Author Interviews, Exercise - Fitness, Frailty, Geriatrics, JAMA / 13.11.2018

MedicalResearch.com Interview with: "COUCHair for physical therapy" by ewa garniec is licensed under CC BY-NC-ND 3.0Mikel Izquierdo PhD Head and Full professor Department of Health Sciences Public University Navarra, Spain  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Acute hospital admissions are a major contributor to disability in the elderly. Despite resolution of the reason for hospitalization, patients (especially those who are frail) are often discharged with a new major disability. This is a problem that providers of health care and policy makers should prioritize given the expectations of further growth of the population segment composed by old people.  Traditional models of acute hospitalization for older adults seldom include a comprehensive approach to prevent hospitalization-associated impairment in functional and cognitive capacity. In contrast, exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients and are associated with a reduced length of stay and lower costs. Yet, patients with cognitive impairment or multimorbidity at baseline are commonly excluded from exercise intervention trials and only ‘conservative’ or ‘traditional’ programs (i.e., focusing on light walking while avoiding resistance training) have been typically applied to elders who are acutely hospitalized. Our intervention proved safe and effective to reverse the aforementioned impairment. We therefore propose that an individualized prescription of multicomponent exercise should become an inherent part of the routine management of hospitalized older adults.  (more…)
Author Interviews, JAMA, OBGYNE / 13.11.2018

MedicalResearch.com Interview with: Joel Ray MD, MSc, FRCPC Institute of Health Policy, Management and Evaluation Faculty of Medicine University of Toronto, Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many women who die within childbirth or soon thereafter experience rapid onset of morbidity/illness before succumbing. Thus, severe maternal morbidity (SMM) offers a detectable (or set of detectable) conditions that might be dealt with before they progress to a fatality. Even so, severe maternal morbidity alone can be non-fatal, but create disability for a new mother (e.g., a stroke), or prolong separation of mother and newborn. So, we showed that, as the number of severe maternal morbidity indicators rises, so does the probability of maternal death. This relation was exponential in nature.   (more…)
Author Interviews, JAMA, Sexual Health / 11.11.2018

MedicalResearch.com Interview with: "Sex in stone" by Nagarjun Kandukuru is licensed under CC BY 2.0Janna A Dickenson, PhD Doug Braun-Harvey Postdoctoral Fellow Program in Human Sexuality Department of Family Medicine University of Minnesota Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Researchers and clinicians have contested the term “sex addiction” in favor of alternative definitions and symptom presentations. Recently, the ICD-11 has characterized compulsive sexual behavior disorder (CSBD) as a persistent pattern that involves failing to control intense sexual urges or sexual behaviors that results in significant levels of distress and/or impairment in one’s functioning.
Researchers estimate that CSBD affects 2-6% of the population and is much more common among cisgender men than cisgender. Using a randomized national sample, we assessed the prevalence of a key feature of CSBD that researchers and clinicians agree upon: distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors.
We performed this assessment with a screening tool called the Compulsive Sexual Behavior Inventory (CSBI). Of the 2,325 adults, 8.6 percent overall (10.3 percent of individuals who identified as men and 7 percent of individuals who identified as women) met the clinical threshold of the CSBI; meaning that 8.6% of people expressed difficulty controlling their sexual feelings, urges and behaviors and experienced distress and/or impairment as a result. To be clear, this does not mean the 8.6% of the sample endorsed CSBD, but that 8.6% of our sample exhibited significant distress or impairment related to difficulty controlling one's sexual behaviors.
(more…)
Aging, Author Interviews, Hearing Loss, JAMA / 11.11.2018

MedicalResearch.com Interview with: David Loughrey PhD Atlantic Fellow for Equity in Brain Health Global Brain Health Institute DeafHear Research Partner NEIL Programme Trinity College Institute of Neuroscience MedicalResearch.com: What is the background for this study? Response: The World Organisation (WHO) estimate that one-third of older adults aged 65 and over have a disabling hearing loss. Increasingly, research is finding that age-related hearing loss (ARHL) may be associated with other negative health outcomes, including dementia which currently affects 50 million people worldwide. A study recently published in The Lancet reported that of nine possible modifiable risk factors, addressing age-related hearing loss (ARHL) could potentially lead to the largest reduction in the prevalence of dementia globally. (more…)
Author Interviews, JAMA, Ophthalmology / 09.11.2018

