Author Interviews, JAMA, Primary Care, Smoking, USPSTF / 28.01.2021

MedicalResearch.com Interview with: Dr. Michael Silverstein M.D., M.P.H Professor of Pediatrics Director of the Division of General Academic Pediatrics Vice Chair of Research, Department of Pediatrics Boston University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Tobacco use is the leading preventable cause of disease, disability, and death in the United States and quitting is one of the best things people can do for their health. Additionally, smoking during pregnancy can cause serious harms to both the pregnant person and the baby. The Task Force continues to recommend that clinicians ask all adults and pregnant people about their tobacco use, advise those who use tobacco to quit, and connect them to proven, safe methods to help them quit.  (more…)
Author Interviews, Health Care Systems, JAMA / 22.01.2021

MedicalResearch.com Interview with: Sara Machado PhD Fellow at the Department of Health Policy London School of Economics and Political Science MedicalResearch.com: What is the background for this study? Response: Physician distribution is a determinant of health care access, so knowing how physician density patterns evolve over time is important if we are trying to address disparities in access to care. Moreover, the last 10 years have brought about changes in health care coverage, across the US. Recent evidence points to an uneven physician distribution between urban and rural communities. We examined recent trends in physician density by physician category across rural and urban US counties.  MedicalResearch.com: What are the main findings? Response: We have two main findings.
  • First, density of primary care physicians steadily decreased in more than half of rural counties (994 out of 1,976).
  • Second, medical specialist density, which would care for cardiovascular and pulmonary disease, for example, has been largely stagnant in rural counties, at the lowest density levels (less than 10 physicians per 100,000), and increasing in metropolitan counties.
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Author Interviews, Breast Cancer, Genetic Research, JAMA, Race/Ethnic Diversity / 22.01.2021

MedicalResearch.com Interview with: Kent Hoskins, MD Eileen Lindsay Heidrick Professor in Oncology Division of Hematology/Oncology University of Illinois at Chicago Director of Cancer Genetics Co-Leader, Breast Cancer Research Group University of Illinois Cancer Center MedicalResearch.com: What is the background for this study? Response: The racial disparity in breast cancer mortality emerged in the US in the late 1980s in the wake of widespread implementation of mammography screening and the development of successful systemic adjuvant therapies for early breast cancer. Unfortunately, more than three decades later, Black women in the US still have a 40% higher mortality rate from breast cancer compared with non-Hispanic White women despite similar disease incidence. Health disparities research has primarily focused on the fact that Black women have a higher incidence of the aggressive triple-negative subtype, and that they are more likely to present with more advanced stages of disease. As important as those factors are, in recent years our group and others reported that Black women with hormone receptor-positive breast cancer have worse survival than non-Hispanic white women even after adjustment for stage at diagnosis and treatment. Since nearly 2/3 of breast cancers in Black women are hormone receptor-positive, this is a significant contributor to the overall mortality disparity. Importantly, these studies also suggested that Black women disproportionately develop biologically aggressive forms of hormone-dependent breast cancer, which is typically considered a more favorable disease subtype. Using data on more than 70,000 patients from the SEER registry that is linked to data from Genomic Health Laboratory, which provides the Oncotype DX recurrence score (the most commonly ordered prognostic/predictive multi-gene expression assay for early breast cancer), we set out to address three questions: 1) is there evidence of disproportionately aggressive tumor biology among Black women with hormone receptor (HR)-positive breast cancer, as reflected in the Oncotype DX recurrence score? 2) Is there a racial survival disparity even among patients with early stage, axillary node-negative tumors with comparable recurrence scores on the Oncotype assay? and 3) Is there is a difference in the prognostic accuracy of the Oncotype assay between Black and non-Hispanic white patients, since there was limited representation of Black women in the development and validation of the Oncotype assay and other prognostic/predictive assays?  (more…)
Author Interviews, Diabetes, JAMA, Weight Research / 14.01.2021

