Author Interviews, Cancer Research, Lymphoma, Nutrition, University of Pennsylvania / 24.12.2024

MedicalResearch.com Interview with: Shan Liu, PhD, Postdoctoral fellow Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: Our study provides evidence that the efficacy of CAR T cell immunotherapies can be influenced by an important lifestyle factor: diet.   MedicalResearch.com: What are the main findings? Response:  Our study found that a ketogenic diet can enhance CAR T cell function through its metabolite, β-Hydroxybutyrate (BHB). Importantly, instead of altering the diet, providing BHB via oral supplementation in our preclinical model is sufficient to improve the anti-tumor function of CAR T cells. However, it's important to note that we’re still in the early stages, and we’re not yet recommending any dietary changes or supplements for patients. (more…)
ASCO, Author Interviews, Cancer Research, Lung Cancer, University of Pennsylvania / 05.06.2023

MedicalResearch.com Interview with: Lova L. Sun, MD, MSCE Medical Oncology Assistant Professor of Medicine Hospital of the University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: An common clinical question for patients with metastatic non-small cell lung cancer with long-term response to immunotherapy-based treatment is how long to continue treatment. The major clinical trials stopped immunotherapy at a maximum of 2 years, but in clinical practice many patients and clinicians continue treatment beyond this time point. We conducted a retrospective study of lung cancer patients across the US with long-term response to immunotherapy, to compare survival between those who stopped treatment at 2 years vs those who continued beyond 2 years. We found that there was no statistically significant difference in survival between the two groups. (more…)
Addiction, Author Interviews, JAMA, Mental Health Research, Race/Ethnic Diversity, University of Pennsylvania / 15.12.2022

MedicalResearch.com Interview with: Rebecca Arden Harris, MD, MSc Assistant Professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania Senior Fellow, Leonard Davis Institute of Health Economics Perelman School of Medicine, University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: The impact of the nationwide overdose epidemic on Black women has received little attention from policy-makers, researchers, or the press. MedicalResearch.com: What are the main findings? Response:  Over the 7-year study period, preventable overdose deaths among Black women resulted in nearly 0.75 million years of life lost (YLL). Women aged 25-34 have suffered a rising proportion of this burden. (more…)
Author Interviews, Diabetes, JAMA, Race/Ethnic Diversity, University of Pennsylvania / 20.12.2021

MedicalResearch.com Interview with: Lauren A. Eberly, MD, MPH Clinical Fellow, Cardiovascular Medicine Perelman School of Medicine Cardiovascular Division, Perelman School of Medicine Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Cardiovascular Center for Health Equity and Social Justice, Leonard Davis Institute of Health Economics University of Pennsylvania, Philadelphia MedicalResearch.com: What is the background for this study? Response: Racial inequities are pervasive in our country, and cardiovascular therapeutics with proven benefit have been shown to be underutilized among Black and Latinx patients. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a recommended treatment option for glycemic control in patients with diabetes, have recently emerged as a cardioprotective therapy as multiple large randomized clinical trials have shown they prevent cardiovascular events among patients with Type 2 Diabetes (T2D), particularly patients with established atherosclerotic cardiovascular disease (ASCVD). Given this, they are now recommended therapy for patients with diabetes and established or high risk of ASCVD. Given the known inequitable utilization of other therapies, along with the known higher burden of diabetes and cardiovascular disease among Black patients, the aim of this study was to evaluate the uptake of GLP-1 RA as well as for inequities in utilization. (more…)
Author Interviews, JAMA, Opiods, University of Pennsylvania / 14.12.2021

MedicalResearch.com Interview with: Ashish Thakrar, MD Internal Medicine & Addiction Medicine National Clinician Scholars Program University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: About 1.8 million Americans are currently incarcerated, more than any other country in the world per capita. Of those 1.8 million, about 1 in 7 suffers from opioid addiction, putting them at high risk of overdose and death, particularly in the weeks following release. Opioid use disorder is a treatable condition, particularly with the medications buprenorphine or methadone, but historically, prisons and jails have not offered treatment. Over the past five years, a few states and municipalities have enacted policies to provide access for OUD treatment. We examined whether these policies were actually improving access to treatment.  (more…)
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity, University of Pennsylvania / 18.11.2021