MedicalResearch.com Interview with: Jennifer P. Craig, Associate Professor Department of Ophthalmology New Zealand National Eye Centre Auckland, New Zealand MedicalResearch.com: What is the background for this study? Response: Dry eye disease is a complex multi-factorial condition, which affects between 5% to 50% of the adult population in different parts of the world. The condition can have profound effects on the ocular comfort, visual function, and quality of life of sufferers. In both clinical practice and academic research settings, validated questionnaires are frequently used to screen for dry eye symptomology, before clinical assessment of tear film homeostatic markers is conducted to make an overall diagnosis of dry eye disease. Although a large number of validated symptomology questionnaires has previously been developed, the recently convened Tear Film and Ocular Surface Dry Eye Workshop II (TFOS DEWS II) identified that the considerable heterogeneities in the study populations, methodologies, and reference standards used in earlier diagnostic accuracy studies introduced significant challenges when trying to compare the diagnostic performance of these screening instruments. The current study is the first to offer a direct comparison of five commonly used validated questionnaires within the same study population, and uses the global consensus criteria for tear film homeostatic disturbance developed by the TFOS DEWS II as the reference standard. (more…)
Author Interviews, Cost of Health Care, Duke, Geriatrics, Hearing Loss, Hospital Readmissions, JAMA / 08.11.2018

MedicalResearch.com Interview with: Nicholas S. Reed, AuD Assistant Professor | Department of Otolaryngology-Head/Neck Surgery Core Faculty | Cochlear Center for Hearing and Public Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health MedicalResearch.com: What is the background for this study? Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization. MedicalResearch.com: What are the main findings? Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively. Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss. (more…)
Anesthesiology, Author Interviews, JAMA, Pediatrics, Surgical Research / 08.11.2018

MedicalResearch.com Interview with: "Anesthesia" by Liran Szeiman is licensed under CC BY-NC-ND 4.0James D. O’Leary, MD Department of Anesthesia and Pain Medicine, Child Health Evaluative Sciences The Hospital for Sick Children Department of Anesthesia, University of Toronto Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is substantial evidence from laboratory studies that the developing brain is susceptible to injury from general anesthetic drugs, which culminated in the US Food Drug Administration issuing a safety communication in 2017 stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. Considering the substantial number of children who require general anesthesia every year (almost 3 million in the US annually) even small differences in child development outcomes after surgical procedures that require general anesthesia may have significant public health implications. Undertaking studies of anesthesia-related neurotoxicity in humans is difficult as adverse child development is a function of the complex interaction between many risk and protective factors. By examining differences between biological siblings in Ontario, Canada, this study seeks to mitigate differences in risk from biological vulnerability and environmental factors, to provide a more accurate estimate of the adverse effects of anesthesia and surgery on child development. In the current study, young children who had surgical procedures that require general anesthesia were not found to be at increased risk of adverse child development outcomes compared to their biological siblings who did not have surgery. These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes. (more…)
Author Interviews, JAMA, Opiods, Surgical Research, University of Michigan / 07.11.2018

MedicalResearch.com Interview with: Joceline Vu, MD Resident, PGY-5 Department of Surgery University of Michigan  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study examined how much opioid patients use after surgery, and looked at factors that might predispose some patients to use more or less. Patient opioid use after surgery is an interesting question that’s gained a lot of attention recently, because it’s different from other uses for opioids. If you have chronic pain, you’re probably going to use all of your prescription. But if you have surgery, you may not take all of your pills, and this leaves people with leftover pills that can be dangerous later. From this study, we found that patients only use, on average, about quarter of their prescription, meaning that a lot of them are left with leftover pills. Moreover, we found that the biggest determinant of how much they used wasn’t how much pain they reported, or any other factor—it was how big their original prescription was. What this means is that opioid use after surgery isn’t just determined by pain, but also by what surgeons prescribe. It’s important to keep this in mind as we try to reduce unnecessary opioid prescribing after surgical procedures.  (more…)
Author Interviews, Heart Disease, JAMA / 07.11.2018

