Drug Overdoses and Mental Disorders Tied to Drop in Longevity in US

MedicalResearch.com Interview with:

Samuel Preston, Ph.D. Professor of Sociology University of Pennsylvania 

Dr. Preston

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. Continue reading

Prostate Cancer: Effects of Hormone Therapy on Cognitive Function Addressed in Large Study

MedicalResearch.com Interview with:

Ravi Jayadevappa, PhD, MS Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-2676 

Dr. Jayadevappa

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.

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More Appointments with Advanced Care Practitioners Linked to Medicaid Expansion

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 

Dr. Candon

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.  Continue reading

Blood Test Abnormalities Rare During Isotretinoin Treatment for Cystic Acne

MedicalResearch.com Interview with:

John Barbieri, MD, MBA Hospital & Health Care University of Pennsylvania 

Dr. Barbieri

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.

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Medicaid Expansion Linked to Reduced Deaths from Heart Disease

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

Dr. Khatana

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.

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Do Hospitals Designated as Centers of Excellence Have Better Outcomes?

MedicalResearch.com Interview with:

Sameed Khatana, MDFellow, Cardiovascular Medicine, Perleman School of MedicineAssociate Fellow, Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania

Dr. Khatana

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. 

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Amyloid and Tau Biomarkers Help Distinguish Alzheimer’s from Other Forms of Mild Cognitive Impairment

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].

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Some with Elevated Alzheimer’s Biomarkers Interested in Aid-in-Dying Information

MedicalResearch.com Interview with:

Emily Largent, PhD, JD, RNAssistant Professor, Medical Ethics and Health PolicyPerelman School of MedicineLeonard Davis Institute of Health EconomicsUniversity of Pennsylvania

Dr. Largent

Emily Largent, PhD, JD, RN
Assistant ProfessorMedical 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.  

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Medical Interns Spend 87 percent of Their Work Time Away From Patients

MedicalResearch.com Interview with:

Krisda Chaiyachati, MD, MPH, MSHPAssistant Professor , Medicine, Perelman School of MedicineClinical Innovation Manager, Penn's Center for Health Care InnovationPerelman School of MedicineMedical Director, Penn Medicine's FirstCall Virtual Care

Dr. Chaiyachati

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.  Continue reading

Patients’ Trust in Medical Profession Declined After Open Payments

MedicalResearch.com Interview with:

Genevieve Kanter, PhD Assistant Professor Department of Health Management and Policy Drexel University Dornsife School of Public Health Philadelphia, PA

Dr. Genevieve Kanter


Genevieve P. Kanter, PhD

Assistant Professor (Research) of Medicine
Medical Ethics and Health Policy
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA  19104-6021

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

 

Response: Physicians frequently have financial relationships with pharmaceutical and medical device firms, but only recently has information on these financial ties been made available to the public. The Open Payments program, created by the Physician Payment Sunshine Act, has made this industry payments information available through a public website since 2014.

Because transparent institutions are believed to engender greater public trust, public disclosure of industry payments could increase public trust in the medical profession, which may have been weakened by physicians’ relationships with industry. On the other hand, Open Payments may have decreased public trust because of the focus of media reporting on physicians receiving the largest sums of money.

We sought to investigate how Open Payments and the public disclosure of industry payments affected public trust in physicians and in the medical profession. We compared changes in trust among patients who lived in states where payments information had, by state statute, previously been made available, to changes in trust among patients who lived in states where this information became newly available through Open Payments.

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Sunshine Act Has Not Increased Number of Patients Who Know Whether Their Own Physician Receives Industry Payments

MedicalResearch.com Interview with:

Genevieve P. Kanter, PhDAssistant Professor (Research) of Medicine, Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of MedicinePhiladelphia, PA  19104-6021

Dr. Kanter

Genevieve P. Kanter, PhD
Assistant Professor (Research) of Medicine
Medical Ethics and Health Policy
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA 

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

Response: In 2010, the US Congress—concerned about the adverse influence of financial relationships between physicians and drug and device firms, and the lack of transparency surrounding these relationships—enacted the Physician Payments Sunshine Act. This legislation required pharmaceutical and medical device firms to report, for public reporting through the Open Payments program, the payments that these firms make to physicians.