MedicalResearch.com Interview with: Ashwin Nathan, MD, MSHP Assistant Professor, Medicine, Perelman School of Medicine Interventional Cardiologist Hospital of the University of Pennsylvania and at the Corporal Michael C. Crescenz VA Medical Center in Philadelphia Penn Cardiovascular Outcomes, Quality & Evaluative Research Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: We found that the rates of TAVR were lower in areas with higher proportions of Black, Hispanic and socioeconomically disadvantaged patients. Inequities in access in areas with higher proportions of Black and Hispanic patients existed despite adjusting for socioeconomic status. (more…)
Author Interviews, Gender Differences, JAMA, University of Pennsylvania / 12.07.2021

MedicalResearch.com Interview with: Nosheen Reza, MD, FACC, FHFSA Assistant Professor of Medicine, Division of Cardiovascular Medicine Penn Center for Inherited Cardiovascular Disease Section of Advanced Heart Failure, Transplantation, and Mechanical Support Hospital of the University of Pennsylvania & the Perelman School of Medicine at the University of Pennsylvania  MedicalResearch.com: What is the background for this study? Response: In academic internal medicine in the United States, gender disparities in salary and promotion have been researched and documented for over 20 years. Despite this, in recent years, the number of women pursuing careers in medicine has increased, and now, more women than men are enrolled in U.S. medical schools. We wanted to take a contemporary look at the composition of the U.S. academic internal medicine physician workforce and evaluate the relationships between the representation of women in each internal medicine specialty with their salaries and academic rank. We hypothesized that even though there may be more women physicians practicing in these specialties compared with prior years, the disparities in academic rank and salary, as compared with men, would still exist. (more…)
Author Interviews, Dental Research, Microbiome, University of Pennsylvania / 19.05.2021

MedicalResearch.com Interview with: Geelsu Hwang, Ph.D. Assistant Professor Department of Preventive and Restorative Sciences Center for Innovation and Precision Dentistry (CiPD) School of Dental Medicine University of Pennsylvania  MedicalResearch.com: What is the background for this study? What is the significance of this oral biofilm?  Response: Dental caries is one of the most common and costly biofilm-dependent diseases that afflict children and adults worldwide. Particularly, Early Childhood Caries (ECC) is a hyper-virulent type of chronic tooth decay that most frequently afflicts underprivileged preschool children. The onset and progression of carious lesions in ECC are rapid and aggressive, causing rampant destruction of the smooth surfaces of teeth. ECC is painful and often requires surgical procedure under general anesthesia, while current treatment modalities are inefficient and recurrence of ECC is common. Notably, interactions between a fungus, Candida albicans, and a bacterium, Streptococcus mutans, have been known to play important roles in the pathogenesis of dental caries. Thus, we attempted to strategically develop a targeted measure to effectively prevent cross-kingdom interactions and subsequent biofilm development. (more…)
Author Interviews, COVID -19 Coronavirus, Heart Disease, JAMA, Social Issues, University of Pennsylvania / 02.02.2021

MedicalResearch.com Interview with: Sameed Khatana MD, MPH Instructor, Cardiovascular Medicine Perelman School of Medicine, University of Pennsylvania Physician, Philadelphia VA Medical Center  MedicalResearch.com: What is the background for this study? Response: After declining for decades, the fall in cardiovascular mortality rates in the US has started to slow down and rates may be rising in certain groups. This stagnation in mortality has been most start among middle-aged adults. These trends have occurred at the same time as growing economic inequality. Our analysis aimed to study the relationship between change in cardiovascular mortality rates between 2010 and 2017 for middle-aged adults across the US and change in economic prosperity levels. (more…)
Author Interviews, Brain Injury, Exercise - Fitness, Gender Differences, Pediatrics, University of Pennsylvania / 30.01.2021

