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…)
Author Interviews, Cancer Research, JAMA, Nutrition / 23.10.2018

MedicalResearch.com Interview with: "Sunday market in Paris: all organic food" by Richard Smith is licensed under CC BY 2.0Julia Baudry & Emmanuelle Kesse-Guyot PhD Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Institut National de la Recherche MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among the environmental risk factors for cancer, there are concerns about exposure to different classes of pesticides, notably through occupational exposure. Organic foods are less likely to contain pesticide residues than conventional foods, and studies have showed that an organic diet reduces exposure to certain pesticides (Baudry et al 2018, Oates et al 2014, Curl et al 2015). In the general population, the primary route of exposure is diet, especially intake of conventionally grown fruits and vegetables. However, few studies have examined the association of organic food consumption with cancer risk. In a population of 68 946 French adults from the NutriNet-Santé study, we found a reduction of 25% of cancer risk among consumers with a high frequency of organic foods compared to consumers with a low frequency, after accounting for many factors (such as lifestyle, diet and sociodemographic factors). Specifically a 34% and 76% decrease in risk was observed for post-menopausal breast cancer and all lymphomas, respectively, among frequent organic food consumers compared to consumers with a low organic food consumption frequency. (more…)
Addiction, Author Interviews, Cost of Health Care, JAMA / 20.10.2018

MedicalResearch.com Interview with: Tyler Winkelman MD, MSc   Clinician-Investigator Division of General Internal Medicine, Hennepin Healthcare Center for Patient and Provider Experience, Hennepin Healthcare Research Institute Assistant Professor Departments of Medicine & Pediatrics University of Minnesota  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Trends in amphetamine use are mixed across data sources. We sought to identify trends in serious, problematic amphetamine use by analyzing a national sample of hospitalizations. Amphetamine-related hospitalizations increased over 270% between 2008 and 2015. By 2015, amphetamine-related hospitalizations were responsible for $2 billion in hospital costs. While opioid-related hospitalizations were more common, amphetamine-related hospitalizations increased to a much larger degree. After accounting for population growth, amphetamine hospitalizations grew 245% between 2008 and 2015, whereas opioid-related hospitalizations increased 46%. Amphetamine-related hospitalizations were more likely to be covered by Medicaid and be in the western United States compared with other hospitalizations. In-hospital mortality was 29% higher among amphetamine-related hospitalizations compared with other hospitalizations.  (more…)
Abbott, Author Interviews, Biomarkers, Heart Disease, JAMA / 20.10.2018

MedicalResearch.com Interview with: Dr John W Pickering, BSc(Hons), PhD, BA(Hons) Associate Professor , Senior Research Fellow in Acute Care Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board |  Christchurch Hospital Research Associate Professor | Department of Medicine University of Otago Christchurch MedicalResearch.com: What is the background for this study? What are the main findings? Response: The assessment of patients with suspected myocardial infarction is one of the most common tasks in the emergency department. Most patients assessed (80 to 98% depending on the health system) are ultimate not diagnosed with an MI.   High-sensitivity troponin assays have been shown to have sufficient precision at low concentrations to allow very early rule-out of myocardial infarction. However, these are lab-based assays which typically result in a delay from blood sampling before the result is available and the physician is able to return to a patient to make a decision to release the patient or undertake further investigation. Point-of-care assays provide results much quicker, but have to-date not had the analytical characteristics that allow precise measurements at low concentrations. In this pilot study we demonstrated that a single measurement with a new point-of-care assay (TnI-Nx; Abbott Point of Care) which can measure low troponin concentrations, could safely be used to rule-out myocardial infarction a large proportion of patients (57%). The performance was at least comparable to the high-sensitivity troponin I assay, if not a little better (44%). (more…)
Author Interviews, Cognitive Issues, Geriatrics, JAMA, Surgical Research / 17.10.2018

MedicalResearch.com Interview with Mark Oldham, M.D. Assistant Professor of Psychiatry Medical Director, PRIME Medicine Proactive Integration of Mental Health Care in Medicine University of Rochester Medical Center MedicalResearch.com: What is the background for this study? Response: Patients who have undergone coronary artery bypass graft (CABG) surgery and, specifically, those who have been placed on cardiopulmonary bypass (CPB) have received attention for the potential effects of such procedures on brain health. Heart valve surgery patients have received far less attention, which often leaves clinicians to extrapolate the data from CABG cohorts to their patients preparing to undergo valve surgery. However, there are many reasons why this is far less than ideal, especially as the CABG literature increasingly points to person- and procedure-specific factors as the determinants of postoperative cognitive outcomes. (more…)
Author Interviews, Geriatrics, JAMA, Pharmacology / 17.10.2018