We sought to evaluate the effect of Open Payments’ public disclosure of industry payments information on US adults’ awareness of the issue of industry payments and knowledge of whether their physicians’ had received industry payments.  Continue reading

Genes Linked to Alcohol Use Disorder Identified

MedicalResearch.com Interview with:

Henry R. Kranzler, MDProfessor of PsychiatryPerelman School of MedicineUniversity of Pennsylvania

Dr. Kranzler

Henry R. Kranzler, MD
Professor of Psychiatry
Perelman School of Medicine
University of Pennsylvania

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

Response: Alcohol consumption and alcohol use disorder (AUD) are moderately heritable traits.  To date, genome-wide association studies (GWAS) have not examined these traits in the same sample, which limits an assessment of the extent to which genetic variation is unique to one or the other or shared.

This GWAS examined a large sample (nearly 275,000 individuals) from the U.S. Veterans Affairs Million Veteran Program (MVP) for whom data on both alcohol consumption and alcohol use disorder diagnoses were available from an electronic health record.  We identified 18 genetic variants that were significantly associated with either alcohol consumption, AUD, or both. Five of the variants were associated with both traits, eight with consumption only, and five with alcohol use disorder only.  Continue reading

Not All Skilled Nursing Patients Seen Promptly By Physicians After Transfer From Hospital

MedicalResearch.com Interview with:

Kira L. Ryskina  MD MSAssistant Professor Of MedicineDivision of General Internal MedicinePerelman School of Medicine, University of Pennsylvania

Dr. Ryskina

Kira L. Ryskina  MD MS
Assistant Professor Of Medicine
Division of General Internal Medicine
Perelman School of Medicine,
University of Pennsylvania 

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

Response: Post-acute care in skilled nursing facilities (SNF or sometimes called subacute rehab) is a very common discharge destination after a hospital stay. Patients discharged to these facilities represent more clinically complex and high-need patients than patients discharged home.

We wanted to understand how soon after discharge from the hospital to a skilled nursing facility are patients seen by a physician. We found that first visits by a physician or advanced practitioner (a nurse practitioner or physician assistant) for initial medical assessment occurred within four days of SNF admission in 71.5 percent of the stays. However, there was considerable variation in days to first visit at the regional, facility, and patient levels.

One in five initial physician visits occurred more than 4 days after admission to skilled nursing facilities.  In 10.4 percent of stays there was no physician or advanced practitioner visit. Much of the variability in visit timing had to do with SNF characteristics and geography compared to patient clinical or demographic characteristics. Patients who did not receive a physician visit had nearly double the rates of readmissions or deaths compared to patients who were seen.  Continue reading

Flexible Medical Resident Duty Hours Did Not Pose Risks To Patients

MedicalResearch.com Interview with:

Jeffrey H. Silber, MD, PhDDirector, Center for Outcomes ResearchNancy Abramson Wolfson Endowed Chair in Health Services ResearchChildren's Hospital of PhiladelphiaProfessor of Pediatrics, Anesthesiology and Critical CarePerelman School of Medicine, University of PennsylvaniaProfessor of Health Care ManagementWharton School, University of Pennsylvania

Dr. Silber

Jeffrey H. Silber, MD, PhD
Director, Center for Outcomes Research
Nancy Abramson Wolfson Endowed Chair
Health Services Research
Children’s Hospital of Philadelphia
Professor of Pediatrics, Anesthesiology and Critical Care
Perelman School of Medicine, University of Pennsylvania
Professor of Health Care Management
Wharton School, University of Pennsylvania 

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

Response: This was a year-long randomized trial that involved 63 internal medicine residency programs from around the US.  In 2015-2016, about half of the programs were randomized to follow the existing rules about resident duty hours that included restrictions on the lengths of shifts and the rest time required between shifts (the standard arm of the trial) and the other half of the programs didn’t have those shift length or rest period rules (the flexible arm of the trial).  We measured what happened to the patients cared for in those programs (the safety study), and other studies examined how much sleep the residents received, and how alert they were at the end of shifts (the sleep study), and previously we published on the educational outcomes of the interns.