MedicalResearch.com Interview with: Dr. Jean Philippe Empana, MD, PhD Research Director, INSERM U970 Paris Cardiovascular Research Center (PARCC) Team 4 Cardiovascular Epidemiology & Sudden Death Paris Descartes University MedicalResearch.com: What is the background for this study?  Response: In 2010, the American Heart Association (AHA) has emphasized the primary importance of the Primordial prevention concept, i.e. preventing the development of risk factors before they emerge, as a complementary prevention strategy for cardiovascular disease (CVD). Accordingly, the AHA has developed a simple 7-item tool, including 4 behavioral (nonsmoking, and ideal levels of body weight, physical activity and diet) and 3 biological metrics (ideal levels of untreated blood pressure, fasting blood glucose and total cholesterol) for promoting an optimal cardiovascular health (CVH). The relevance of the concept and of the tool has been several times reported by individual studies and meta-analyses (combining the results of several studies) showing substantial and graded benefit for cardiovascular disease but also mortality, quality of life and even cancer risk with higher level of CVH. However, most studies relied on one measure of  cardiovascular health. In the present work, using serial examinations from the well-known Whitehall Study II, we described change in CVH over time and then quantified the association of change in cardiovascular health over 10 years with subsequent incident cardiovascular disease and mortality. This analysis is based on 9256 UK men and women aged 30 to 55 in 1985-88, and thereafter examined every 5 years on average during 30 years. (more…)
Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JAMA / 06.11.2018

MedicalResearch.com Interview with: Yuichiro Yano MD PhD Assistant Professor in Community and Family Medicine Duke University MedicalResearch.com: What is the background for this study? Response: New blood pressure guidelines, issued in 2017 in the US, lowered the blood pressure thresholds for hypertension from systolic blood pressure/diastolic ≥140/90 mm Hg to systolic/diastolic ≥130/80 mm Hg. This change increased the prevalence of hypertension two- to three-fold among young adults. The guidelines also newly defined elevated blood pressure as, 120-129 mmHg systolic blood pressure over 80 mmHg diastolic or less. However, no study investigated that high blood pressure, as defined by the new criteria, is something that younger people should be concerned about as a potential precursor to serious problems. Our study is among the first to report that people younger than age 40 who have elevated blood pressure or hypertension are at increased risk of heart failure, strokes and blood vessel blockages as they age. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 06.11.2018

MedicalResearch.com Interview with: "Blood Pressure Monitor" by Medisave UK is licensed under CC BY 2.0Seulggie Choi MD, (one of the co-first authors) Department of Biomedical Sciences Seoul National University Graduate School Seoul, South Korea MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) issued a new High Blood Pressure Management Guideline, in which the definition of hypertension was modified as blood pressure of 130/80 mmHg or higher. This new criteria for hypertension was based on a number of previous studies that demonstrated higher cardiovascular disease risk for participants in the systolic blood pressure of 130-139 mmHg and diastolic blood pressure of 80-89 mmHg range, which is now defined as stage 1 hypertension. However, there is a relative lack of evidence on whether this association of higher cardiovascular disease risk among those within the stage 1 hypertension category according to the 2017 ACC/AHA guidelines is also true among young adults aged 20-39 years. Our study consisted of about 2.4 million young men and women aged 20-39 years from the Korean National Health Insurance Service claims database. Compared to those with normal blood pressure, young adults with stage 1 hypertension had higher risk for cardiovascular disease, coronary heart disease, and total stroke for both men and women. Moreover, among those who were prescribed anti-hypertensive medications within the next 5 years since blood pressure measurement, young adults with stage 1 hypertension had their higher cardiovascular disease risk attenuated to that of normal blood pressure participants. (more…)
Author Interviews, Cancer Research, ENT, JAMA, Surgical Research / 06.11.2018

MedicalResearch.com Interview with: Dr. Evan M. Graboyes MD Otolaryngologist: Head and Neck Surgeon Medical University of South Carolina MedicalResearch.com: What is the background for this study? Response: Unfortunately, there is no screening test for head and neck cancer like there is for colorectal, prostate, breast, lung, or cervical cancers. As a result, two-thirds of patients with head and neck cancer (HNC) present with loco-regionally advanced disease, making other aspects of timely treatment that much more critically important. We therefore sought to understand the association between treatment delay at different points along the cancer care continuum and oncologic outcomes for patients with head and neck cancer. (more…)
Author Interviews, Cannabis, Diabetes, JAMA / 06.11.2018