MedicalResearch.com Interview with: Dr. Steven Heymsfield, MD Professor, Pennington Biomedical Research Center Baton Rouge, LA MedicalResearch.com: What is the background for this study? Response: Bimagurmab is a monoclonal antibody that blocks the activin type 2 receptor. This receptor is found mainly on skeletal muscles and when blocked acts to stimulate muscle growth. Bimagrumab was developed as a potential treatment for skeletal muscle disorders. However, the first-in-man studies revealed an unexpected response to the drug: not only did skeletal muscle mass increase, but marked lowering in body fat and improved insulin sensitivity were observed. The current study was launched to follow up on these initial observations.  (more…)
Author Interviews, CDC, COVID -19 Coronavirus, JAMA / 08.01.2021

MedicalResearch.com Interview with: Jay C. Butler, MD, FAAP, MACP, FIDSA Deputy Director for Infectious Diseases Centers for Disease Control and Prevention Atlanta, GA  30333 MedicalResearch.com: What is the background for this study? Response: There are still disagreements about the significance of transmission of SARS-CoV-2 from asymptomatic persons.  It has been known since at least March 2020 that, unlike the closely related coronavirus that causes SARS, transmission of COVID-19 from asymptomatic and presymptomatic persons occurs and that at least 30% of infected persons do not develop symptoms.  Estimating the proportion of transmissions from persons without symptoms informs the decision analysis for prioritization of community mitigations opportunities:  wearing of masks, social distancing, and hand hygiene. If only a low proportion of transmission occurs from people without symptoms, these interventions would be less likely to control transmission when broadly applied in the community.  On the other hand, if a significant proportion of spread is from infected persons without symptoms, the value of these measures is enhanced. Additionally, obtaining strategic and systematic screening tests for SARS-CoV-2 to identify and isolate persons without symptoms in selected settings, such as congregational housing settings, will have greater potential impact if spread from persons without symptoms is common.  (more…)
Author Interviews, JAMA, Surgical Research / 08.01.2021

MedicalResearch.com Interview with: Melina R. Kibbe, MD, FACS, FAHA Colin G. Thomas Jr. Distinguished Professor and Chair Department of Surgery Professor, Department of Biomedical Engineering The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7050 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Fluoroquinolones are a commonly prescribed antibiotic.  Recent data from Taiwan, Sweden, and Canada suggests that the use of fluoroquinolones increase the short-term risk of aneurysm formation in certain older patient  populations.  As such, the FDA issued a warning in 2018 regarding the use of fluoroquinolone antibiotics suggesting that this class of antibiotics should not be used in patients at increased risk. The FDA defined the high risk population as those with a history of aneurysms or blockages, high blood pressure, certain genetic disorders related to blood vessels, and the elderly.  However, we hypothesized that this risk of taking fluoroquinolones extends to all patient populations and not just high risk patient populations.  (more…)
Author Interviews, Cancer Research, JAMA / 31.12.2020

MedicalResearch.com Interview with: Deborah C. Marshall, MD New York University School of Medicine New York, New York  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Tarras ES, Marshall DC, Rosenzweig K, Korenstein D, Chimonas S. Trends in Industry Payments to Medical Oncologists in the United States Since the Inception of the Open Payments Program, 2014 to 2019. JAMA Oncol. Published online December 30, 2020. doi:10.1001/jamaoncol.2020.6591  MedicalResearch.com: What should readers take away from your report? Response: Overall, though, there has not been a dramatic shift in these interactions after the inception of Open Payments. (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, Clots - Coagulation, COVID -19 Coronavirus, Heart Disease, JAMA / 30.12.2020

MedicalResearch.com Interview with: Ana Blasco, MD, PhD Cardiology Department, Hospital Universitario Puerta de Hierro–Majadahonda Madrid, Spain MedicalResearch.com: What is the background for this study? Response: Our group has been investigating issues related to coronary thrombosis in patients with acute myocardial infarction for years. Recently, we developed a standardized technique for the detection and quantification of extracellular neutrophil networks (NETs) in coronary thrombi. During the first wave of the COVID-19 pandemic in Madrid, Spain, we had some cases of myocardial infarctions with ST elevation and a large thrombotic component among patients with severe SARS-CoV-2 infection. Given the important participation of NETs in severe COVID-19 disease, causing occlusion of microvessels as shown in pulmonary samples, we decided to analyze their role in coronary thrombi. Thanks to similar previous analyzes in patients without COVID-19, we have been able to compare our results with a historical series. (more…)
Accidents & Violence, Author Interviews, Cannabis, JAMA / 24.12.2020