To measure the impact on patient outcomes when allowing program directors the ability to use a flexible shift length for their interns, we compared patient outcomes after the flexible regimen went into place to outcomes the year before in the same program. We did the same comparison for the standard arm. Then we compared the difference between these comparisons. Comparing before and after the implementation of the trial within the same program allowed us to be more confident that a particularly strong or weak program, or a program with especially sick or healthy patients, would not throw off the results of the study. The trial was designed to determine, with 95% confidence, if the flexible arm did not do more than 1% worse than the standard arm. If this were true for the flexible arm, we could say the flexible regimen was “non-inferior” to the standard regimen.

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Variations in Humans Related to Both Nuclear and Mitochondrial DNA

MedicalResearch.com Interview with:

Arslan Zaidi PhD University of Pennsylvania

Dr. Zaidi

Arslan Zaidi PhD
University of Pennsylvania and

Kateryna Makova, Ph.D.
Francis R. and Helen M. Pentz Professor
Director, Center for Medical Genomics
Department of Biology
Penn State University
University Park, PA 16802

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

Response: Mitochondria are organelles that are involved in vital functions in eukaryotic cells, e.g., energy production. Even though they carry their own DNA (mitochondrial DNA, or mtDNA), most of the proteins required for mitochondrial function are encoded by the nuclear genome. Thus, mitochondrial and nuclear proteins must work together in a coordinated manner for proper mitochondrial function. These interactions can sometimes be disrupted leading to phenotypic consequences in inter-species and inter-population laboratory crosses of model organisms when the ancestry of the mitochondrial genome is very different from the nuclear genome.

While human populations are genetically not very different from each other, it has been suggested that recent admixture between geographically distant populations might also have phenotypic consequences in humans. We investigated whether there is evidence for this in six different recently admixed populations from the Americas.

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Youth with Conduct Problems More Likely To Use Cannabis

MedicalResearch.com Interview with:

Dan Romer PhD Research director, Annenberg Public Policy Center Director of its Adolescent Communication Institute University of Pennsylvania

Dr. Daniel Romer

Daniel Romer PhD
Annenberg Public Policy Center
The University of Pennsylvania
Philadelphia, PA

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

Response: Previous research has found some troubling relations between adolescent cannabis use and subsequent increases in conduct problems and other unhealthy consequences.  These studies were done in New Zealand in the late 90’s and we wanted to re-examine those relationships using more contemporary data in the US.

We had data on 364 adolescents who were followed from age 13 to 19 in Philadelphia that could provide a more up to date picture of the effects of using cannabis on one important outcome, conduct disorder.  We also wanted to use more sensitive methods than had been used in prior research that would enable us to examine reciprocal relations between cannabis use and c (CP).  That is, it might be the case that youth with CP are prone to using cannabis and that this helps to explain why there appears to be a relation over time between cannabis use and CP rather than cannabis use leading to CP.

Our findings supported that hypothesis.  There was no prospective relation between changes in cannabis use and subsequent changes in conduct problems.  Instead, changes in conduct problems were found to predict changes in use of cannabis.  Youth with conduct problems also affiliated more with peers who used cannabis, adding further to their own use.  There was also no evidence that youth who used cannabis sought out peers who used it apart from the effects of CP.

Finally, both use of cannabis and  conduct problems predicted subsequent development of a mild cannabis use disorder (CUD).  Continue reading

Is Social Media Making You Depressed and Lonely?

MedicalResearch.com Interview with:
Melissa G. Hunt, Ph.D. Diplomate - Academy of Cognitive Therapy Chair - PENDELDOT Associate Director of Clinical Training Department of Psychology University of PennsylvaniaMelissa G. Hunt, Ph.D.

