ICU Treatment For Pneumonia May Decrease Readmissions and Costs

Thomas Valley, MD Fellow, Division of Pulmonary and Critical Care University of Michigan Ann Arbor, MIMedicalResearch.com Interview with:
Thomas Valley, MD
Fellow, Division of Pulmonary and Critical Care
University of Michigan
Ann Arbor, MI

Medical Research: What is the background for this study? What are the main findings?

Dr. Valley: There has been dramatic growth in intensive care unit (ICU) use over the past 30 years. As the reasons for this growth are not entirely clear, some have suggested that the ICU is a meaningful source of low-value care. The value of the ICU, however, depends on the net benefit that ICUs provide patients. Prior observational studies assessing the effectiveness of the ICU were limited because patients admitted to the ICU are inherently sicker and more likely to die than patients admitted to the general ward. Given the substantial number of patients with pneumonia who are admitted to an ICU, it is vital to understand whether admission to the ICU is beneficial.

In our study of 1.1 million Medicare beneficiaries with pneumonia between 2010 and 2012, we used an instrumental variable, a statistical technique to pseudo-randomize patients based on their proximity to a hospital that uses the ICU frequently for pneumonia, in order to determine whether ICU admission saved lives and at what financial cost. An estimated 13 percent of patients were admitted to the ICU solely because they lived closest to a hospital that used the ICU frequently for pneumonia. Among these patients, ICU admission was associated with a nearly six percent reduction in 30-day mortality compared to general ward admission. In addition, there were no significant differences in hospital costs or Medicare reimbursement between patients admitted to the ICU and to the general ward.

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Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases

Dr. Rashid Bashshur PhD Director of Telemedicine University of Michigan Health System Emeritus Professor of Health Management and Policy University of Michigan, School of Public HealthMedicalResearch.com Interview with:
Dr. Rashid Bashshur PhD

Director of Telemedicine
University of Michigan Health System
Emeritus Professor of Health Management and Policy
University of Michigan, School of Public Health 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bashshur: The impetus for this research derives from the confluence of several factors, including the increasing incidence and prevalence of chronic diseases, their associated morbidity and  mortality and their high cost. The search for solutions has taken center stage in health policy.  Patients must be engaged in  in managing their health and health care, and they must assume greater responsibility for adopting and maintaining a healthy life style to reduce their dependence on the health system and to help themselves in maintaining an optimal level of health.  The  telemedicine intervention promises to  address all these issues and concerns, while also providing ongoing monitoring and guidance for patients who suffer from serious chronic illness.

The preponderance of the evidence from robust scientific studies points to the beneficial effects of the telemedicine intervention (through telemonitoring and patient engagement) in terms of reduction in use of service (including hospital admissions/readmissions, length of hospital stay, and emergency department visits) as well as improved health outcomes.  The single exception was reported in a study among frail  elderly patients with co-morbidities who did not benefit from the telemedicine intervention.

There is an ever-growing and complex body of empirical evidence that attests to the potential of telemedicine for addressing the triad problems of limited access to care, uneven distribution of quality across communities, and cost inflation.  Research demonstrates the effectiveness of the telemedicine intervention in addressing all three problems, especially when patients are engaged in managing their personal health and healthcare.  The enabling technology can be used to promote healthy life styles, informed decision making, and prudent use of health resources.

Unintended consequences of delaying mortality for older adults may also increase the use of resources, especially in the long run, and society must decide on the ultimate values it chooses to promote.
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Hospital Mortality Outcomes Differ After Lung Cancer Surgery Complications

Tyler Grenda, MD House Officer VI Section of General Surgery Department of Surgery University of Michigan

MedicalResearch.com Interview with:
Tyler Grenda, MD
House Officer VI
Section of General Surgery
Department of Surgery
University of Michigan

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Grenda: The main purpose for this study was to better understand the factors underlying differences in mortality rates for hospitals performing lung cancer resection.  The methodology we used included only the highest and lowest mortality hospitals (Commission on Cancer accredited cancer programs) so the sampling frame was specific. There are wide variations in mortality rates across hospitals performing lung cancer resection (overall unadjusted mortality rates were 10.8% vs. 1.6%, respectively.