MedicalResearch.com Interview with: Christina L. Master, MD, FAAP, CAQSM, FACSM Professor of Clinical Pediatrics Perelman School of Medicine at the University of Pennsylvania Co-Director, Minds Matter Concussion Program Pediatric and Adolescent Sports Medicine, Division of Pediatric Orthopedics Attending Physician, Care Network - Karabots Center The Children's Hospital of Philadelphia Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? Response: There have been multiple studies investigating potential sex differences in outcomes from concussion which have sometimes had conflicting results with some studies indicating that females take longer to recover than males and some studies reporting no difference in recovery between females and males, with most of these studies being conducted either retrospectively or prospectively in smaller cohorts. This large-scale multi-center prospective study in collegiate athletes provided an opportunity to compare females and males across comparable sports to examine both potential intrinsic or biologic factors (sex differences) or extrinsic (environmental or gender differences) that contribute to outcomes. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA, Race/Ethnic Diversity, Social Issues, Technology, University of Pennsylvania / 30.12.2020

MedicalResearch.com Interview with: Srinath Adusumalli, MD, MSc, FACC Assistant Professor of Clinical Medicine Division of Cardiovascular Medicine| Penn Medicine Lauren A. Eberly, MD, MPH Division of Cardiovascular Medicine, Department of Medicine Hospital of the University of Pennsylvania, Philadelphia MedicalResearch.com: What is the background for this study?   Response: The coronavirus disease 2019 (COVID-19) pandemic has uprooted conventional health care delivery for routine ambulatory care, requiring health systems to rapidly adopt telemedicine capabilities. At Penn Medicine, we wanted to ensure that as we developed a new system of telemedical care, we were reaching all of the patients we serve and access to care was maintained. As such, we undertook this study to examine utilization of care as we continued to iterate on and develop our telemedical system of care. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA, University of Pennsylvania, Vaccine Studies / 18.12.2020

MedicalResearch.com Interview with: Emily Largent, PhD, JD, RN Senior Fellow Leonard Davis Institute of Health Economics Assistant Professor, Medical Ethics and Health Policy Perelman School of Medicine  MedicalResearch.com: What is the background for this study? Response: Ending the COVID-19 pandemic through vaccination will require sufficient vaccine uptake.  Various means are being considered to promote uptake, including mandatory vaccination.  For instance, COVID-19 vaccination might be mandated by states (e.g., as a condition for children to attend public school) or by employers.  Given the opposition we’ve seen to masks, to choose just one example, our team wanted to gauge the acceptability of COVID-19 vaccine mandates. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, University of Pennsylvania / 09.08.2020

MedicalResearch.com Interview with: Genevieve Kanter, PhD Leonard Davis Institute of Health Economic Research Assistant Professor, General Internal Medicine, Assistant Professor, Medical Ethics and Health Policy Perelman School of Medicine MedicalResearch.com: What is the background for this study? Response: With the resurgence of COVID-19 and the likely seasonal resurgences, we were interested in whether those in low-income areas would be able to get access to the hospital care they might need. So we examined the distribution of ICU beds across the country and also looked at differences in the availability of ICU beds by household income in the community.  (more…)
Author Interviews, Heart Disease, JAMA, Opiods, Surgical Research, University of Pennsylvania / 20.06.2020

MedicalResearch.com Interview with: Chase Brown, MD Associate Fellow, Leonard Davis Institute of Health Economics Integrated Cardiac Surgery Resident Hospital of the University of Pennsylvania Nimesh D. Desai, MD, PhD Director, Thoracic Aortic Surgery Research Program Associate Professor of Surgery Hospital of the University of Pennsylvania MedicalResearch.com: What is the background for this study? Dr. Chase Brown:  Opioid use in the United States is a public health emergency. We know that opioids prescribed after general surgery operations to patients who never received them within the year prior to their surgery are at increased risk for continuing to take opioids months later. However, this has not been studied in patients undergoing cardiac surgery, who often times have more severe post-operative pain. Our goal in this study was to determine how many patients after cardiac surgery and are opioid naive are continuing to take opioids within 90-180 days after their surgery.   (more…)
Author Interviews, Compliance, Electronic Records, JAMA, University of Pennsylvania / 05.03.2020