Diplomate – Academy of Cognitive Therapy
Chair – PENDELDOT
Associate Director of Clinical Training
Department of Psychology
University of Pennsylvania


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

Response: Lots of prior research has established a correlation, or association, between social media use and depression.  Ours is the first study to establish an actual causal relationship between using more social media, and feeling more depressed.   Continue reading

Errors in Dementia Drugs Surprising Common in Parkinson’s Disease

MedicalResearch.com Interview with:

Allison W. Willis, MD, MS Assistant Professor of Neurology Assistant Professor of Biostatistics and Epidemiology Senior Fellow, Leonard Davis Institute Senior Scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine

Dr. Willis

Allison W. Willis, MD, MS
Assistant Professor of Neurology
Assistant Professor of Biostatistics and Epidemiology
Senior Fellow, Leonard Davis Institute
Senior Scholar, Center for Clinical Epidemiology and Biostatistics
University of Pennsylvania School of Medicine

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

Response: This study was motivated by my own experiences as a neurologist-neuroscientist.

I care for Parkinson disease patients, and over the year, have had numerous instances in which a person was taking a medication that could interact with their Parkinson disease medications, or could worsen their PD symptoms.
Continue reading

Medicare’s Bundled Payment Program–Does it Change Hospital Volume or Case Mix?

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
Penn Leonard Davis Institute of Health Economics

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

Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients.

Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched.

The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  Continue reading

 Four Brain-Guided Dimensions of Psychopathology: Mood, Psychosis, Fear, and Disruptive Behavior

MedicalResearch.com Interview with:
MedicalResearch.com Interview with: Dr. Theodore Satterthwaite MD Assistant professor in the department of Psychiatry, and Cedric Xia, a MD-PhD candidate Perelman School of Medicine at the University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unlike other branches of modern medicine, psychiatry still solely replies on patient reports and physician observations for clinical decision-making. Without biologically-based tests, the diagnostic categories for mental health do not carve nature at its joint. This is evident in the high levels of co-morbidity across disorders and heterogeneity within disorders. Through this research, we studied a large sample of adolescents who completed MRI-based functional imaging, and used recently-developed machine learning techniques to uncover specific abnormalities that are highly predictive of a wide variety of psychiatric symptoms. Essentially, we tried to find brain patterns that were predictive of different types of psychiatric symptoms. We discovered four such brain-guided dimensions of psychopathology: mood, psychosis, fear, and disruptive behavior. While each of these dimensions exhibits a unique pattern of brain connectivity, a common feature of brain anomaly is shared across the dimensions. Notably, in all linked dimensions, the default mode network and fronto-parietal network, two brain regions that usually become increasingly distinct as the brain matures, were abnormally connected. This loss of normal brain network segregation supports the hypothesis that many psychiatric illnesses may be disorders of brain development. MedicalResearch.com: What should readers take away from your report? Response: This study shows that we can start to use the brain to guide our understanding of psychiatric disorders in a way that’s fundamentally different than grouping symptoms into clinical diagnostic categories. By moving away from clinical labels developed decades ago, we can begin to let the biology speak for itself. Our ultimate hope is that understanding the biology of mental illnesses will allow us to develop better treatments for our patients. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: This study demonstrates the importance of incorporating vast amounts of biological data to study mental illness across clinical diagnostic boundaries. Moving forward, we hope to integrate genomic data in order to describe pathways from genes to brain to symptoms, which could ultimately be the basis for novel treatments for mental illness. MedicalResearch.com: Is there anything else you would like to add? Response: Future breakthroughs in brain science to understand mental illness requires large amount of data. While the current study takes advantage of one of the largest samples of youth, the size (n=999) remains dwarfed by the complexity of the brain. The neuroscience community is actively working towards collecting higher quality data in even larger samples, so we can validate and build upon the findings. Citation: Cedric Huchuan Xia, Zongming Ma, Rastko Ciric, Shi Gu, Richard F. Betzel, Antonia N. Kaczkurkin, Monica E. Calkins, Philip A. Cook, Angel García de la Garza, Simon N. Vandekar, Zaixu Cui, Tyler M. Moore, David R. Roalf, Kosha Ruparel, Daniel H. Wolf, Christos Davatzikos, Ruben C. Gur, Raquel E. Gur, Russell T. Shinohara, Danielle S. Bassett, Theodore D. Satterthwaite. Linked dimensions of psychopathology and connectivity in functional brain networks. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-05317-y  [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
Dr. Theodore Satterthwaite MD
Assistant professor in the department of Psychiatry, and
Cedric Xia, a MD-PhD candidate
Perelman School of Medicine at the University of Pennsylvania

