University of Pennsylvania
13 Feb Patient Demands Not A Significant Driver Of Health Care Costs
Posted at 01:33h
in Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania
MedicalResearch.com Interview with:
Ezekiel Jonathan Emanuel MD PhD
Department of Medical Ethics and Health Policy
Perelman School of Medicine and
Department of Health Care Management
The Wharton School University of Pennsylvania
Philadelphia, PA
Editor’s note: Dr. Emanuel is a medical oncologist as well as director of the department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel was kind enough to answer several questions regarding his most recent study, published in the new JAMA Oncology journal, Patient Demands and Requests for Cancer Tests and Treatments.
Medical Research: What is the background for this study? What are the main findings?
Dr. Emanuel: The genesis for this study is twofold.
One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers...all were more to blame than doctors themselves for the high cost of US health care.
Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience.
In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters).
We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means.
26 Jan Expired Medicaid Payment Bump Had Increased New Patient Appointment Availability
MedicalResearch.com Interview with:
Daniel Polsky PhD
Executive Director, Leonard Davis Institute of Health Economics
Professor of Medicine and Health Care Management
Perelman School of Medicine and the Wharton School
University of Pennsylvania
Medical Research: What is the background for this study? What are the main findings?
Dr. Polsky: The Medicaid Fee bump, a provision of the Affordable Care Act (ACA), raised Medicaid payments to Medicare levels in 2013 and 2014 for selected services and providers expired on January 1, 2015 before policymakers had much empirical evidence about its effects. The federally funded increase in reimbursements was aimed at expanding access to primary care for the growing number of Medicaid enrollees. The reimbursement increase expired at the end of 2014 in most states. We found that this policy worked to increase the number of providers offering primary care appointments to Medicaid patients. The Medicaid pay bump was associated with a 7.7 percentage points increase in new patient appointment availability without longer wait times. This increase in availability was largest in the states where primary care physicians received the largest increase in their Medicaid reimbursements.
30 Dec Racial Disparities in Colon Cancer Survival Persist
Posted at 01:41h
in Annals Internal Medicine, Author Interviews, Colon Cancer, Race/Ethnic Diversity, University of Pennsylvania
MedicalResearch.com Interview with:
Jeffrey H. Silber, M.D., Ph.D.
The Nancy Abramson Wolfson Endowed Chair in Health Services Research Director, Center for Outcomes Research
The Children's Hospital of Philadelphia
Professor of Pediatrics, Anesthesiology & Critical Care
The Perelman School of Medicine
Professor of Health Care Management, The Wharton School
The University of Pennsylvania Philadelphia, PA 19104
Medical Research: What is the background for this study? What are the main findings?
Response: Differences in colon cancer survival by race is a well recognized problem among Medicare beneficiaries. We wanted to determine to what extent the racial disparity in survival is due to a racial disparity in presentation characteristics at diagnosis (such as advanced stage and the presence of chronic diseases) versus a disparity in subsequent treatment by surgeons and oncologists.
To answer this question, we compared black colon cancer patients to three matched white groups:
(1) “Demographics” match controlling age, sex, diagnosis year, and Survey, Epidemiology, and End Results (SEER) site;
(2) “Presentation” match controlling demographics plus comorbidities and tumor characteristics including stage and grade; and
(3) “Treatment” match including presentation variables plus details of surgery, radiation and chemotherapy.
We studied Medicare patients 65 years of age and older diagnosed between 1991-2005 in the SEER-Medicare database. There were 7,677 black patients and 3 sets of 7,677 matched white controls.
We found that difference in 5-year survival (black-white) was 9.9% in the demographics match. This disparity remained unchanged between 1991-2005. After matching on presentation characteristics, this difference fell to 4.9%. Finally, after additionally matching on treatment, this same difference hardly changed, moving to only 4.3%. So the disparity in survival attributed to treatment differences comprised only an absolute 0.6% of the overall 9.9% survival disparity.