MedicalResearch.com Interview with: Li Li, MS, PhD Candidate Division of Epidemiology, College of Public Health, Ohio State University Graduate Research Associate, Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children’s Hospital MedicalResearch.com: What is the background for this study? Response: Marijuana use impairs cognitive abilities necessary for safe driving, including reaction time, road lane-tracking ability, and attention maintenance. Given increasing legalization of marijuana use in the US, our study aimed to estimate marijuana-impaired driving among teens at a national level and help to identify the current prevalence to guide future intervention programs. (more…)
Author Interviews, JAMA, Neurology / 24.12.2020

MedicalResearch.com Interview with: Dr. Roopa Rajan MD, DM Post Doctoral Fellowship (Movement Disorders) Assistant Professor Department of Neurology AIl India Institute of Medical Sciences New Delhi  MedicalResearch.com: What is the background for this study? Response: This study was inspired by the need for more effective treatments for patients with disabling hand tremor, particularly dystonic tremor. Dystonic tremor is a movement disorder in which both dystonia (abnormal posturing) and tremor co-exist in the same body part. In general, this common and often disabling disease responds only modestly to oral medications. Surgical treatments such as deep brain stimulation may be offered to persons with severe tremor, however the outcomes are not as robust as seen in other tremor conditions,  for instance, essential tremor. Therefore, there is a critical need for more effective treatments for people living with this disease. Botulinum toxin injections are known to be effective for dystonic tremor affecting the head and voice, although these remain off-label indications. Previous studies using botulinum toxin injections for other hand tremors like essential tremor led to limited clinical application, in part due to transient hand weakness that may be a side effect of botulinum toxin injections. Recently, advances in injection delivery such as electromyographically guided botulinum toxin injections with individualized muscle and dose selections were reported to be beneficial in essential tremor. We built upon this existing data to explore the effects of such a treatment in patients with dystonic hand tremor.   (more…)
Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus, JAMA, Social Issues / 23.12.2020

MedicalResearch.com Interview with: Kenneth Freedberg, MD Director, Medical Practice Evaluation Center Massachusetts General Hospital Professor of Medicine at Harvard Medical School Study senior author Jessie Gaeta, MD Chief Medical Officer Boston Health Care for the Homeless Program Assistant Professor of Medicine Boston University School of Medicine Travis P. Baggett, MD, MPH Faculty clinician-investigator MGH Division of General Internal Medicine Assistant Professor of Medicine Harvard Medical School MedicalResearch.com: What are the main findings?  Dr. Baggett: We found that two strategies are crucial for addressing COVID-19 among people staying in homeless shelters: 1) Proactively identifying and testing people with symptoms, and 2) Providing a dedicated, medically supervised, non-hospital space for isolation and management of people with mild to moderate COVID. Together these two strategies would reduce infections, hospitalizations, and health care costs compared to not doing them. During a pandemic surge, like we are seeing now, it makes sense to add periodic universal testing of all shelter residents, even those without symptoms. (more…)
Author Interviews, Cognitive Issues, Hearing Loss, JAMA, Race/Ethnic Diversity / 23.12.2020

MedicalResearch.com Interview with: Ariana M. Stickel, Ph.D. Postdoctoral Scholar Department of Neurosciences University of California, San Diego MedicalResearch.com: What is the background for this study? Response: Latinos are projected to have the largest increase in Alzheimer’s disease and related dementia in the coming years, yet we know so little about important risk factors for dementia amongst Latinos. As there has been too little widespread research on diverse Latinos and dementia until recently, we examined the individual and combined relationships of two important risk factors for dementia --hearing impairment and cardiovascular disease risk--in over 9,000 Latinos 45 – 74 years old. Diverse Latinos participated in the study, including Central Americans, Cubans, Dominicans, Mexicans, Puerto Ricans and South Americans residing in the Bronx, NY; Chicago, IL; Miami, FL and San Diego, CA. It is important to study a wide range of Latinos in order to appropriately reflect the diversity of this population. Each participant underwent extensive cardiovascular and diabetes testing, hearing examinations, and cognitive assessments. (more…)
Author Interviews, CDC, Hepatitis - Liver Disease, JAMA, USPSTF / 21.12.2020