MedicalResearch.com Interview with: Alexander C. Fanaroff, MD, MHS Assistant Professor of Medicine, Division of Cardiovascular Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: This is a secondary analysis of the ARTEMIS, a cluster randomized trial of copayment assistance for P2Y12 inhibitors in patients that had myocardial infarction. One of the primary endpoints of ARTEMIS was persistence with P2Y12 inhibitors: Did the patient continue to take a P2Y12 inhibitor over the entire 1 year following MI? In ARTEMIS, we captured persistence data in two ways, patient report and pharmacy fill records. What we did in this study was to look at the agreement between persistence as measured by these two methods. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania / 20.02.2020

MedicalResearch.com Interview with: Samuel Takvorian, MD, MS Instructor in the Division of Hematology and Oncology LDI Associate Professor University of Pennsylvania Perelman School of Medicine MedicalResearch.com: What is the background for this study? Response: The Affordable Care Act’s Medicaid expansions have been associated with improved access to care, affordability, and for certain surgical and medical conditions, health outcomes. However, studies have also suggested unintended consequences such as lengthened wait times, and there is continued debate about the overall impact of the expansions. (more…)
Author Interviews, Cancer Research, Radiation Therapy, University of Pennsylvania / 09.01.2020

MedicalResearch.com Interview with: Keith A. Cengel, M.D., Ph.D. Associate Professor of Radiation Oncology Hospital of the University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: FLASH radiotherapy involves delivering the treatment dose at a rate that is 1000s of times faster than standard radiotherapy.  Scientists have studied the differential biological effects of various dose rates for dose rates for the past ~80 years, but the unique effects of FLASH dose rates have only been appreciated in the last few years. While the mechanism(s) and applications of FLASH radiotherapy remain an area of active investigation,  t is clear so far that FLASH dose rates can provide similar levels of tumor control with less toxicity to normal tissues when compared to the same dose of radiotherapy delivered at a standard dose rate. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, End of Life Care, Primary Care, Pulmonary Disease, University of Pennsylvania / 07.10.2019

MedicalResearch.com Interview with: Gary Weissman, MD, MSHP Assistant Professor of Medicine Pulmonary, Allergy, and Critical Care Division Palliative and Advanced Illness Research (PAIR) Center University of Pennsylvania Perelman School of Medicine  MedicalResearch.com: What is the background for this study? Response: There are millions of hospitalizations every year in the United States (US) that include a stay in an intensive care unit (ICU). Such ICU stays put strain on health system resources, may be unwanted by patients, and are costly to society. As the population of the US gets older and more medically complex, some have argued that we need more ICU beds and a larger ICU workforce to keep pace. We hypothesized that some proportion of these ICU admissions could be prevented with early and appropriate outpatient care. Such a strategy would alleviate some of the strains and costs associated with ICU stays. If an appreciable proportion of ICU stays were preventable in this way, it would strengthen support for an alternative population-health based framework instead of further investments in the ICU delivery infrastructure.  (more…)
Author Interviews, Herpes Viruses, Science, University of Pennsylvania, Vaccine Studies / 23.09.2019

MedicalResearch.com Interview with: Harvey M. Friedman, MD Professor of Medicine/Infectious Diseases University of Pennsylvania Philadelphia, PA 19104-6073  MedicalResearch.com: What is the background for this study? Response:  Mice and guinea pigs are the animal models used to evaluate candidate vaccines for preventing genital herpes. My lab has been working on such a vaccine. Our candidate vaccine contains 3 immunogens. One immunogen is a protein on the virus that is required for the virus to enter cells (viruses need to enter cells to replicate). The other two immunogens are proteins on the virus that help the virus escape immune attack. Our intent is to produce antibodies to these 3 proteins by immunization and that the antibodies will bind to the proteins on the virus and block the protein functions. The virus then will not be able to enter cells and will not be able to use its evasion strategies to avoid the immune responses generated by the vaccine. Our vaccine aimed at preventing immune evasion is novel as a component of a genital herpes vaccine.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, University of Pennsylvania / 09.09.2019