22 Nov Sleep Deprivation: Specific Molecular Changes Lead To Memory Impairment
MedicalResearch.com Interview with: Jennifer Choi Tudor, Ph.D. Postdoctoral Fellow Ted Abel Lab Department of Biology 10-17 Smilow Center for Translational Research Philadelphia, PA 19104 Medical Research: What is the background for this study? What are the main findings? Dr. Tudor: We (Dr. Tudor, Dr. Abel, and colleagues) are interested in better understanding the molecular changes that occur with sleep deprivation. Previously, we found that the expression of over 500 genes changes with sleep deprivation and that many of the genes were involved with protein synthesis. Upon further investigation, we found that 5 hours of sleep deprivation impairs protein synthesis in the hippocampus, a brain region critical for memory. This impairment is due to changes in mammalian target of rapamycin (mTOR) signaling and eukaryotic initiation factor 4E binding protein 2 (4EBP2) is critical to this process. When we boosted levels of 4EBP2 in the hippocampus, mice that were sleep deprived were resistant to the detrimental effects of sleep deprivation on memory.10 Nov Septic Shock Patients Often Require Hospital Readmission
Posted at 14:38h
in Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, University of Pennsylvania
MedicalResearch.com Interview with:
Mark E Mikkelsen, MD, MSCE
Assistant Professor of Medicine
Hospital of the University of Pennsylvania
Medical Research: What is the background for this study? What are the main findings?
Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized?
We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice.
22 Oct Shared Savings May Promote Lower Costs With Equally Effective Health Care
MedicalResearch.com Interview with
Dr. Harald Schmidt, MA, PhD
Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine
University of Pennsylvania Philadelphia, PA 19104-3308
Medical Research: What are the main findings of the study?
Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions.
15 Oct Sepsis-Sniffer Tool Better Identifies Patients Requiring Advance Care
MedicalResearch.com Interview with:
Craig A Umscheid, MD, MSCE, FACP
Assistant Professor of Medicine and Epidemiology
Director, Center for Evidence-based Practice
Medical Director, Clinical Decision Support
Chair, Department of Medicine Quality Committee
Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center, University of Pennsylvania Philadelphia, PA 19104
Medical Research: What are the main findings of the study?
Dr. Umscheid: We developed an automated early warning and response system for sepsis that has resulted in a marked increase in sepsis identification and care, transfer to the ICU, and an indication of fewer deaths due to sepsis.
Sepsis is a potentially life-threatening complication of an infection; it can severely impair the body’s organs, causing them to fail. There are as many as three million cases of severe sepsis and 750,000 resulting deaths in the United States annually. Early detection and treatment, typically with antibiotics and intravenous fluids, is critical for survival.
The Penn prediction tool, dubbed the “sepsis sniffer,” uses laboratory and vital-sign data (such as body temperature, heart rate, and blood pressure) in the electronic health record of hospital inpatients to identify those at risk for sepsis. When certain data thresholds are detected, the system automatically sends an electronic communication to physicians, nurses, and other members of a rapid response team who quickly perform a bedside evaluation and take action to stabilize or transfer the patient to the intensive care unit if warranted.
We developed the prediction tool using 4,575 patients admitted to the University of Pennsylvania Health System (UPHS) in October 2011. We then validated the tool during a pre-implementation period from June to September 2012, when data on admitted patients was evaluated and alerts triggered in a database, but no notifications were sent to providers on the ground. Outcomes in that control period were then compared to a post-implementation period from June to September 2013. The total number of patients included in the pre and post periods was 31,093.
12 Sep Global Variations in microRNAs Linked To Cancer Disparities
Posted at 14:58h
in Author Interviews, Cancer Research, Genetic Research, University of Pennsylvania
MedicalResearch.com Interview with:
Renata Afi Rawlings-Goss, Ph.D.
Postdoctoral Fellow
Tishkoff Lab, University of Pennsylvania
Medical Research: What are the main findings of the study?
Dr. Rawlings-Goss: We found genetic mutations in key gene regulators that have been linked to ethnic disparities in cancer. Our investigation identified more than 30 previously undescribed mutations in important regulatory molecules called microRNAs. Individual microRNA molecules can regulate large numbers of genes in some cases over 6000 genes at once. Therefore, mutations in these genes have been linked to numerous diseases. By and large, however, microRNA mutations have not been studied in people of diverse ethnic backgrounds.
13 Jun Obstructive Sleep Apnea: Obesity, Sleep Apnea and Hypertension Linked
Posted at 10:46h
in Author Interviews, NEJM, Obstructive Sleep Apnea, University of Pennsylvania, Weight Research
MedicalResearch.com Interview with:
Julio A. Chirinos, MD, PhD
Assistant Professor of Medicine
Director, CTRC Cardiovascular Phenotyping Unit
Perelman School of Medicine, University of Pennsylvania
Director of Non-Invasive Imaging
Philadelphia VA Medical Center
MedicalResearch: What are the main findings of the study?