MedicalResearch.com Interview with: Viral Shah, MD Assistant Professor of Medicine & Pediatrics Barbara Davis Center for Diabetes, Adult Clinic School of Medicine University of Colorado Anschutz Medical Campus MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cannabis use is increasing in Colorado and many patients with type 1 diabetes (which is an autoimmune form of diabetes that requires life insulin therapy) are using cannabis. Therefore, we surveyed adult patients with type 1 diabetes to study the association between cannabis use and glycemic control and diabetes acute complications (such as diabetic ketoacidosis) in adults with type 1 diabetes. Main findings of the study:  The risk for diabetic ketoacidosis (a serious condition where body produces high levels of acids called ketones in patients with diabetes)  was two times higher among adults with type 1 diabetes who reported using cannabis in the past 12 months compared to adults with type 1 diabetes who reported not using cannabis. (more…)
Author Interviews, Electronic Records, JAMA, Outcomes & Safety / 06.11.2018

MedicalResearch.com Interview with: "Portable Information station, nurse, computer, hand wipes, 9th floor, Virginia Mason Hospital, Seattle, Washington, USA" by Wonderlane is licensed under CC BY 2.0Timothy Ryan PhD This work was performed while Dr. Ryan was at Precera Biosciences, 393 Nichol Mill Lane Frankluin, Tennessee  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The study design is quite simple.  We measured medication concentrations in patients, then compared empirically detected medications with prescribed medications in each patient’s medical record.  We used this information to estimate how many prescribed medications patients had actually taken and how often they took medications that were not in their medical record.  The later comparison is a particularly novel measure of the number and types of medications taken by patients unbeknownst to healthcare providers who use the medical record as a guide to patient care. Further, the test was performed in blood and not urine, so we could obtain an estimate of how often patients were in range for medications that they did take – at least for medications where the therapeutic range for blood concentrations are well established. In sum, we found that patients do not take all of their medications, the medical records are not an accurate indicator of the medications that patients ingest, and that even when taken as prescribed, medications are often out of therapeutic range.  The majority of out-of-range medications were present at subtherapeutic levels.  (more…)
Author Interviews, Brain Injury, Gender Differences, JAMA, Pediatrics / 05.11.2018

MedicalResearch.com Interview with: Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada MedicalResearch.com: What is the background for this study? Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care. The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery. Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 05.11.2018

MedicalResearch.com Interview with: Robin M. Shaw, MD, PhD Wasserman Foundation Chair in Cardiology in honor of S. Rexford Kennamer MD Division of Cardiology, Smidt Heart Institute Department of Medicine, Cedars-Sinai Medical Center, Division of Cardiology, Department of Medicine University of California, Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: At present, doctors do not have a clinical tool that assesses the biochemical health of heart muscle.  Biomarkers are available that tests the amount of fluid in the heart, and whether a heart is overloaded (which can be resolved with diuretics).  However, we don’t have biomarkers that assess the state of heart muscle itself.  As a result, doctors can use biomarkers to determine whether, when a patient has trouble breathing, there is heart failure present. However, biomarkers do not work when the patient does not have symptoms or when we already know the patient has heart failure and are trying to make clinical management decisions about the condition. Current biomarkers also don’t work to assess the health of the heart before symptoms develop which is to detect cellular changes in muscle before overall heart function is impaired. The new biomarker, CS, address the above unmet needs.  CS is based on cBIN1 which is a heart muscle protein that is essential for the heart to both contract and relax.  cBIN1 decrease when hearts are stressed such as in heart failure.  cBIN1 is also released into the blood stream, so it can be detected from a simple blood draw.  CS is determined from the inverse of cBIN1, so low cBIN1 in blood will give a high CS signal.  A low cBIN1, or a high CS, indicates failing heart muscle, and an increased likelihood for being admitted to the hospital with acute heart failure within the next twelve months.  (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Electronic Records, JAMA / 03.11.2018

MedicalResearch.com Interview with: Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost. We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records. Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning.    (more…)
Author Interviews, Autism, JAMA, OBGYNE / 01.11.2018

MedicalResearch.com Interview with: Magdalena Janecka PhD Department of Psychiatry Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Our paper explored the association between maternal use of medication during pregnancy and the rates of autism in a large cohort from Israel. This followed on from a number of earlier studies reporting that the use of certain medications - for example antidepressants - during pregnancy is associated with higher rates of autism in children. However, rather than test the effects of any particular drug, or a set of drugs aggregated based on maternal condition, our large dataset allowed us to group all medications prescribed to pregnant women based on their drug target, and in the subsequent analyses focus on over 50 groups that included drugs with neurotransmitter-relevant targets - for example agonists and antagonists of their receptors. (more…)
Author Interviews, Brain Injury, Heart Disease, JAMA, Neurology / 31.10.2018

