Author Interviews, Endocrinology, JAMA, Prostate Cancer, UCLA / 22.09.2018

MedicalResearch.com Interview with: Amar U. Kishan, MD Assistant Professor Department of Radiation Oncology University of California, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Three large randomized trials demonstrated an overall survival (OS) benefit when androgen deprivation therapy (ADT) is combined with radiotherapy (RT) for high-risk prostate cancer (PCa). The duration of ADT in these seminal studies ranged from six months to lifelong. Because ADT has multiple attendant adverse effects--including bone loss, altered metabolism, diminished muscle mass, gynecomastia, hot flashes, and possibly increased cardiovascular events--shortening the duration of ADT without compromising oncologic effectiveness has been an area of active study. Five trials have compared various durations of ADT, reaching conflicting conclusions with respect to overall survival outcomes, with some suggesting an improvement with longer durations of ADT and others failing to show a uniform survival benefit. Most of these trials have amalgamated Gleason grade group 4 (Gleason score 8) PCa with Gleason grade group (GG) 5 (Gleason score 9-10) PCa. Emerging data indicate that GS 9-10 PCa constitutes a distinct subset of high-risk PCa with inferior outcomes and earlier progression than GS 8 disease. With the knowledge that GS 9-10 PCas constitute a distinct, more aggressive form of PCa, one might hypothesize that longer durations of ADT may be more advantageous in both augmenting local control and controlling potential micrometastatic disease. Alternatively, as GS 9-10 lesions by definition contain highly de-differentiated Gleason pattern 5 disease foci and may proceed to a castrate-resistant state more rapidly, one may also hypothesize that GS 9-10 lesions are less responsive to ADT, and longer durations may be counter-productive. In order to identify differences in the impact of ADT duration on clinical outcomes of patients with GG 4 and GG 5 PCa, we performed an individual patient-level meta-analysis of six randomized trials. Our working hypothesis was that longer durations of ADT would offer significant survival benefits in both groups. (more…)
Author Interviews, Cancer Research, Cost of Health Care, Dermatology, Emory, JAMA, Medicare / 21.09.2018

MedicalResearch.com Interview with: “Actinic Keratosis” by Ed Uthman is licensed under CC BY 2.0Howa Yeung, MD Assistant Professor of Dermatology Emory University School of Medicine Atlanta, GA 30322  MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses? Response: Actinic keratoses are common precancerous skin lesions caused by sun exposure. Because actinic keratoses may develop into skin cancers such as squamous cell carcinoma and basal cell carcinoma, they are often treated by various destructive methods. We used Medicare Part B billing claims to estimate the number and cost of treated actinic keratoses from 2007 to 2015. MedicalResearch.com: What are the main findings?  Response: While the number of Medicare Part B beneficiaries increased only moderately, the number of actinic keratoses treated by destruction rose from 29.7 million in 2007 to 35.6 million in 2015. Medicare paid an average annual amount of $413.1 million for actinic keratosis destruction from 2007 to 2015. Independently billing non-physician clinicians, including advanced practice registered nurses and physician assistants, are treating an increasing proportion of actinic keratosis, peaking at 13.5% in 2015. MedicalResearch.com: What should readers take away from your report? Response: Readers should understand that the burden of actinic keratosis treatment is increasing in the Medicare population. There is also an increasing proportion of actinic keratoses being treated by advanced practice registered nurses and physician assistants.  (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Lipids / 20.09.2018

MedicalResearch.com Interview with: Luca A. Lotta, MD, PhD Senior Clinical Investigator MRC Epidemiology Unit University of Cambridge MedicalResearch.com: What is the background for this study? What are the main findings?
  • Drugs that enhance the breakdown of circulating triglycerides by activating lipoprotein lipase (LPL) are in pre-clinical or early-clinical development.
  • It is not known if these drugs will reduce heart attacks or diabetes risk when added to the current first line therapies (statins and other cholesterol-lowering agents).
  • Studying this would require large randomised controlled trials, which are expensive (millions of GBPs) and time-consuming (years).
  • Human genetic data can be used to provide supportive evidence of whether this therapy is likely to be effective by “simulating” a randomised controlled trial.
  • Our study used naturally occurring genetic variants in the general population (study of ~400,000 people) to address this.
  • Individuals with naturally-lower cholesterol due to their genetic makeup were used as model for cholesterol-lowering therapies (eg. Statins).
  • Individuals with naturally-lower triglycerides due to genetic variants in the LPL gene were used as model for these new triglyceride-lowering therapies.
  • We studied the risk of heart attacks and type 2 diabetes in people in different groups.
(more…)
Author Interviews, JAMA, USPSTF, Weight Research / 20.09.2018