Dr. Chirinos: The main findings of the study is that, among patients with obesity and moderate to severe obstructive sleep apnea, obesity, rather than OSA, appears to be the primary cause of inflammation, insulin resistance and dyslipidemia. However, both obesity and obstructive sleep apnea appear to be causally related to hypertension. In this population, weight loss, but not CPAP, can be expected to reduce the burden of inflammation, insulin resistance and dyslipidemia. However, CPAP, among patients who comply with therapy, can be expected to provide a significant incremental benefit on blood pressure. The latter is an important potential benefit of CPAP and should not be disregarded.
16 May Antidepressants May Slow Growth of Brain Amyloid Plaques
MedicalResearch.com Interview with:
Yvette I. Sheline, M.D.
Professor of Psychiatry, Radiology, Neurology
Director, Center for Neuromodulation in Depression and Stress (CNDS)
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA 19104
MedicalResearch: What are the main findings of this study?
Prof. Sheline: The main findings were that in transgenic mice who are genetically altered to develop Alzheimer's amyloid plaques, citalopram dramatically slowed the growth of plaques but did not cause existing plaques to shrink. In normal young people, it decreased the production of amyloid.
11 Apr Mental Illness Raises Risk of HIV Infection
MedicalResearch.com Interview with:
Michael B. Blank, PhD
Associate Professor of Psychology in Psychiatry
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104-3309
MedicalResearch.com: What are the main findings of the study?
Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection.
09 Mar Decreasing Bacterial Contamination from Surgical Gloves, Gowns
Posted at 02:14h
in Author Interviews, Hospital Acquired, Infections, NIH, Surgical Research, University of Pennsylvania, Wake Forest
MedicalResearch.com Interview with:
William G Ward, Sr. MD
Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line - Guthrie Clinic
Sayre, Pennsylvania 18840
(Professor Emeritus - Wake Forest University Dept of Orthopaedic Surgery)
MedicalResearch.com: What are the main findings of this study?
Dr. Ward: The main findings of the study include:
- The use of disposable spun-lace “paper” gowns was associated with a dramatic decrease in the likelihood of culture-detected bacterial contamination on the surgeon’s gloved hand and gown sleeve.
- For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%.
- Bacteria suspended in saline solution transgressed the material of standard reusable scrub attire in 96% (26/27) of tested gowns and in 0% (0/27) of spun-lace disposable “paper” gowns.
05 Mar Genetically Elevated BMI Raises Risks of Hypertension and Diabetes
Posted at 21:44h
in Author Interviews, Blood Pressure - Hypertension, Diabetes, Genetic Research, University of Pennsylvania
MedicalResearch.com Interview with:
Brendan Keating D.Phil
Assistant Professor, Dept of Pediatrics and Surgery, University of Pennsylvania
Lead Clinical Data Analyst, Center for Applied Genomics
Children's Hospital of Philadelphia
Michael V. Holmes, MD, PhD, MSc, BSc, MRCP
Transplant Surgery
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
MedicalResearch.com: What are the main findings of the study?
Answer: We found that individuals with a genetically-elevated BMI had higher
blood pressure, inflammatory markers, metabolic markers and a higher
risk of type 2 diabetes, although there was little correlation with
coronary heart disease in this study population of over 34,500
European-descent individuals of whom over 6,000 had coronary heart
disease.
04 Mar Hospital Mortality: Association With Nurses’ Work Load and Education
Posted at 00:25h
in Author Interviews, Health Care Systems, Lancet, Nursing, University of Pennsylvania
MedicalResearch.com Interview with:
Professor Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology
Director of the Center for Health Outcomes and Policy Research
Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
MedicalResearch.com: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. Against that backdrop, can you start by letting us know the background of the study?
Prof. Aiken: European Surgical Outcomes Study in 28 countries showed higher than necessary deaths after surgery.
A comparable study in the US showed that despite the nation spending hundreds of millions of dollars on improving patient safety, there were no improvements in adverse outcomes after surgery in US hospitals between 2000 and 2009. Clearly it is time to consider new solutions to improving hospital care for surgical patients, who make up a large proportion of all hospital admissions. Our study was designed to determine whether there are risks for patients of reducing hospital nurse staffing, and what, if any, are the benefits to patients of moving to a more educated nurse workforce.