MedicalResearch.com Interview with: Aaron B. Caughey, M.D.,M.P.P., M.P.H. Professor and Chair of the Department of Obstetrics and Gynecology Associate Dean for Women’s Health Research and Policy Oregon Health & Science University Portland, OR Founder and Chair Centers for Disease Control and Prevention–funded Oregon Perinatal Collaborative USPSTF Task Force Member  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Hepatitis B virus infection is a serious condition that affects about 860,000 people in the United States. Screening for hepatitis B can detect the infection early, so that you can receive treatment that will reduce the potential for serious complications, including cancer, liver failure, and even death. Hepatitis B often has no signs or symptoms, so clinicians should screen teens and adults who are at increased risk for hepatitis B to help protect their health. (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, Cancer Research, CDC, JAMA, Lung Cancer / 10.12.2020

MedicalResearch.com Interview with: David A. Siegel, MD, MPH Division of Cancer Prevention and Control US Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: Why is it important to better understand the smoking histories (both current/former and never smokers) among lung cancer patients? Response: Knowledge of smoking status of patients diagnosed with lung cancer can help us understand how to best prevent, detect, and treat lung cancer in the future. More than 84% of women and 90% of men newly diagnosed with lung cancer had ever smoked cigarettes, and half of patients aged 20 to 64 years newly diagnosed with lung cancer were current cigarette smokers. These findings reinforce the importance of cigarette cessation and lung cancer screening. 1 out of every 8 people diagnosed with lung cancer had never smoked cigarettes, which reiterates the importance of learning more about their risk factors for lung cancer, which could impact prevention and treatment.  (more…)
Author Interviews, JAMA, Pulmonary Disease / 10.12.2020

MedicalResearch.com Interview with: Andrew M. Wilson, MD Clinical Senior Lecturer in Respiratory Health University of East Anglia Norwich and Honorary Consultant Physician in Respiratory Medicine Norfolk and Norwich University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Idiopathic pulmonary fibrosis has a poor prognosis and limited treatment options. Clinical trial evidence suggested a survival benefit for people taking co-trimoxazole and microbiological data suggested that infection was implicated in prognosis. However this large multicentre study did not show that co-trimoxazole had an beneficial effect in terms of time to all-cause mortality, hospitalisation or lung transplant in people with moderate and severe idiopathic pulmonary fibrosis (more…)
Author Interviews, Geriatrics, Hearing Loss, JAMA, Race/Ethnic Diversity, Social Issues / 10.12.2020

MedicalResearch.com Interview with: Nicholas S. Reed, AuD Assistant Professor | Department of Epidemiology Core Faculty  | Cochlear Center for Hearing and Public Health Johns Hopkins University Bloomberg School of Public Health MedicalResearch.com: What is the background for this study? Response: It is known that hearing aid ownership is relatively low in the United States at less than 20% of adults with hearing loss owning and using hearing aids. However, many national estimates of hearing aid ownership are based on data that is over 10 years old. Our team was interested in trying to understand whether ownership in hearing aids had changed over time. We used data from 2011 to 2018 in a nationally representative (United States) observational cohort (The National Health and Aging Trends Study) of Medicare Beneficiaries aged 70 years and older to estimate the change in hearing aid ownership. In our analysis, the proportion of Medicare beneficiaries 70 years and older who reported owning and using their hearing aids increased 23.3% from 2011 to 2018. However, this growth in ownership was not equal across all older adults. For example, while White males saw a 28.7% increase in hearing aid ownership, Black females saw only a 5.8% increase over the same 8-year period. Moreover, adults living at less than 100% federal poverty level actually saw an overall 13.0% decrease in hearing aid ownership while those living at more than 200% federal poverty line saw an overall 30.6% increase.   (more…)
Author Interviews, COVID -19 Coronavirus, Infections, JAMA, NYU, Race/Ethnic Diversity / 04.12.2020