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Shorter Courses of Radiation For Breast Cancer Found Safe and Effective with Fewer Side Effects

Dr. Reshma Jagsi MD, DPhil Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System Research Investigator at the Center for Bioethics and Social Sciences in Medicine University of MichiganMedicalResearch.com Interview with:
Reshma Jagsi, MD, DPhil
Associate Professor and Deputy Chair
Department of Radiation Oncology
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Response: In recent years, there has been accumulating evidence from clinical trials that have supported the long-term safety and effectiveness of shorter courses of radiation therapy—“hypofractionated radiation therapy”—for patients with breast cancer.  However, little has been known about the experiences of patients during treatment, especially when this new approach is administered outside the setting of closely controlled clinical trials.  Our study examined the side effects and patient-reported experiences during radiation treatment of over 2000 breast cancer patients in the state of Michigan.  It found that women who received hypofractionated treatment were less likely to report side effects (including skin reaction and fatigue) than patients treated with more traditional courses of radiation treatment, delivered daily over 5-6 weeks or longer.

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Evaluating Liver Fat On Cardiac CT Helps Predict Risk vs Benefit of Statin Therapy

MedicalResearch.com Interview with:
Venkatesh L. Murthy, MD, PhD, FACC, FASNC University of Michigan
Venkatesh L. Murthy, MD, PhD, FACC, FASNC

University of Michigan

Dr. Ravi Shah MD Beth Israel Deaconess Medical Centerand Dr. Ravi Shah MD
Beth Israel Deaconess Medical Center

 


MedicalResearch: What is the background for this study?

Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile.

MedicalResearch: What are the main findings?

Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study of Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies.

We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients. Continue reading

Choice of Kidney Function Equation Important In Risk Evaluation Prior To Stent Surgery

MedicalResearch.com Interview with:
Jessica Parsh MD
Hitinder Gurm MBBS

Department of Internal Medicineb
University of Michigan Health System

Medical Research: What is the background for this study? What are the main findings?

Response: Chronic kidney disease (CKD) is associated with adverse events after percutaneous coronary interventions (PCI). Estimated glomerular filtration rate (eGFR) is used for CKD stage classification and there are several widely used eGFR equations, including the Cockcroft-Gault, CKD-EPI, and MDRD. Others have shown that the CKD-EPI equation is more accurate, more precise and less bias. The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of CKD-EPI. Even so, there remains wide variability among equation choice between different institutions as well as between different health care providers (physicians, pharmacists, etc). In addition, in a recent survey, up to 12% of providers were “unsure” of which equation they used. Furthermore, the FDA has no clear guidelines regarding equation selection for pharmacokinetic studies of novel medications and the equation used for development of a particular drug is not always clearly labeled on package inserts.

Using data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium for almost 130,000 patients who underwent PCI, we investigated whether use of different eGFR equations would lead to discrepant eGFR output, how this would lead to CKD stage reclassification and whether CKD stage reclassification by a certain equation led to improved risk prognostication for adverse events. We also studied how calculation of eGFR by various equations would affect drug dosing recommendations for common renally-dosed antiplatelet and antithrombotic medications. We found that there was wide discrepancy among the eGFR output of the various equations and this led to significant CKD stage reclassification (with agreement on stage classification as low as 56% for CKD-EPI and Cockcroft-Gault). Further, our data from receiver operating characteristic analysis and net reclassification index analysis support CKD-EPI as superior for risk prognostication for renal adverse outcomes of acute kidney injury and new requirement for dialysis. In regards to drug dosing, agreement between all three equations on dosing adjustment was as low as 34% (bivalirudin with eGFR cutoff < 30 ml/min/1.732).

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JAK1-2 inhibitor Baricitinib May Limit Progression of Diabetic Kidney Disease

MedicalResearch.com Interview with:
Frank C. Brosius, MD
Professor, Internal Medicine and Physiology
Chief, Division of Nephrology
University of Michigan Ann Arbor, MI

Dr. Matthias Kretzler MD
Professor, Internal Medicine
Research Professor, Computational Medicine and Biology
University of Michigan Ann Arbor, MI

Katherine R. Tuttle MD
Clinical Professor of Medicine, Division of Nephrology
Medical & Scientific Director, Providence Medical Research Center/Sacred Heart Center
Professor of Basic Medical Sciences, WWAMI Program
Washington State University

Medical Research: What is the background for this study?

Response: Our University of Michigan team had found that JAK-STAT gene expression was increased in kidneys in patients with diabetic kidney disease and that these changes correlated with progression of kidney disease.  We subsequently substantiated these changes in other studies and have found that by increasing expression of just one of these genes, JAK2, in a single kidney cell type (podocytes) in mice that we can make their diabetic kidney disease much worse.