MedicalResearch.com Interview with: Marion Moseby-Knappe, MD Neurologist and Researcher Center for Cardiac Arrest at Lund University and Skane University Hospital Lund, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research focuses on improving methods for examining unconscious patients treated on intensive care units after cardiac arrest. If a patient does not wake up within the first days after cardiac arrest, physicians need to evaluate how likely it is that the patient will awaken at all and to which extent there is brain injury. According to European and American guidelines, decisions on further medical treatment of cardiac arrest patients should always be based on a combination of examinations and not only one single method. Various methods are combined when assessing the patient such as examining different neurologic reflexes, head scans (computed tomography or magnetic resonance imaging), other specialist examinations (electroencephalogram or somatosensory evoked potentials) or blood markers. Our research focuses on patients included in the largest cardiac arrest trial to date, the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial. (more…)
Author Interviews, Cost of Health Care, JAMA, Kidney Disease / 31.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH Associate Professor of Health Services, Policy and Practice Associate Professor of Medicine Brown University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown. Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.      (more…)
Accidents & Violence, Author Interviews, JAMA / 31.10.2018

MedicalResearch.com Interview with: "Halloween Parade 2014" by GoToVan is licensed under CC BY 2.0Dr. John A. Staples, MD Clinical Assistant Professor University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings? Response: At this time last year, my co-author Candace Yip and I noticed an impressive number of advertisements for Halloween-themed parties at bars taped to lamp-posts. We wondered if the combination of dark costumes, dark evenings, alcohol and trick-or-treaters made the streets more dangerous for pedestrians. To see if our hunch was correct, we examined 42 years of data on all fatal vehicle crashes in the United States between 1975 and 2016. We compared the number of pedestrian fatalities between 5 p.m. and midnight on Halloween with the number during the same hours on control days one week earlier and one week later. We found that 14 pedestrian deaths occurred on the average Halloween, while only 10 pedestrian deaths occurred on the average control evening. This corresponded to a 43% increase in the relative risk of pedestrian fatality on Halloween. Among children aged 4 to 8 years of age, the risk of death was ten times higher on Halloween evening compared to control evenings. Risks were highest around 6pm, which is prime trick-or-treating time. Absolute risks were small and declined throughout the four decades of the study, but the relative risk increase on Halloween persisted throughout the entire study interval.  (more…)
Author Interviews, Cost of Health Care, JAMA / 30.10.2018

MedicalResearch.com Interview with: Samir C. Grover MD, MEd, FRCPC Division of Gastroenterology Program Director Division of Gastroenterology Education Program University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that physician-industry interactions are commonplace. Because of this, there has been a movement to make the presence of these relationships more transparent. For clinical practice guidelines, this is especially important as these documents are meant to be objectively created, evidence based, and intended to guide clinical practice. The standard in the US come from the National Academy of Medicine report, "Clinical Practice Guidelines We Can Trust", which suggests that guideline chairs should be free of conflicts of interest, less than half of the guideline committee should have conflicts, and that guideline panel members should declare conflicts transparently. Other studies, however, have shown that some guidelines don't adhere to this advice and have committee members who don't disclose all conflicts. We thought to look at this topic among medications that generate the most revenue, hypothesizing that undeclared conflicts would be especially prevalent in this setting. We found that, among 18 guidelines from 10 high revenue medications written by 160 authors, more than (57%) had a financial conflict of interest, meaning they received payments from pharmaceutical companies that make or market medications recommended in that guideline. About a quarter of authors also received, and didn't disclose payments from one of these companies. Almost all the guidelines did not adhere to National Academy of Medicine standards. (more…)
Accidents & Violence, Author Interviews, JAMA, Johns Hopkins, Surgical Research / 30.10.2018