MedicalResearch.com Interview with: Dr. Emily Reeve BPharm(Hons) PhD NHMRC-ARC Dementia Research Fellow Northern Clinical School University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: Older adults commonly take multiple medications. All medications carry the potential for both benefit and harm. When a medication is started a decision has been made between the healthcare professional and the patient that the likely benefits outweigh the potential risks. But over time the potential benefits and harms can change. So, part of good clinical care is discontinuation of medications when the benefit no longer outweighs the risks – for example when it is no longer needed or high risk. This is called “deprescribing”. Previously we knew that older adults could have mixed feelings about their medications, that is, they believe that all their medications are necessary but also feel that they are a burden to them. Qualitative research has explored this further, finding that there are a number of barriers and enablers to deprescribing from the patient perspective. For example, someone might have fear of deprescribing because they are worried that their symptoms may come back. But if they know that deprescribing is a trial and they will be monitored and supported by their physician or other healthcare professional they might be more open to deprescribing. From the physician perspective, there were concerns that older adults and their families were resistant to deprescribing and so there was fear that discussing possible medication discontinuation could damage the doctor-patient relationship. In this study of almost 2000 older adults in the United States, we found that over 90% were willing to stop one of more of their medications if their doctor said it was possible. Additionally, one third of participants wanted to reduce the number of medications that they were taking.  (more…)
Author Interviews, Cannabis, Genetic Research, JAMA, Mental Health Research / 17.10.2018

MedicalResearch.com Interview with: Dr. Nicole Karcher, PhD Post-doctoral scholar with the NIMH Training in Clinical Sciences fellowship Department of Psychiatry Washington University School of Medicine   MedicalResearch.com: What is the background for this study? What are the main findings? Response: For over fifteen years, researchers have debated the role that cannabis use plays in the development of both psychotic disorders as well as subthreshold psychotic symptoms, such as psychotic-like experiences (PLEs). There is still a lack of consensus regarding the nature of the association between cannabis use and psychosis risk, with some research finding evidence for genetic overlap, while other research finds evidence for potentially causal pathways. The current study examined data from twins and siblings from two different samples, the U.S.-based Human Connectome Project and the Australian Twin Registry, with a total of 4,674 participants. Overall, psychotic-like experiences were associated with three separate cannabis use variables [frequent (≥100 times) use, a Cannabis Use Disorder diagnosis, and current cannabis use]. Furthermore, the current research found evidence for both shared genetic and individual-specific contributions to the association between PLEs and these three cannabis use variables. More specifically, while the association between cannabis use and psychotic-like experiences was largely attributable to shared genetic factors, cannabis users were more likely to endorse PLEs in comparison to the relative who used cannabis less.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Colon Cancer, JAMA, Weight Research / 15.10.2018

MedicalResearch.com Interview with: Stuart Po-Hong Liu, MD, MPH Clinical and Translational Epidemiology Unit Massachusetts General Hospital and Harvard Medical School Boston MedicalResearch.com: What is the background for this study? Response: Although there were global decreases in overall colorectal cancer (CRC) incidence, CRC rates have increased dramatically in those aged 20 to 49 years in the United States, parts of Europe, and Asia. The etiology and early detection of young-onset becomes an emerging research and clinical priority. Another important fact that is that this emerging public health concern has resulted in updated guidelines from the American Cancer Society advising average-risk screening begin at age 45, rather than 50. However, up to this point, the etiology of young onset CRC remains largely unknown. Elucidating the role of traditional CRC risk factors in the etiopathogenesis of young-onset CRC is one of the first research agenda. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Melanoma / 14.10.2018

MedicalResearch.com Interview with: Caroline C. Kim, M.D. Associate Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director, Cutaneous Oncology Program Beth Israel Deaconess Medical Center Boston, MA 02215 MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: Atypical/dysplastic nevi have been identified as risk factors for melanoma, however the majority of melanomas arise as new lesions on the skin. Unlike other models of dysplasia having a clear trajectory towards cancer as seen in cervical dysplasia, dysplastic nevi are not proven to be obligate precursors for melanoma.  However, there is little evidence to guide the management of biopsied dysplastic nevi with positive margins, with much clinical variation in the management of moderately dysplastic nevi in particular. In this multi-center national study of 9 U.S. academic centers, we examined outcomes of 467 moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins with at least 3 years of clinical follow-up.  We found that no cases developed into a same-site melanoma with a mean follow-up time of 6.9 years. However, 22.8% of our patients went on to develop a future separate site melanoma. (more…)