MedicalResearch.com Interview with: Jordana Cohen, MD, MSCE Assistant Professor of Medicine and Epidemiology Renal-Electrolyte and Hypertension Division Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: In the June 18, 2019 issue of Annals of Internal Medicine, we published a systematic review and meta-analysis evaluating the cardiovascular risks of white coat hypertension (WCH; i.e. elevated office blood pressure and normal out-of-office blood pressure). The goal of the meta-analysis was to clarify previous mixed results regarding the risks of untreated WCH and treated WCH. The meta-analysis examined 27 studies – including 64,273 patients – and demonstrated that untreated WCH is associated with an increased risk of cardiovascular events (36%), all-cause mortality (33%), and cardiovascular mortality (109%) compared to normotension. This risk was strongest in studies with a mean age ≥55 years or that included participants with cardiac risk factors, such as diabetes and chronic kidney disease. We found no increased cardiovascular risk associated with treated white coat hypertension. (more…)
Author Interviews, Flu - Influenza, Pulmonary Disease, Stem Cells, University of Pennsylvania / 22.08.2019

MedicalResearch.com Interview with: Andrew E. Vaughan, PhD Assistant Professor, Biomedical Sciences School of Veterinary Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Severe respiratory infections, including influenza, can progress to acute respiratory distress syndrome (ARDS), wherein barrier function and gas exchange are compromised.  It’s a very life threatening scenario.  This is due in part to loss of alveolar type 2 (surfactant producing) and type 1 cells (gas exchanging).  Interestingly alveolar type 2 cells are also stem cells in the lung.  We wondered whether transplant of these cells might aid in recovery from severe influenza infection, and sure enough, it did! (more…)
Author Interviews, Lifestyle & Health, Mental Health Research, Opiods, University of Pennsylvania / 15.07.2019

MedicalResearch.com Interview with: Samuel Preston, Ph.D. Professor of Sociology University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Life expectancy at birth in the United States is low by international standards and has been declining in recent years. Our study aimed to identify how these trends differed by age, sex, cause of death, metropolitan status, and region. We found that, over the period 2009-11 to 2014-16, mortality rose at ages 25-44 in large metropolitan areas and their suburbs as well as in smaller metropolitan areas and non-metropolitan areas. Mortality at ages 45-64 also rose in all of these areas except large metropolitan areas. These were the ages responsible for declining life expectancy. Changes in life expectancy were particularly adverse for non-metropolitan areas and for women. The metropolitan distinctions in mortality changes were similar from region to region. The cause of death contributing most strongly to mortality declines was drug overdose for males and mental and nervous system disorders for women. (more…)
Author Interviews, Cancer Research, Hormone Therapy, JAMA, Prostate Cancer, University of Pennsylvania / 15.07.2019

MedicalResearch.com Interview with: Ravi Jayadevappa, PhD, MS Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-2676  MedicalResearch.com: What is the background for this study? Response: In the US, prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among men. Research shows that hormone therapy or ADT reduces the levels of male hormones in the body, called androgens, to stop them from stimulating cancer cells to grow., and thus is effective in reducing the spread and progression of prostate cancer. At the same time, some research has suggested that decreasing androgen levels may increase the risk factors for Alzheimer’s and dementia, including loss of lean body mass, diabetes, cardiovascular disease, and depression. The ADT therapy may lead to impaired neuron growth and the regeneration of axons, thus affecting the cognitive function. Thus there is growing interest in the possible association between exposure to ADT and cognitive dysfunction. Our study investigates the association between exposure to ADT and subsequent diagnosis of Alzheimer’s or dementia in elderly, fee-for-service Medicare enrollees using SEER-Medicare linked databases. (more…)
Author Interviews, Health Care Systems, Primary Care, University of Pennsylvania / 11.07.2019