03 Mar After Outgrowing One Food Allergy, Some Patients Develop Second Allergic Reaction to Same Food
MedicalResearch.com Interview with: Jonathan M. Spergel, M.D., Ph.D. The Children's Hospital of Philadelphia Chief, Allergy Section Associate Professor of Pediatrics Perelman School of Medicine at the University of Pennsylvania MedicalResearch.com: What are the main findings of the study? Dr. Spergel: We were examining patients with Eosinophilic Esophagitis, an unique food allergy of the esophagus. We found...
14 Feb Gene Modifies Response to Topiramate in Heavy Drinkers
MedicalResearch.com Interview with:
Henry R. Kranzler, MD
Professor, Department of Psychiatry
Director of the Center for Studies of Addiction.
University of Pennsylvania Perelman School of Medicine, Philadelphia
MedicalResearch.com: What are the main findings of the study?
Dr. Kranzler: The study had two main findings:
- First, topiramate, at a maximal dosage of 200 mg/day, which is lower than the 300 mg/day used in prior treatment trials, substantially reduced the frequency of heavy drinking and increased the frequency of abstinent days more than placebo. The lower dosage was well tolerated.
- Second, a variant in a gene that encodes a receptor subunit that binds topiramate moderated the response to topiramate. That is, C-allele homozygotes in the single nucleotide polymorphism rs2832407 in GRIK1, the gene encoding the GluK1 subunit of the kainate receptor, were the subgroup that accounted for the effects of topiramate on heavy drinking. This has important implications for the personalized treatment of alcohol use disorder, in that 40% of people of European ancestry have this genotype and, if confirmed, these findings would make it possible to screen people genetically to select an effective treatment.
13 Feb Teledermatololgy As Triage Tool For Dermatology Hospital Consultation
MedicalResearch.com Interview with:
Dr. Misha A. Rosenbach
Assistant Professor of Dermatology Hospital of the University of Pennsylvania Section Editor,
JAMA Dermatology Patient Page
MedicalResearch.com: What are the main findings of the study? Dr. Rosenbach: There is strong agreement between teledermatologists and in-person dermatologists when evaluating inpatients at a tertiary care academic hospital. The primary aim of this study was to assess telederm as a triage tool. Many dermatologists are not full-time hospitalists, but work in private practice or clinics which may be remote from affiliated hospitals. The goal was to evaluate whether teledermatology could help those providers assess the acuity of inpatient consults. There was strong concordance.
26 Dec Gastroparesis: Nortriptyline Found Ineffective
 MedicalResearch.com Interview Invitation with
Henry P. Parkman, MD
Professor, Medicine
Director, GI Motility Laboratory
Temple University, Philadelphia, Pennsylvania |
| MedicalResearch.com: What are the main findings of the study? Dr. Parkman: Gastroparesis remains a challenging syndrome to manage with few effective treatments and a lack of rigorously controlled trials. Tricyclic antidepressants are often used to treat refractory symptoms of nausea, vomiting, and abdominal pain. Evidence from well-designed studies for this is lacking. However, in this study, among patients with idiopathic gastroparesis, the use of nortriptyline compared with placebo for 15 weeks did not result in improvement in overall symptoms. These findings do not support the use of nortriptyline for idiopathic gastroparesis. |
19 Dec Costs of Health Care: Teaching Medical Residents How to Provide Cost-Conscious Care
Posted at 00:04h
in Author Interviews, Cost of Health Care, Education, JAMA, University of Pennsylvania
MedicalResearch.com Interview with:
Mitesh Patel, MD, MBA
RWJF Clinical Scholar, University of Pennsylvania
Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care. We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care. Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts.
06 Dec Medical School Minority Faculty Not Markedly Increased by Development Programs
MedicalResearch.com Interview with:
James Guevara, MD, MPH
Associate Professor of Pediatrics & Epidemiology
Senior Diversity Search Advisor, Perelman School of Medicine
University of Pennsylvania,Director of Interdisciplinary Initiatives
PolicyLab: Center to Bridge Research, Practice, & Policy
The Children's Hospital of Philadelphia,Philadelphia, PA 19104
MedicalResearch.com: What did the study attempt to address?
Dr. Guevara: Medical schools have sought to build more diverse faculty in their institutions through faculty development programs targeted to underrepresented minority faculty members. This study was conduct by THE CHILDREN'S HOSPITAL OF PHILADELPHIA'S POLICYLAB and The University of Pennsylvania and sought to determine if there was an association between minority faculty development programs and the representation, recruitment, and promotion of underrepresented minority faculty.