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

Response: Unlike other branches of modern medicine, psychiatry still solely replies on patient reports and physician observations for clinical decision-making. Without biologically-based tests, the diagnostic categories for mental health do not carve nature at its joint. This is evident in the high levels of co-morbidity across disorders and heterogeneity within disorders.

Through this research, we studied a large sample of adolescents who completed MRI-based functional imaging, and used recently-developed machine learning techniques to uncover specific abnormalities that are highly predictive of a wide variety of psychiatric symptoms. Essentially, we tried to find brain patterns that were predictive of different types of psychiatric symptoms. We discovered four such brain-guided dimensions of psychopathology: mood, psychosis, fear, and disruptive behavior.

While each of these dimensions exhibits a unique pattern of brain connectivity, a common feature of brain anomaly is shared across the dimensions. Notably, in all linked dimensions, the default mode network and fronto-parietal network, two brain regions that usually become increasingly distinct as the brain matures, were abnormally connected. This loss of normal brain network segregation supports the hypothesis that many psychiatric illnesses may be disorders of brain development. Continue reading

Not All HDL Cholesterol is Good – Size Matters

MedicalResearch.com Interview with:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA Associate Professor, Epidemiology PITT Public Health Epidemiology Data Center University of Pittsburgh Pittsburgh, PA 15260 

Dr. El Khoudary

Samar R. El Khoudary, Ph.D., M.P.H. BPharm, FAHA
Associate Professor
Department of Epidemiology
University of Pittsburgh Graduate School of Public Health

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

Response: The background for this study is based on the current measurements used to determine cardiovascular disease risk in postmenopausal women. Higher levels of HDL “good cholesterol” as measured by the widely available clinical test, HDL-Cholesterol, may not always be indicative of a lower risk of cardiovascular disease in postmenopausal women.

HDL is a family of particles found in the blood that vary in sizes, cholesterol contents and function. HDL particles can become dysfunctional under certain conditions such as chronic inflammation. HDL has traditionally been measured as the total cholesterol carried by the HDL particles, known as HDL cholesterol. HDL cholesterol, however, does not necessarily reflect the overall concentration, the uneven distribution, or the content and function of HDL particles.

We looked at 1,138 women aged 45 through 84 enrolled across the U.S. in the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH). MESA began in 1999 and is still following participants today. We assessed two specific measurements of HDL: the number and size of the HDL particles and total cholesterol carried by HDL particles. Our study also looked at how age when women transitioned into post menopause, and the amount of time since transitioning, may impact the expected cardio-protective associations of HDL measures.

Our study points out that the traditional measure of the good cholesterol, HDL cholesterol, fails to portray an accurate depiction of heart disease risk for postmenopausal women. We reported a harmful association between higher HDL cholesterol and atherosclerosis risk that was most evident in women with older age at menopause and who were greater than, or equal to, 10 years into post menopause. In contrast to HDL cholesterol, a higher concentration of total HDL particles was associated with lower risk of atherosclerosis. Additionally, having a high number of small HDL particles was found beneficial for postmenopausal women. These findings persist irrespective of age and how long it has been since women became postmenopausal.

On the other hand, large HDL particles are linked to an increased risk of cardiovascular disease close to menopause. Women are subject to a variety of physiological changes in their sex hormones, lipids, body fat deposition and vascular health as they transition through menopause. We are hypothesizing that the decrease of estrogen, a cardio-protective sex hormone, along with other metabolic changes, can trigger chronic inflammation over time, which may alter the quality of HDL particles. Future studies should test this hypothesis.