MedicalResearch.com Interview with: Molly Candon PhD Research Assistant Professor of Psychiatry Lecturer, Department of Health Care Management The Wharton School, University of Pennsylvania Co-Instructor, Health Services and Policy Research Methods II, MS in Health Policy Research Program, Perelman School of Medicine, University of Pennsylvania  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: A team of researchers (led by Karin Rhodes, MD and Dan Polsky, PhD) conducted a secret shopper study of thousands of primary care practices across 10 states, with trained callers simulating patients with Medicaid and requesting appointments. One of the outcome measures was whether an appointment was scheduled with a physician or Advanced Practitioner. Between 2012 and 2016, the share of appointments scheduled with Advanced Practitioners increased by five percentage points.  (more…)
Author Interviews, Dermatology, University of Pennsylvania / 08.07.2019

MedicalResearch.com Interview with: John Barbieri, MD, MBA Hospital & Health Care University of Pennsylvania  MedicalResearch.com: What is the background for this study? Would you briefly describe the type of acne treated with Isotretinoin? Response: Isotretinoin is often used to treat moderate to severe acne or acne that has been unresponsive to other treatments. It is also used for patients with scarring acne. While highly effective for acne, due to concerns about medication related side-effects, patients are often monitoring with frequent blood tests, sometimes up to once per month. However, there have been several studies over the past two decades questioning the value of these frequent blood tests for patients on isotretinoin for acne. The purpose of this study was to examine whether blood test monitoring has been decreasing over time in response to these studies. We also evaluated the frequency of blood test abnormalities for patients being treated with isotretinoin. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, University of Pennsylvania / 07.06.2019

MedicalResearch.com Interview with: Sameed Khatana, MD, MPH Fellow, Cardiovascular Medicine, Perleman School of Medicine Associate Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania  MedicalResearch.com: What is the background for this study?   Response: The Affordable Care Act (ACA) led to the largest increase in Medicaid coverage since the beginning of the program. However, a number of states decided not to expand eligibility. Studies of prior smaller expansions in Medicaid, such as in individual states, have suggested evidence of improved outcomes associated with Medicaid expansion. Additionally, studies of Medicaid expansion under the ACA of certain health measures such as access to preventive care and medication adherence have suggested some improvements as well. However, there have been no large, population-level studies to examine whether Medicaid expansion under the ACA led to changes in mortality rates. Given, a high burden of cardiovascular risk factors in the uninsured, we examined whether states that had expanded Medicaid had a change in cardiovascular mortality rates after expansion, compared to states that have not expanded Medicaid. (more…)
Author Interviews, Hospital Readmissions, JAMA, Neurology, Outcomes & Safety, University of Pennsylvania / 20.05.2019

MedicalResearch.com Interview with: Sameed Khatana, MD Fellow, Cardiovascular Medicine, Perleman School of Medicine Associate Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: There has been a growing use of quality metrics and indices in the US healthcare system. Much attention has been paid to quality measurement programs used by public payors, however, the use of such programs by commercial payors is much less studied. "Centers of excellence" are one type of quality designation program that is growing in use by commercial payors where certain hospitals are determined to be "high quality" for a certain disease state or procedure based on meeting certain criteria. For some people, this is even impacting the choice of providers and hospitals they can use by payors. We evaluated centers of excellence programs from three large commercial payors, Aetna, Cigna and Blue Cross Blue Shield, targeted at cardiovascular diseases and interventions and examined publicly reported outcomes for all hospitals performing percutaneous coronary interventions (cardiac stenting) in New York State.  (more…)
Alzheimer's - Dementia, Author Interviews, Biomarkers, Neurological Disorders, Neurology, University of Pennsylvania / 08.05.2019