28 Nov Electronic Medical Records: Tool to Identify Readmission Risk
Posted at 01:37h
in AHRQ, Author Interviews, Electronic Records, Hospital Readmissions, University of Pennsylvania
MedicalResearch.com Interview with:
Craig A Umscheid, MD, MSCE, FACP
Assistant Professor of Medicine and Epidemiology
Director, Center for Evidence-based Practice
Medical Director, Clinical Decision Support
Chair, Department of Medicine Quality Committee
Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center
University of Pennsylvania Philadelphia, PA 19104
MedicalResearch.com: What are the main findings of the study?
Dr. Umscheid: We developed and successfully deployed into the electronic health record of the University of Pennsylvania Health System an automated prediction tool which identifies newly admitted patients who are at risk for readmission within 30 days of discharge. Using local data, we found that having been admitted to the hospital two or more times in the 12 months prior to admission was the best way to predict which patients are at risk for being readmitted in the 30 days after discharge. Using this finding, our automated tool identifies patients who are “high risk” for readmission and creates a “flag” in their electronic health record (EHR). The flag appears next to the patient’s name in a column titled “readmission risk.” The flag can be double-clicked to display detailed information relevant to discharge planning. In a one year prospective validation of the tool, we found that patients who triggered the readmission alert were subsequently readmitted 31 percent of the time. When an alert was not triggered, patients were readmitted only 11 percent of the time. There was no evidence for an effect of the intervention on 30-day all-cause readmission rates in the 12-month period after implementation.
11 Oct Thyroid Cancer: Incidence on the Rise, Cause Unknown
MedicalResearch.com Interview with:
David Goldenberg MD, FACS
Professor of Surgery and Oncology
Director of Head and Neck Surgery
Associate Director of Surgical Services- Penn State Hershey Cancer Institute
Division of Otolaryngology-Head and Neck Surgery
The Pennsylvania State UniversityThe Milton S. Hershey Medical Center, Hershey, PA 17033
MedicalResearch.com: What are the main findings of this study?
Dr. Goldenberg: The incidence of thyroid cancer is on the rise and has nearly tripled in the last thirty years.
Some authors have attributed this increase in incidence to improved sensitivity of diagnostic techniques and imaging allowing for diagnosis of small insignificant thyroid cancers. Others do not agree and state that is a real rise in this disease.
Many patients have their cancer discovered by accident when they undergo a diagnostic study for some other reason- such as trauma, neck pain, or carotid artery studies (for clogged arteries).
We aimed to compare incidentally discovered versus non incidentally discovered thyroid cancers to determine whether the thyroid cancers in both groups harbor different characteristics.
03 Oct Yoga and Effect on Menopause Symptoms
MedicalResearch.com Interview with: Katherine Newton, PhD Senior Investigator at Group Health Research Institute in Seattle MedicalResearch.com: What are the main findings of the study? Answer: We found that when women took a 12-week yoga class and practiced yoga at home, they had significantly less insomnia than did women who did not. This was the only statistically significant finding in this MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network randomized controlled trial. We also found that being in the yoga class did not decrease the number of hot flashes or night sweats. Yoga was linked to better sleep quality and less depression—but these effects were not statistically significant. In separate papers, published slightly earlier, our MsFLASH group reported that a non-yoga exercise program seemed linked to slightly improved sleep and less insomnia and depression—but these effects were not statistically significant. And an omega-3 (fish oil) supplement was not linked to any improvement in hot flashes, night sweats, sleep, or mood.20 Aug Lung Cancer: Calcineurin Pathway Helps Enable Metastases
MedicalResearch.com Interview with:
Sandra Ryeom, PhD,
Assistant professor of Cancer Biology,
Perelman School of Medicine, University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases.
MedicalResearch.com: Were any of the findings unexpected?
Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling was all unexpected.
13 Aug Parkinson’s Disease: ApoA1 may be a Protection Marker
MedicalResearch.com: Interview with Alice Chen-Plotkin, MD
Assistant Professor
Department of Neurology
University of Pennsylvania School of Medicine
MedicalResearch.com: What are the main findings of the study?