MedicalResearch.com Interview with: Gbenga Ogedegbe, MD, MPH Dr. Adolph & Margaret Berger Professor of Population Health Director, Division of Health & Behavior Director Center for Healthful Behavior Change Department of Population Health NYU Langone Health NYU School of Medicine MedicalResearch.com: What is the background for this study? Response: The background for the study is the disproportionately higher rates of COVID-19 hospitalizations and deaths in Blacks and Hispanics compared to Whites in major cities across the country. We asked two questions: 1) are there racial/ethnic differences in COVID-19 outcomes (likelihood of testing positive, hospitalizations, severe illness, and deaths) among patients who receive care at NYU Langone Health? If there are differences, are they explained by comorbidity and neighborhood characteristics (poverty, educational status, employment, housing, proportion of Blacks and Hispanics in communities)? (more…)
Author Interviews, JAMA, Social Issues / 04.12.2020

MedicalResearch.com Interview with: Amal Trivedi, MD, MPH Professor of Health Services, Policy & Practice Director of Graduate Studies, Health Services Research Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: Nearly all hospitals in the United States, including all Veterans Affairs Medical Centers (VAMCs), report mortality rates for patients hospitalized for common medical and surgical conditions. But these mortality rates do not adjust for socioeconomic factors that are associated with worse outcomes following hospitalization. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA, Pediatrics, Smoking, Stanford, Tobacco, Tobacco Research / 03.12.2020

MedicalResearch.com Interview with: Bonnie Halpern-Felsher, PhD, FSAHM (pronouns: she/her) Professor of Pediatrics Taube Endowed Research Faculty Scholar Professor (by courtesy), Epidemiology and Population Health Professor (by courtesy), Psychiatry and Behavioral Sciences Director of Fellows’ Scholarship, Department of Pediatrics Director of Research, Division of Adolescent Medicine Co-leader, Scholarly Concentrations, Pediatrics Residency Program MedicalResearch.com: What is the background for this study? What are the main findings? Response: To examine adolescent and young adult e-cigarette use during the COVID-19 pandemic. There were 4 main findings:
  • About 2/3 of adolescent and young adult ever-e-cigarette users reported either quitting or cutting back on e-cigarette use since COVID-19 began.
  • Users least likely to quit or cut back e-cigarette use were those showing higher levels of nicotine dependence and those who had used e- cigarettes a large number of times.
  • Adolescent and young adult e-cigarette users found it harder to access e-cigarettes, but unlike studies before COVID-19, the dominant source of purchasing e-cigs was online instead of brick-and-mortar during COVID-19 pandemic.
  • Youth below 21 years were able to purchase e-cigarettes without any age verification, and those whose age was verified were asked to physically show ID or provided an email, which are less effective means to prevent underage youth use.
(more…)
Addiction, Author Interviews, COVID -19 Coronavirus, JAMA, Opiods, UCLA / 03.12.2020

MedicalResearch.com Interview with: Joseph Friedman, MD/PhD student David Geffen School of Medicine UCLA MedicalResearch.com: What is the background for this study? Response: Numerous researchers, clinicians, officials, harm reduction agencies, and people who use drugs have sounded the alarm that the COVID-19 pandemic is exacerbating the United States overdose crisis. However, data sources typically used to track overdoses in the US often have long lags that impede timely monitoring and response. For example, the CDC released preliminary overdose figures for 2019 in July 2020, and even these numbers may change. As they are available in near real-time, emergency medical services (EMS) data have increasingly been used as a source of up-to-date information to monitor epidemiological shifts during the COVID-19 pandemic. In this study, we used data from the National EMS Information System (NEMSIS), a large registry of over 10,000 EMS agencies in 47 states that represented over 80% of all EMS activations nationally in 2020. We used the data to track shifts in overdose-related cardiac arrests observed by EMS.   (more…)
Author Interviews, Heart Disease, JAMA, Lifestyle & Health, USPSTF / 03.12.2020