The study findings indicate that measuring size and number of HDL particles can better reflect the well-known cardio-protective features of the good cholesterol in postmenopausal women. Continue reading

Could Oxytocin Be a Social Equalizer?

MedicalResearch.com Interview with:
“Monkeys” by Dmitry Baranovskiy is licensed under CC BY 2.0Yaoguang Jiang PhD
Postdoctoral Researcher
PLATT Lab
University of Pennsylvania 

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

Response: Oxytocin (OT) and arginine vasopressin (AVP) are important neuropeptides known to influence social behaviors in a wide array of mammals. In humans, OT is widely referred to as the ‘prosocial’ hormone and is thought to promote social functions in neurotypical individuals as well as those diagnosed with autism spectrum disorder (ASD). Currently, dozens of ongoing clinical trials in the US are trying to evaluate the therapeutic potential of these neuropeptides in remedying social deficits associated with disorders such as ASD. Yet there are significant gaps in our knowledge especially regarding the neurobiological basis of OT and AVP function. Most importantly, we are unclear which brain areas and pathways these neuropeptides act on to influence social behavior. Additionally, due to strong similarity in molecular structure, OT can bind to AVP receptors with high affinity and vice versa, making it difficult to rule out the possibility that, for example, the behavioral effect of exogenous oxytocin is mediated through the AVP system. Both of these questions have been thoroughly investigated in rodents, but unfortunately the same thing cannot be said for humans.

Our study aims to bridge the gap between rodent and human literature on neuropeptide function by studying rhesus macaque monkeys. These monkeys resemble human beings not only in their social behaviors, but also in the neural network that is supporting those behaviors. In this study we show that treating one male macaque monkey intranasally with aerosolized OT relaxes his spontaneous social interactions with another monkey.

Oxytocin reduces differences in social behavior between dominant and subordinate monkeys, thereby flattening the status hierarchy.Oxytocin also increases behavioral synchrony within a pair, perhaps through increased attention and improved communication. Intranasal delivery of aerosolized AVP reproduces the effects of OT with greater efficacy. Remarkably, all behavioral effects are replicated when either OT or AVP is injected focally into the anterior cingulate gyrus (ACCg), a brain area linked to empathy, vicarious reward, and other-regarding behavior. ACCg lacks post-synaptic OT receptors but is rich in post-synaptic AVP receptors, suggesting exogenous OT may shape social behavior, in part, via nonspecific binding, particularly when available at supra-physiological concentrations.  Continue reading

Engineered Single Cell ‘Cured’ Patient of CLL

MedicalResearch.com Interview with:

Dr. J Joseph Melenhorst, PhD Director, Product Development & Correlative Sciences laboratories (PDCS) Adjunct Associate Professor Penn Medicine Center for Cellular Immunotherapies University of Pennsylvania

Dr. Melenhorst

Dr. J Joseph Melenhorst, PhD
Director, Product Development & Correlative Sciences laboratories (PDCS)
Adjunct Associate Professor
Penn Medicine
Center for Cellular Immunotherapies
University of Pennsylvania

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by CLL and CAR T cells? 

Response: We started treating patients with a form of blood cancer called CLL (chronic lymphocytic leukemia) using a form of gene therapy wherein we engineer the patient’s own immune cells – T cells – with a tumor targeting molecule: The CAR, which stands for chimeric antigen receptor. When we engineer the patient’s immune cells we use a vehicle, in this case virus, that inserts the payload – the CAR – into the patient’s DNA. The virus disappears, and the CAR stays. Where this CAR inserts itself is unpredictable, but we always get stably engineered cells.  Continue reading

Amyloid PET Scan Can Predict Progression to Alzheimer’s in Patients With Mild Cognitive Impairment

MedicalResearch.com Interview with:

David A. Wolk, MD Associate Professor Department of Neurology Co-Director, Penn Memory Center Associate Director, Alzheimer’s Disease Core Center University of Pennsylvania

Dr. Wolk

David A. Wolk, MD
Associate Professor
Department of Neurology
Co-Director, Penn Memory Center
Associate Director, Alzheimer’s Disease Core Center
University of Pennsylvania

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

Response: Mild Cognitive Impairment (MCI) is a state when individuals have mild memory problems, but not enough to impact day-to-day function.  Many patients with MCI are on the trajectory to developing Alzheimer’s Disease dementia, but about half will not and remain stable.  As such, patients with MCI are often uncertain about the likelihood they should expect to decline in the future which obviously may be associated with considerable anxiety and this may delay opportunities for them to plan for the future or begin therapeutic interventions.