At around the same time, investigators at Eli Lilly and Co. had FDA approval to test a JAK1-2 inhibitor, baricitinib, in patients with rheumatoid arthritis.  The Lilly scientists saw our human results and thought about using baricitinib in patients with diabetic kidney disease.  After initial discussions with Dr. Kretzler and myself they concluded that there was good reason to move ahead with this study and just 14 months after the initial meeting the phase 2 clinical trial of baricitinib in the treatment of patients with diabetic kidney disease was initiated.

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Metformin Linked To Reduced Risk of Glaucoma

Julia E. Richards, Ph.D. Harold F. Falls Professor of Ophthalmology and Visual Sciences Professor of Epidemiology Director, Glaucoma Research Center The University of MichiganMedicalResearch.com Interview with:
Julia E. Richards, Ph.D.

Harold F. Falls Professor of Ophthalmology and Visual Sciences
Professor of Epidemiology
Director, Glaucoma Research Center
The University of Michigan

Medical Research: What is the background for this study?

Response: We have a special interest in how the developmental processes of aging increase the risk of late onset diseases. We wondered whether drugs that target known aging pathways might be able to reduce risk of late onset disease. In the aging field, an emerging area of interest has been the category of drugs called caloric restriction mimetic (CRM) drugs, which have been found to extend life span and to reduce risk or delay onset of some late-onset diseases. These caloric restriction mimetic drugs target a set of pathways that have come to be seen as playing roles in longevity. One of these caloric restriction mimetic drugs, metformin, happens to also be one of the most common drugs used in the treatment of type 2 diabetes.

Glaucoma is a leading cause of blindness worldwide and classical open-angle glaucoma shows onset in late middle age or late age, so we hypothesized that a caloric restriction mimetic drug might be able to reduce the risk of open-angle glaucoma. We used data from a large health services database to compare the rate at which open-angle glaucoma developed in individuals with diabetes mellitus who used metformin versus those who did not use metformin. We predicted that metformin would be associated with reduced risk of open-angle glaucoma.

Medical Research: What are the main findings?

Response: We found that use of metformin was associated with reduced risk of open-angle glaucoma. A 2 gram per day dose of the CRM drug metformin for two years was associated with a 20.8% reduction in risk of developing open-angle glaucoma. When we looked at the highest quartile of drug prescribed (>1,100 grams over a two year period) we found a 25% reduction in risk relative to those taking no metformin. This risk reduction is seen even when we account for glycemic control in the form of glycated hemoglobin, and use of other diabetes drugs was not associated with reduced risk of open-angle glaucoma. A possible explanation for our findings might be that the mechanism of risk reduction is taking place by CRM drug mechanisms that target aging pathways rather than through glycemic control of diabetes.

In the long run, the approaches to late onset diseases in general will become much more powerful if we can use parallel approaches that simultaneously target both the aging processes going on and the disease-specific pathways going on. In the literature we see caloric restriction mimetic drugs metformin, rapamycin and resveratrol all being explored for their ability to target points in aging pathways in ways that can impact the risk of a variety of late-onset diseases, so it will be important for those interested in the risk factors affecting late onset diseases to pay attention to how caloric restriction mimetic drugs might be altering risk for those late onset diseases. Continue reading

Low Testosterone May Affect More Than 25% of US Males

MedicalResearch.com Interview with: Jim Dupree, MD, MPH Assistant Professor Department of Urology, Division of Andrology University of MichiganMedicalResearch.com Interview with:
Jim Dupree, MD, MPH

Assistant Professor
Department of Urology, Division of Andrology
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Dr. Dupree: There are increasing discussions in the United States about testosterone therapy and men with clinical hypogonadism (or low testosterone).  Yet, to date, there have not been any nationally-representative studies of the prevalence of low testosterone in the United States.  Using a validated national health examination program from the CDC, we found that the national prevalence of low testosterone (serum testosterone ≤ 300 ng/dL) in adult males in the US was 28.9%.  Among other factors, men who were older, had a higher body mass index (BMI), or had a larger waist circumference were at risk for having lower testosterone levels.

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Family Members Can Help Patients Understand Hospital Discharge Instructions

Dennis Tsilimingras, M.D., M.P.H. Assistant Professor, Co-Director of Michigan AHEC (Area Health Education Center), Director of Patient Safety, Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit, MichiganMedicalResearch.com Interview with:
Dennis Tsilimingras, M.D., M.P.H.
Assistant Professor,
Co-Director of Michigan AHEC (Area Health Education Center),
Director of Patient Safety,
Department of Family Medicine and Public Health Sciences
Wayne State University School of Medicine
Detroit, Michigan

Medical Research: What is the background for this study?