MedicalResearch.com Interview with: Chyke Doubeni, M.D., M.P.H. Harrison McCrea Dickson, M.D. and Clifford C. Baker, M.D. Presidential Professor Associate Professor of Epidemiology Senior scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obesity is an important public health issue that affects nearly 4 in 10 American adults. It increases the risk for many chronic health conditions as well as premature death from diabetes, coronary heart disease, various types of cancer, and other conditions. As such, it was important for the U.S. Preventive Services Task Force to review the current evidence and update the recommendation on this topic. Based on a review of the most recent studies, we found that intensive, multicomponent behavioral interventions are safe and effective. They can help people lose weight, maintain their weight loss, and reduce the risk of obesity-related conditions such as diabetes in people with high blood sugar. Therefore, the Task Force is recommending that clinicians offer or refer adults with a body mass index, or BMI, of 30 kg/m2 or higher to these behavioral interventions.    (more…)
Alzheimer's - Dementia, Author Interviews, CT Scanning, JAMA, Medical Imaging / 20.09.2018

MedicalResearch.com Interview with: PET scanner Wikipedia imageRik Ossenkoppele -PhD Lund University & VU University Medical Center Oskar Hansson - Lund University MedicalResearch.com: What is the background for this study? What are the main findings? Response: [18F]flortaucipir is a relatively novel PET tracer that can be used to detect tau pathology in the living human brain. Previous studies have shown a robust signal in patients with Alzheimer’s disease, but in patients with other types of dementia the signal was more variable. We aimed to assess the ability of [18F]flortaucipir PET to distinguish Alzheimer’s disease from other neurodegenerative disease in more than 700 study participants. T he main finding was that [18F]flortaucipir discriminated Alzheimer’s disease patients from patients with other neurodegenerative diseases with high accuracy. Furthermore, [18F]flortaucipir PET outperformed established MRI markers and showed higher specificity than amyloid-β PET.  (more…)
Author Interviews, Cancer Research, Cost of Health Care, ENT, HPV, JAMA, Surgical Research / 18.09.2018

MedicalResearch.com Interview with: Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The Patient Protection and Affordable Care Act (ACA) is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care. This legislation is commonly debated and objective data is needed to evaluate its impact.  As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.  Main findings below:     MedicalResearch.com: What should readers take away from your report? Response: This population-based study found an increase in the percentage of patients enrolled in Medicaid and private insurance and a large decrease in the rates of uninsured patients after implementation of the Patient Protection and Affordable Care Act (ACA).  This change was only seen in states that adopted the Medicaid expansion in 2014. The decrease in the rate of uninsured patients was significant, 6.2% before versus 3.0% after. Patients who were uninsured prior to the Patient Protection and Affordable Care Act had poorer survival outcomes. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 18.09.2018

MedicalResearch.com Interview with: Dr Ruth Blackburn PhD  UKRI Innovation Fellow UCL Institute of Health Informatics Dr Ruth Blackburn PhD  UKRI Innovation Fellow UCL Institute of Health Informatics  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In England one child in every classroom is admitted to hospital with an adversity related injury (i.e. violence, intentional self-injury, or drug or alcohol misuse) between the ages of 10 and 19 years. These young people are more likely than their classmates to be re-admitted to hospital or to die within 10 years. We investigated how the rate of hospital admissions with an adversity related injury has changed over time among young people aged 10-24 years, using administrative data for National Health Service hospitals in England. We found that between 2012 and 2016, rates of admission with an adversity related injury (including intentional self-injury) increased steeply for girls, with the biggest increase (6% per year) among 15-19 year olds. During the same time period, rates of admission with an adversity related injury decreased in boys aged 15-24 years (4-5% per year) but increased slightly for 10-14 year olds (3% per year).  (more…)
Author Interviews, Cost of Health Care, JAMA, Kaiser Permanente, Primary Care / 17.09.2018

MedicalResearch.com Interview with: Richard W. Grant MD MPH Research Scientist III, Kaiser Permanente Division of Resarch Adjunct Associate Professor, UCSF Dept Biostatistics & Epidemiology Director, Kaiser Permanente Delivery Science Fellowship Program Co-Director, NIDDK Diabetes Translational Research post-doctoral training program MedicalResearch.com: What is the background for this study? Response: Primary care in the United States is in a state of crisis, with fewer trainees entering the field and more current primary care doctors leaving due to professional burnout. Changes in the practice of primary care, including the many burdens related to EHR documentation, has been identified as a major source of physician burnout. There are ongoing efforts to reduce physician burnout by improving the work environment. One innovation has been the use of medical scribes in the exam room who are trained to enter narrative notes based on the patient-provider interview. To date, there have only been a handful of small studies that have looked at the impact of medical scribes on the provider’s experience of providing care. (more…)
Author Interviews, CDC, JAMA, Pediatrics, Social Issues / 17.09.2018