MedicalResearch.com Interview with: Dr. John Epling, M.D., M.S.Ed Professor of family and community medicine Virginia Tech Carilion School of Medicine in Roanoke, VA. Medical director of research for family and community medicine Medical director of employee health and wellness for the Carilion Clinic Dr. Epling joined the U.S. Preventive Services Task Force in January 2016. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cardiovascular disease, which includes heart disease and stroke, is one of the leading causes of death in the United States. Nearly half of all adults have at least one risk factor for cardiovascular disease. Evidence shows that counseling aimed at helping people improve their diet and increase their physical activity can help prevent cardiovascular disease. This typically involves a trained counselor who provides education, helps people set goals, shares strategies, and stays in regular contact.  The Task Force recommends behavioral counseling interventions that promote a healthy diet and physical activity to help people at risk for cardiovascular disease stay healthy. (more…)
Author Interviews, COVID -19 Coronavirus, Inflammation, JAMA, Pediatrics, Race/Ethnic Diversity / 30.11.2020

MedicalResearch.com Interview with: Ellen H. Lee, MD Incident Command System Surveillance and Epidemiology Section New York City Department of Health and Mental Hygiene Long Island City, New York  MedicalResearch.com: What is the background for this study? Response: Published reports of the COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) have described higher proportions of cases among Black and Hispanic children. However, case series are limited by the lack of population-level data, which could help provide context for the racial/ethnic distribution of cases described in these reports. The New York City (NYC) Department of Health and Mental Hygiene required reporting of all possible cases of MIS-C among NYC residents, and for cases meeting MIS-C criteria, applied population denominators to calculate MIS-C incidence rates stratified by race/ethnicity. To help characterize the burden of severe COVID-19 disease in NYC, we also calculated COVID-19 hospitalization rates stratified by race/ethnicity. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, JAMA, Yale / 26.11.2020

MedicalResearch.com Interview with: Lajos Pusztai, M.D, D.Phil. Professor of Medicine Director, Breast Cancer Translational Research Co-Director, Yale Cancer Center Genetics and Genomics Program Yale Cancer Center Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: In HER2-positive early stage (stage I-II) breast cancer, several different preoperative (also called neoadjuvant) chemotherapy options exist, each of these is associated with a different rate of complete eradication of cancer from the breast and lymph nodes (called pathologic complete response or pCR). Patients who experience pCR have excellent long term survival. The complete response rates range from 20% to 80%, the rates are higher with regimens that include several different chemotherapy drugs and dual HER2 blockade. Unfortunately, these highly effective multi-drug treatment regimens are also more toxic and more expensive.  We also learned that patients who do not achieve pCR after preoperative therapy, have high rates of recurrence, but the recurrence rate can be improved by administering postoperative adjuvant therapy. These two observations together, (1) different regimens with different toxicities and costs resulting in different pCR rates, and (2) existence of effective postoperative therapies for patients with residual cancer after preoperative therapy, sets the stage for combining various pre- and post-operative treatment strategies. Starting with a shorter, less toxic and less expensive neoadjuvant regimen would allow a substantial minority (20-45%) of patients who archive pCR to be spared of longer and more toxic regimens, whereas those with residual disease could receive the remaining part of the currently most effective regimens post-operatively as adjuvant therapy. In this study we examined the cost effectiveness of different neoadjuvant followed by adjuvant treatment strategies from a healthcare payer perspective. (more…)
Author Interviews, Heart Disease, JAMA, Pediatrics, Surgical Research / 25.11.2020

MedicalResearch.com Interview with: Michael R. Flaherty, DO Attending, Pediatric Critical Care Medicine Co-Director, Trauma and Injury Prevention Outreach Program, MGH Instructor in Pediatrics, Harvard Medical School Boston, MA 02114 MedicalResearch.com: What is the background for this study? What are the main findings?   Response: This study was a joint collaboration between Massachusetts General Hospital and Boston Children’s Hospital. The Consumer Product Safety Commission (CPSC) found an increasing incidence of rare earth magnet ingestions by children causing serious injury; Injuries are particularly serious when a child ingests two of these small magnets, or a magnet with another metal object – this can lead to bowel walls becoming attached and kinked, leading to catastrophic bowel injury and/or death. The Consumer Product Safety Commission initiated campaigns to limit sales in 2012 with voluntary recalls and safety standards, as well as public awareness campaigns, legislative advocacy, and lawsuits. In October 2014, the CPSC published their final rule, “Safety Standard for Magnet Sets,” which prohibited the sale of magnets based on a pre-specified size and power scale, essentially eliminating the ability to sell SREMs. This rule was appealed by largest manufacturer of these magnets, Zen Magnets, LLC., and in November 2016 this rule was legally reversed by the U.S. Court of Appeals Tenth Circuit resulting in a resurgence of these magnets on the market. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Social Issues / 18.11.2020