This study examined the degree to which amyloid PET, which detects the amyloid pathology of Alzheimer’s Disease, a measure of shrinkage of the hippocampus with MRI, and cognitive measures predicted development of dementia over 3 years.  We found that each of these measures enhances prediction of whether an individual will or will not develop dementia in the future.  If all of these measures are positive, one has a very high risk of progression whereas if amyloid PET and the MRI measurement are normal, there is very little risk of progression. Continue reading

Maryland’s Global Budget Plan Did Not Change Hospital or Primary Care Usage

MedicalResearch.com Interview with:

Eric T. Roberts, PhD Assistant Professor of Health Policy & Management University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261

Dr. Roberts

Eric T. Roberts, PhD
Assistant Professor of Health Policy & Management
University of Pittsburgh Graduate School of Public Health
Pittsburgh, PA 15261

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

Response: There is considerable interest nationally in reforming how we pay health care providers and in shifting from fee-for-service to value-based payment models, in which providers assume some economic risk for their patients’ costs and outcomes of care.  One new payment model that has garnered interest among policy makers is the global budget, which in 2010 Maryland adopted for rural hospitals.  Maryland subsequently expanded the model to urban and suburban hospitals in 2014.  Maryland’s global budget model encompasses payments to hospitals for inpatient, emergency department, and hospital outpatient department services from all payers, including Medicare, Medicaid, and commercial insurers.  The intuition behind this payment model is that, when a hospital is given a fixed budget to care for the entire population it serves, it will have an incentive to avoid costly admissions and focus on treating patients outside of the hospital (e.g., in primary care practices).  Until recently, there has been little rigorous evidence about whether Maryland’s hospital global budget model met policy makers’ goals of reducing hospital use and strengthening primary care.

Our Health Affairs study evaluated how the 2010 implementation of global budgets in rural Maryland hospitals affected hospital utilization among Medicare beneficiaries.  This study complements work our research group published in JAMA Internal Medicine (January 16, 2018) that examined the impact of the statewide program on hospital and primary care use, also among Medicare beneficiaries.

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Declining Medicaid Fees Translates To Fewer Available Primary Care Appointments

MedicalResearch.com Interview with:

Molly Candon, PhD Postdoctoral Fellow, Leonard Davis Institute of Health Economics Center for Mental Health Policy and Services Research University of Pennsylvania

Dr. Candon

Molly Candon, PhD
Postdoctoral Fellow
Leonard Davis Institute of Health Economics
Center for Mental Health Policy and Services Research
University of Pennsylvania

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

Response: We conducted a secret shopper study in 2012, 2014, and 2016 in which simulated Medicaid patients called primary care practices and attempted to schedule an appointment. When Medicaid fees were increased to Medicare levels in 2013 and 2014, primary care appointment availability increased. Once the federally-funded program ended in 2015, most states returned to lower fees. As expected, provider participation in Medicaid declined as well.

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Transplant Network Undercaptures Post-Transplant Skin Cancers

MedicalResearch.com Interview with:

Thuzar M.Shin MD, PhD Assistant Professor of Dermatology Hospital of the University of Pennsylvania

Dr. Shin

Thuzar M.Shin MD, PhD
Assistant Professor of Dermatology
Hospital of the University of Pennsylvania

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

Response: The Organ Procurement Transplant Network (OPTN) collects data on cancers that develop after organ transplantation. Previous studies have shown incomplete reporting to the OPTN for many cancers (including melanoma). Skin cancer is the most common malignancy in solid organ transplant recipients and the most common post-transplant skin cancer, cutaneous squamous cell carcinoma (cSCC), is not captured in standard cancer registries. We hypothesized that cSCC and melanoma are underreported to the OPTN. When compared to detailed medical record review obtained from the Transplant Skin Cancer Network database (JAMA Dermatol. 2017 Mar 1;153(3):296-303), we found that the sensitivity of reporting to the OPTN was only 41% for cSCC and 22% for melanoma. The specificity (99% for cSCC and 100% for melanoma) and negative predictive values (93% for cSCC and 99% for melanoma) were high. As a result, the OPTN database is unable to robustly and reliably distinguish between organ transplant recipients with and without these two skin malignancies.