MedicalResearch.com Interview with: “Me holding USP gun” by Nghị Trần is licensed under CC BY 2.0Faiz Gani, PhD Postdoctoral research fellow Department of Surgery Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Firearm related injuries are a leading cause of injury and death in the United States, yet, due to combination of factors, limited data exist that evaluate these injuries, particularly among younger patients (patients younger than 18 years). The objective of this study was to describe emergency department utilization for firearm related injuries and to quantitate the financial burden associated with these injuries. In our study of over 75,000 emergency department visits, we observed that each year, over 8,300 children and adolescents present to the emergency department for the treatment / management of a gunshot injury. Within this sub-population of patients, we observed that these injuries are most frequent among patients aged 15-17 years and while these injuries decreased over time initially, were observed to increase again towards the end of the time period studied. In addition to describing the clinical burden of these injuries, we also sought to describe the financial burden associated with these injuries. For patients discharged from the emergency department, the average (median) charge associated with their care was $2,445, while for patients admitted as inpatients for further care, the average (median) charge was $44,966. Collectively these injuries resulted in $2.5 billion in emergency department and hospital charges over the time period studied. This translates to an annual financial burden of approximately $270 million. (more…)
Author Interviews, Biomarkers, Infections, JAMA, Stanford / 29.10.2018

MedicalResearch.com Interview with: "Mycobacterium tuberculosis Bacteria, the Cause of TB" by NIAID is licensed under CC BY 2.0Purvesh Khatri, Ph.D. Associate Professor Stanford Institute for Immunity, Transplantation and Infection (ITI) Stanford Center for Biomedical Informatics Research (BMIR) Department of Medicine Stanford University Stanford, CA 94305 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have previously described a 3-gene signature for distinguishing patients with active tuberculosis (ATB) from those with other diseases, latent mycobacterium tuberculosis (LTB) infection, and healthy controls (Sweeney et al. Lancet Respir Med 2016). The current study in JAMA Network Open is a follow up study to validate the 3-gene signature in 3 additional independent cohorts that were prospectively collected. Using these 3 cohorts we have now showed that the 3-gene signature (1) can identify patients with LTB that will progress to ATB about 6 months prior to diagnosis of active tuberculosis. (2) can identify patients with ATB in active screening, and (3) can identify patients with ATB at diagnosis that have higher likelihood of persistent lung inflammation due to subclinical ATB at the end of treatment.  (more…)
Accidents & Violence, Author Interviews, JAMA / 26.10.2018

MedicalResearch.com Interview with: John W. Epling, Jr., M.D., M.S.Ed Professor of Family and Community Medicine Virginia Tech Carilion School of Medicine Roanoke, VA USPSTF Task Force Member MedicalResearch.com: What is the background for this study? Response: Intimate partner violence, often known as domestic violence, can have devastating consequences to one’s health and wellbeing. It can lead to mental illness, substance abuse, unintended pregnancy, and even death. This is a serious public health issue in America: one in three men—and even more women—experience it in their lifetimes. Because this is such an important topic, and the last time we made a recommendation on it was in 2013, the U.S. Preventive Services Task Force reviewed the most recent evidence to determine how clinicians can help prevent the negative health effects of intimate partner violence. (more…)
Author Interviews, JAMA, Opiods, Pediatrics / 26.10.2018

MedicalResearch.com Interview with: Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting. We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system. We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015.  (more…)
Author Interviews, Dermatology, Gastrointestinal Disease, JAMA / 25.10.2018

MedicalResearch.com Interview with: Prof Ching-Chi Chi, MD, MMS, DPhil  Department of Dermatology Chang Gung Memorial Hospital, Linkou Guishan Dist, Taoyuan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies have shown common genotypes, clinical course, and immunological features shared by psoriasis and inflammatory bowel disease. However, the relationship between psoriasis and inflammatory bowel disease was largely unclear. In this study, we found when compared to the general population, psoriatic patients are more likely to have concomitant inflammatory bowel disease.  (more…)
Author Interviews, Brain Injury, Critical Care - Intensive Care - ICUs, JAMA / 25.10.2018

MedicalResearch.com Interview with: Jamie Cooper AO BMBS MD FRACP FCICM FAHMS Professor of Intensive Care Medicine Monash University Deputy Director & Head of Research, Intensive Care & Hyperbaric Medicine The Alfred, Melbourne MedicalResearch.com: What is the background for this study? Response: 50-60 million people each year suffer a traumatic brain injury (TBI) . When the injury is severe only one half are able to live independently afterwards. Cooling the brain (hypothermia) is often used in intensive care units for decades to  decrease inflammation and brain swelling and hopefully to improve outcomes, but clinical staff have had uncertainty whether benefits outweigh complications. We conducted the largest randomised trial of hypothermia in TBI, in 500 patients, in 6 countries, called POLAR. We started cooling by ambulance staff, to give hypothermia the best chance to benefit patients. We continued for 3-7 days in hospital ind ICU. We measured functional outcomes at 6 months. (more…)