MedicalResearch.com Interview with: David-Dan Nguyen, MPH Research Fellow | Center for Surgery and Public Health Brigham and Women's Hospital Medical Student | McGill University  MedicalResearch.com: What is the background for this study? Response: In 2017, the US Preventive Services Task Force updated its recommendation for PSA screening for prostate cancer from a grade D to a grade C for men aged 55 to 69 years. This updated recommendation endorsed shared decision making and harmonizes with the guidelines of the American Urological Association and the American Cancer Society which also recommend shared decision making for PSA screening. Shared decision making is a meaningful dialogue between the physician and the patient that namely includes a review of risks and expected outcomes of screening as well as the patient’s preferences and values. Understandably, the patient’s ability to critically assess the medical information provided (i.e. their health literacy) likely influences this process. We sought to characterize the effect of health literacy on shared decision making for PSA screening. We used data from 2016 when PSA screening for prostate cancer was not recommended by the US Preventive Services Task Force — in other words, we also sought to understand how health literacy impacted screening rates in the context of countervailing guidelines on PSA screening. (more…)
Author Interviews, Brain Injury, Exercise - Fitness, JAMA / 17.11.2020

MedicalResearch.com Interview with: Tara L Sharma DO Clinical Assistant Professor of Neurology at UWMC Seattle, WA 98133 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Flying can lead to reduced oxygen partial pressures and cerebral blood flow causing worsening clinical outcome in cases of moderate to severe TBI; however, not much is known regarding the clinical consequences of flying in individuals with concussion or mild TBI. Because many athletes suffer concussions during games, it is necessary to know if flying afterward may potentially hinder their ability to return to play. Overall, we found no associated between air travel and increased symptom severity in both our entire cohort and the subset of football players. (more…)
Author Interviews, Brigham & Women's - Harvard, Dermatology, JAMA, McGill, Mental Health Research / 17.11.2020

Editor's note: This piece discusses suicide. If you have experienced suicidal thoughts or have lost someone to suicide and want to seek help, you can contact the Crisis Text Line by texting "START" to 741-741 or call the Suicide Prevention Lifeline at 800-273-8255.  MedicalResearch.com Interview with: David-Dan Nguyen, MPH Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital Medical Student | McGill University MedicalResearch.com: What is the background for this study? Response: There is ongoing concern about the side-effects of finasteride, a drug used for the management of alopecia and benign prostatic hyperplasia. These concerns have led to the coining of the “post-finasteride syndrome” which remains controversial. Indeed, there is conflicting evidence on the post-finasteride syndrome/adverse events associated with finasteride. We wanted to contribute to this conflicting body of evidence by examining suicidality, depression, and anxiety reports linked to finasteride use using the WHO’s pharmacovigilance database, VigiBase. Such pharmacovigilance databases are useful for the study of rare adverse events that are suspected to be associated with medication use. (more…)
Author Interviews, Cancer Research, JAMA, Prostate Cancer, Technology / 13.11.2020

MedicalResearch.com Interview with: Dave Steiner MD PhD Clinical Research Scientist Google Health, Palo Alto, California MedicalResearch.com: What is the background for this study? Response: For prostate cancer patients, the grading of cancer in prostate biopsies by pathologists is central to risk stratification and treatment decisions. However, the grading process can be subjective, often resulting in variability among pathologists. This variability can complicate diagnostic and treatment decisions. As an initial step towards addressing this problem, we and others in the field have recently developed artificial intelligence (AI) algorithms that perform on-par with expert pathologists for prostate cancer grading. Such algorithms have the potential to improve the quality and efficiency of prostate biopsy grading, but the impact of these algorithms when used by pathologists has not been well studied. In the current study, we developed and evaluated an AI-based assistant tool for use by pathologists while reviewing prostate biopsies. (more…)