Dr. Tsilimingras: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.

Medical Research: What are the main findings?

Dr. Tsilimingras: Over 28 % of 684 patients experienced postdischarge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients, but post-discharge adverse events were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tsilimingras: Post-discharge adverse events were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Patients should be accompanied by family members at the time of discharge to better understand post-discharge instructions.  Patients and family members should not be afraid to ask as many questions as possible regarding follow-up care in their community.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tsilimingras: Potentially different risk factors for adverse events in urban versus rural patients suggests the need for further research into

the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.

Citation:

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

Tsilimingras D1, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, Janisse J, Helmkamp L, Bates DW.

J Gen Intern Med. 2015 Mar 31. [Epub ahead of print]

 

MedicalResearch.com Interview with: Dennis Tsilimingras, M.D., M.P.H. (2015). Family Members Can Help Patients Understand Hospital Discharge Instructions 

Depression Less Common In Rural African American Women

Addie Weaver PhD Research Investigator and LEO Adjunct Lecturer School of Social Work University of MichiganMedicalResearch.com Interview with:
Addie Weaver PhD
Research Investigator and LEO Adjunct Lecturer
School of Social Work
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Dr. Weaver: The mental health of both African Americans and rural Americans has been understudied. Though depression is one of the most common, debilitating mental illnesses among women, very little is known about depression among African American women living in rural areas of the United States. In fact, much of what we know about rural women’s depression in general is based on research conducted with community samples, as limited epidemiolgical research includes large enough samples of both African American respondents and rural respondents to assess potentially important subgroup differences by urbanicity (e.g., urban, suburban, rural) and race. Our study used the National Survey of American Life, the first and only nationally representative survey of African Americans, to examine the interaction of urbanicity and race/ethnicity on Major Depressive Disorder and mood disorder prevalence among African American and non-Hispanic white women residing in the South.

We found that rural residence has a differential effect on depression and mood disorder for African American women and non-Hispanic white women. Overall, African American women living in rural areas experienced significantly lower odds of meeting criteria for lifetime and 12-month Major Depressive Disorder and lifetime and 12-month mood disorder than urban African American women. Conversely, non-Hispanic white women residing in rural areas had significantly higher odds of meeting criteria for lifetime and 12-month Major Depressive and lifetime and 12-month mood disorder when compared to rural African American women, and had significantly higher prevalence rates of 12-month Major Depressive Disorder and 12-month mood disorder than urban non-Hispanic white women. All analyses controlled for age, education level, household income, and marital status, suggesting that the urbanicity differences were not due to resource disparities often experienced by individuals residing in rural communities. Continue reading

A Bad Marriage May Lead to High Blood Pressure

Kira S. Birditt, Ph.D. Research Associate Professor Life Course Development Program The Institute for Social Research University of Michigan Ann Arbor, MI MedicalResearch.com Interview with:
Kira S. Birditt, Ph.D.
Research Associate Professor
Life Course Development Program
The Institute for Social Research
University of Michigan Ann Arbor, MI

Medical Research: What is the background for this study? What are the main findings?

Dr. Birditt: We know that negative marital quality (e.g., conflict, irritation) has important implications for physical health but the mechanisms that account for these links are still unclear. This study explored links between negative marital quality (e.g., criticism, demands), stress (long term chronic stresses) and blood pressure among older married couples in  a large longitudinal nationally representative sample of couples in the U.S..  We found that husbands had higher blood pressure when wives reported greater stress and that this link was even greater when husbands felt more negative about the relationship.  In addition, negative marital quality experienced by only one member of the couple was not associated with blood pressure but when both members of the couple reported higher negative marital quality they had higher blood pressure.  Continue reading

Many Women With Breast Cancer Want to Discuss Genetic Testing

Dr. Reshma Jagsi MD, DPhil Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System Research Investigator at the Center for Bioethics and Social Sciences in Medicine University of MichiganMedicalResearch.com Interview with:
Dr. Reshma Jagsi MD, DPhil
Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System
Research Investigator at the Center for Bioethics and Social Sciences in Medicine
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Dr. Jagsi: We surveyed women diagnosed with breast cancer and found that many women were concerned about the genetic risk of developing other cancers themselves or of a loved one developing cancer.  Overall, 35 percent of the women we studied expressed a strong desire for genetic testing, but 43 percent of those did not have a relevant discussion with a health care professional. In addition, minority patients with a strong desire for testing were less likely to discuss it with a professional, even though studies show that minority patients are not at lower risk for these mutations.

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