MedicalResearch.com Interview with: Lauren McCollum, MDCognitive and Behavioral Neurology FellowPenn Memory Center / Cognitive Neurology DivisionLauren McCollum, MD Cognitive and Behavioral Neurology Fellow Penn Memory Center / Cognitive Neurology Division MedicalResearch.com: What is the background for this study?   Response: Alzheimer’s Disease (AD) is a heterogenous condition, with considerable variability in cognitive symptoms and progression rates. One major reason for this heterogeneity is “mixed pathology,” – i.e., both AD- and non-AD pathology. Examples of non-AD pathology include cerebrovascular disease (CVD), Lewy Bodies, and TDP-43. Pathologically, Alzheimer’s Disease is defined by characteristic amyloid plaques and neurofibrillary tangles, which can be assessed for in living patients with CSF- or PET-based biomarkers for amyloid and tau, respectively. Classically, amyloid deposition begins years or even decades before pathologic tau accumulation, which is in turn associated with brain atrophy and cognitive decline. The recently developed NIA-AA “ATN” research framework allows for the classification of individuals with regard to 3 binary biomarkers: Amyloid (A), Tau (T), and Neurodegeneration (N). An individual’s ATN biomarker status indicates where along the “Alzheimer’s Disease continuum” they lie. Additionally, some ATN statuses are on the “typical AD” continuum, while others are not. Research has shown that 15-30% of cognitively normal older adults have elevated amyloid. It stands to reason that some portion of cognitively impaired individuals with elevated amyloid and neurodegeneration have something other than AD driving their neuronal injury. Within the context of the ATN research framework, this subset of people is the A+T-N+ group (i.e., people who have elevated amyloid and neurodegeneration, but are tau-negative), as amyloid alone (that is, amyloid without tau) is not thought to cause significant cognitive impairment or brain atrophy. Our hypothesis was that, compared to A+T+N+ (a set of typical-AD biomarkers), A+T-N+ have cognitive and neuroimaging profiles that deviate from a typical Alzheimer’s Disease pattern – i.e., with less memory loss and less atrophy in AD-signature regions – and may have biomarkers suggestive of alternate non-AD pathologies [e.g., white matter hyperintensities (WMHs), a marker of CVD]. (more…)
Alzheimer's - Dementia, Author Interviews, End of Life Care, JAMA, University of Pennsylvania / 30.04.2019

MedicalResearch.com Interview with: Emily Largent, PhD, JD, RN Assistant Professor, Medical Ethics and Health Policy Perelman School of Medicine Leonard Davis Institute of Health Economics University of Pennsylvania  MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  Public support for aid in dying in the United States is rapidly growing.  As a result, we’re now seeing debates about whether to expand access to aid-in-dying to new populations – such as people with Alzheimer’s disease – who wouldn’t be eligible under current laws. With those debates in mind, we asked currently healthy people who recently learned about their risk for developing Alzheimer’s disease dementia (i.e., due to the presence of amyloid, an Alzheimer’s disease biomarker) whether they would be interested in aid-in-dying. Our findings suggest that about 20% of individuals with elevated amyloid may be interested in aid-in-dying if they become cognitively impaired.   (more…)
Author Interviews, Education, JAMA, University of Pennsylvania / 16.04.2019

MedicalResearch.com Interview with: Krisda Chaiyachati, MD, MPH, MSHP Assistant Professor Medicine, Perelman School of Medicine Clinical Innovation Manager Penn's Center for Health Care Innovation Perelman School of Medicine Medical Director, Penn Medicine's FirstCall Virtual Care   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The United States spends more than $12 billion annually on training young doctors who have rates of burnout and depression at an alarmingly high rate. Yet, we have limited evidence as to what they are doing while training in the hospital. We sought to glimpse into how their day is spent. In the largest study to date, we observed 80 first-year internal medicine physicians (“interns”) for nearly 2200 hours across 194 work shifts at 6 different sites. Our research sought to understand what medical residents did by categorizing training activities into themes such as time spent in education or patient care.  (more…)