MedicalResearch.com Interview with: Melissa T. Merrick, PhD Behavioral Scientist, Surveillance Branch, Division of Violence Prevention CDC MedicalResearch.com: What is the background for this study? Response: Childhood experiences build the foundation for health throughout a person’s life. Adverse childhood experiences (ACEs) are potentially traumatic experiences, which occur in childhood. Exposure to ACEs, especially for young people without access to safe, stable, nurturing relationships and environments, can impact health in many ways, including increased risk of chronic disease, engagement in risky behaviors, limited life opportunities, and premature death. (more…)
Author Interviews, Endocrinology, Environmental Risks, JAMA, Pediatrics, Thyroid Disease / 17.09.2018

MedicalResearch.com Interview with: Carrie Breton ScD Associate Professor and Director of the MADRES Center Division of Environmental Health Los Angeles, CA 90032 MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am interested in how the environment can influence our very early development, starting in the womb. I have studied the health effects of air pollutants on children for several years and wanted to focus now on the earliest windows of susceptibility.  Thyroid hormones play a critical role in fetal growth and development. We knew we could get information on newborn thyroid levels from the California Department of Public Health’s newborn screening program therefore look at this question in our study population. We found that exposure to high levels of PM2.5 and PM10 throughout most of pregnancy affected TT4 levels in newborns. (more…)
Author Interviews, Cannabis, CDC, JAMA, Pediatrics / 17.09.2018

MedicalResearch.com Interview with: Katrina Trivers, PhD, MSP Lead author and lead epidemiologist Office on Smoking and Health CDC MedicalResearch.com: What is the background for this study? Response: Although we’ve seen considerable declines in the use of regular cigarettes among U.S. youth over the past several decades, the tobacco product landscape is evolving, and the use of other tobacco products have become increasingly popular. For example, as of 2014, e-cigarettes have become the most commonly used tobacco product among US youth. During 2011-2015, e-cigarette use increased 900% among U.S. high school students before declining in 2016. No change was observed in 2017, with about 2 million youth, including 12% of high school students and 3% of middle school students, reporting they had used e-cigarettes in the past 30 days. This is a public health concern because the use of any form of tobacco product is unsafe among youth, irrespective of whether it’s smoked, smokeless, or electronic. The U.S. Surgeon General has concluded that the aerosol emitted from e-cigarettes is not harmless. It can contain harmful ingredients, including nicotine, carbonyl compounds, and volatile organic compounds known to have adverse health effects. The nicotine in these products is of particular concern given that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain. In recent years, many youth have also been using other psychoactive substances in e-cigarettes, including cannabinoids and other illicit drugs. This could have been fueled, in part, by shifts in the social acceptability and access to cannabis as several states have or are considering legalized cannabis sales for adults. A previous CDC study found that in 2015, almost 1 in 3 students reported using e-cigarettes with non-nicotine substances. However, it wasn’t possible to identify what exactly those substances were based on the question. Given the high concurrent use of tobacco and other substances, including cannabis, a more detailed question was added to a future survey to assess the use of cannabis in e-cigarettes among U.S. youth. This study presents the findings from that question. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Nutrition, Pediatrics / 17.09.2018

MedicalResearch.com Interview with: Sascha Verbruggen, MD, PhD Pediatric intensivist Erasmus MC-Sophia Children's Hospital MedicalResearch.com: What is the background for this study? Response: In critically ill children treated in the pediatric intensive care unit (PICU) are often difficult to feed. The subsequent macronutrient deficit was found to be associated with impaired outcomes in the PICU. Furthermore, being undernourished in the PICU has also been associated with poor outcome of critical illness in children. These associations formed the basis for guidelines recommending initiation of parenteral nutritional support early when enteral feeding is insufficient. However, the multicenter randomised controlled trial (RCT) 'Pediatric Early versus Late Parenteral Nutrition in Critical Illness' (PEPaNIC), including 1440 critically ill children, showed that withholding PN for one week (Late-PN) resulted in fewer new infections and reduced the duration of PICU stay as compared to initiating PN at day 1 (Early-PN). However, withholding PN for one week in critically ill children, who are already undernourished upon admission to the PICU, raised concerns among experts. Therefore we set out to investigate the impact of withholding supplemental PN in a subgroup of critically ill children who were acutely undernourished upon admission to the PICU.  (more…)
Author Interviews, Dermatology, Environmental Risks, JAMA, Melanoma / 15.09.2018