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Severe Psoriasis Linked To Increased Risk of Mortality

MedicalResearch.com Interview with:

Megan H. Noe MD, MPH Clinical Instructor and Post-Doctoral Research Fellow University of Pennsylvania, Department of Dermatology Perelman Center for Advanced Medicine Philadelphia, PA 19104

Dr. Megan Noe

Megan H. Noe MD, MPH
Clinical Instructor and Post-Doctoral Research Fellow
University of Pennsylvania, Department of Dermatology
Perelman Center for Advanced Medicine
Philadelphia, PA 19104

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

Response: Previous research has shown that patients with psoriasis have higher rates of hypertension, diabetes, cardiovascular disease and chronic kidney disease that may put them at an increased risk of death.

Our research found that patients with psoriasis covering more than 10% of their body had almost double the risk of death than people of the same age with similar medical conditions, but without psoriasis.

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Similar Signaling Pathways Trigger Anxiety In Variety of Species

MedicalResearch.com Interview with:

Yuanyuan Xie, PhD Postdoctoral Researcher Department of Neuroscience University of Pennsylvania Philadelphia, PA 19104

Dr.Yuanyuan Xie

Yuanyuan Xie, PhD
Postdoctoral Researcher
Department of Neuroscience
University of Pennsylvania
Philadelphia, PA 19104

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

Response: I joined Dr. Richard Dorsky’s lab in mid 2013 after a lab switch toward the end of the fourth year in my PhD. By then, the Dorsky lab at the University of Utah had published zebrafish lef1 mutants with a hypothalamic neurogenesis phenotype. I was asked to perform an RNA-sequencing (RNA-seq) experiment to identify Lef1-dependent genes. In doing so, I also characterized the cellular phenotype in the hypothalamus of our zebrafish mutants in a greater detail.

The first transition of this project happened when I proposed in late 2013 to test whether Lef1’s function was conserved in the mouse hypothalamus. Dr. Dorsky liked that idea, but told me that I could only pursue that idea if there was a Lef1-flox mouse strain available, because he did not want me to delay my graduation after a lab switch by making a new mouse line. Fortunately, a quick google search located the right mouse line published from the group of Dr. Hai-Hui Xue, who was generous enough to share some mice with us. Because the Dorsky lab was a zebrafish lab by then, we collaborated with Dr. Edward Levine to maintain our mice under his animal protocol. I was initially trained by Dr. Levine and his lab specialist Anna Clark for general mouse colony management. After Dr. Levine moved to Vanderbilt University in early 2016, we began to maintain our mice under Dr. Camille Fung’s animal protocol. Dr. Dorsky also supported me in attending a 3-week Cold Spring Harbor Laboratory Course on Mouse Development, Stem Cells & Cancer in mid 2015, which made me much more confident in handling mouse work afterwards.

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Diabetes Alters Oral Microbiome Leading to Periodontal Disease

MedicalResearch.com Interview with:

Dana T. Graves DDS Department of Periodontics School of Dental Medicine University of Pennsylvania Philadelphia, PA

Dr. Graves

Dana T. Graves DDS
Department of Periodontics
School of Dental Medicine
University of Pennsylvania
Philadelphia, PA

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

Response: It was previously thought that diabetes did not have a significant effect on oral bacteria. We found that diabetes caused a change in the composition of the oral bacteria. This change caused resulted in a bacterial composition that was more pathogenic and stimulated more inflammation in the gums and greater loss of bone around the teeth.

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