Answer: Parkinson's disease (PD) is an incurable neurodegenerative disease. Many neurons die, but the neurons that make dopamine (dopaminergic neurons) are particularly vulnerable. We think that the disease actually starts well before the time when people show clinical symptoms. We were therefore interested in finding proteins from the blood that correlated with better or worse dopaminergic neuron integrity. Since it's hard to access the dopaminergic neurons directly, we looked at a tracer that labels the ends of the dopaminergic neurons in people who do not have Parkinson's disease but are at high risk for developing it, and we also looked at the age at onset of PD in people who are already symptomatic. Screening just under 100 different proteins from the blood, we found that higher plasma levels of apolipoprotein A1 (ApoA1) were correlated with better tracer uptake in the people who did not yet have PD, and with older ages at onset in the people who already had PD. These data suggest that plasma ApoA1 may be a marker for PD risk, with higher levels being relatively protective.
12 Aug Chronic Kidney Disease: Novel variants of APOL1 gene may play a role in susceptibility
Posted at 11:07h
in Author Interviews, Genetic Research, Kidney Disease, Nature, University of Pennsylvania
MedicalResearch.com Interview with:
Dr. Wen-Ya Ko, Ph.D.
Postdoctoral Fellow, First author of the paper
Department of Genetics
School of Medicine
University of Pennsylvania
426 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104-6145
Dr. Sarah Tishkoff, Ph.D., Senior author of the paper
David and Lyn Silfen University Professor
Departments of Genetics and Biology
School of Medicine
School of Arts and Sciences
University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: In humans the APOL1 gene codes for Apolipoprotein L1, a major component of the trypanolytic factor in serum. The APOL1 gene harbors two risk alleles (G1 and G2) associated with chronic kidney disease (CKD) among individuals of recent African ancestry. We studied APOL1 across genetically and geographically diverse ethnic groups in Africa. We have discovered a number of novel variants at the APOL1 functional domains that are required to lyse trypanosome parasites inside human blood vessels.
We further identified signatures of natural selection influencing the pattern of variation on chromosomes carrying some of these variants. In particular, we have identified a haplotype (a cluster of genetic variants linked along a short region of a chromosome), termed G3, that has evolved adaptively in the Fulani population who have been practicing cattle herding which has been historically documented as early as in the medieval ages (but which could have begun thousands of years earlier). Many of the novel variants discovered in this study are candidates to play a role conferring protection against trypanosomiasis and/or to play a role in susceptibility of CKD in humans.
08 Aug Intestinal Virus Populations Huge and Rapidly Changing
MedicalResearch.com Interview with Frederic D. Bushman, Ph.D.
Professor, Department of Microbiology
Department of Microbiology
Perelman School of Medicine
University of Pennsylvania
426A Johnson Pavilion 3610 Hamilton Walk
Philadelphia, PA 19104
MedicalResearch.com: What are the main findings of the study?
Dr. Bushman: Viral populations in the human gut are huge, and some of the viruses change rapidly over time.
08 Aug Alcohol dependence and PTSD: Simultaneous Treatment Improves Outcomes
MedicalResearch.com Interview with Edna B. Foa, PhD Department of Psychiatry, University of Pennsylvania, Philadelphia MedicalResearch.com: What are the main findings of the study? Dr. Foa: Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment. Six months after treatment discontinuation, participants who received prolonged exposure therapy for PTSD drank less than those who did not receive prolonged exposure. Participants who received a combined treatment of prolonged exposure and naltrexone had the lowest drinking level after six-month treatment discontinuation. The main message of the study is that simultaneous treatment of alcohol dependence and PTSD yield superior outcome than each treatment alone. Importantly, the findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators. In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts that common view that trauma-focuses therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use.25 Jul TAp73, a molecular relative of p53 Tumor Suppressor Protein, gives tumor cells a growth advantage
 MedicalResearch.com Interview with:
Xiaolu Yang, Ph.D.
Professor of Cancer Biology at the Perelman School of Medicine
University of Pennsylvania
and the Abramson Family Cancer Research Institute,
MedicalResearch.com: What are the main findings of the study?
Dr. Yang: TAp73 is a structural homologue of the preeminent tumor suppressor p53, but its role in tumorigenesis has been unclear. In this study, we show that TAp73 supports the proliferation of tumor cells. Mechanistically, TAp73 activates the expression of glucose-6-phosphate dehydrogenase (G6PD), a rate-limiting enzyme in the pentose phosphate pathway. This function of TAp73 is required for maintaining a robust biosynthesis and anti-oxidant defense in tumor cells. These finding connects TAp73 to oncogenic growth and suggest that G6PD may be a valuable target for tumor therapy.
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