MedicalResearch.com Interview with: Lori A. Crane, PhD Department of Community and Behavioral Health Colorado School of Public Health University of Colorado Anschutz Medical Campus, Aurora CO  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nevi, which are commonly called “moles”, are brown or black spots on the skin that are usually raised.  Moles are the number one risk factor for malignant melanoma, the most dangerous kind of skin cancer.  About 9,000 people die of melanoma each year in the U.S. The more moles a person has, the higher their risk for melanoma.  Sun exposure is a major factor in the development of moles, and in order to prevent melanoma, it is important to better understand how moles are formed on the skin. Most moles are formed during childhood and adolescence.  We studied non-Hispanic and Hispanic white children age 3-16 and found that non-Hispanic children developed many more moles than Hispanic children.  Overall, boys developed more moles than girls, but there were some important differences.  For parts of the skin that are often covered by clothing but sometimes exposed to the sun, such as the chest and back, upper arms and upper legs, girls developed more moles than boys, especially among Hispanic children.  In contrast, for parts of the skin that are usually exposed to the sun, such as the face, boys developed many more moles than girls.  The development of moles leveled off by age 16 for parts of the skin usually exposed to the sun, while for the less often exposed skin, children continued to develop moles to age 16. (more…)
Author Interviews, JAMA, Mental Health Research, Omega-3 Fatty Acids / 15.09.2018

MedicalResearch.com Interview with: “omega 3” by Khaldaa Photographer is licensed under CC BY 2.0Yutaka MATSUOKA, MD, PhD Division Chief of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Anxiety is the most commonly experienced psychiatric symptom. We have now two major treatment options that include cognitive-behavioral therapy (CBT) and pharmacotherapy.  However, CBT is time-consuming, costly, and limited in availability. And there is concern over potential side effects in pharmacotherapy. Evidence-based and safer treatment options are required. Omega-3 fatty acids have potential preventive and therapeutic effects on depression and anxiety. Clinical and preclinical studies support the effectiveness of omega-3 fatty acids as a treatment for anxiety disorders. Despite the largely positive findings of these trials, the clinical application of the findings is unfortunately limited by their small sample size. Improvement in anxiety symptoms were associated with omega-3 fatty acids treatment compared with controls. The anxiolytic effects of omega-3 fatty acids were also stronger in patients with clinical conditions than in subclinical populations.  (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, MD Anderson / 15.09.2018

MedicalResearch.com Interview with: Kelly K. Hunt, MD Department of Breast Surgical Oncology The University of Texas MD Anderson Cancer Center Houston MedicalResearch.com: What is the background for this study? What are the main findings? Response: We completed a neoadjuvant trial at MD Anderson Cancer Center and published the results in 2005 demonstrating that trastuzumab delivered in combination with anthracycline and taxane based chemotherapy resulted in pathologic complete response rates of up to 60% in patients with HER-2 positive breast cancer. This was a single institutions study and there was concern about cardiac toxicity when using anthracyclines and trastuzumab concurrently. We therefore worked with the NCI cooperative groups, the American College of surgeons oncology group (ACOSOG), to design the ACOSOG Z1041 trial. This trial compared to different regimens in the neoadjuvant setting, one regimen utilizing concurrent anthracycline and taxanes based chemotherapy with trastuzumab and the other regimen utilizing concurrent taxanes with trastuzumab but the anthracycline was delivered in a sequential fashion. The primary end point of the trial was pathologic complete response rates in the breast. The results from this primary end point were published in the Lancet Oncology in 2013 and showed that the pathologic complete response rates were the same with the 2 different regimens. This was important since patients could be assured of similar efficacy without the potential added toxicity of delivering anthracyclines and trastuzumab together. The current publication is a report of the disease-free and overall survival rates from the Z1041 trial. Several studies have shown an association between pathologic complete response rates and survival. The current study shows that there is no difference in survival rates between the 2 different regimens. So once again there is an association between pathologic complete response and survival and it is not important that the anthracycline and trastuzumab are given concurrently in order to achieve these high pathologic complete response rates and improve survival rates. (more…)
Author Interviews, JAMA, Ophthalmology, Toxin Research / 14.09.2018

MedicalResearch.com Interview with: “Vision” by Victoria Ford is licensed under CC BY 2.0Adam J. Paulsen MS Associate Researcher EpiSense Research Program Department of Ophthalmology&  Visual Sciences University of Wisconsin - Madison MedicalResearch.com: What is the background for this study? Response: Contrast Sensitivity is a measure of visual function that indicates how well a person is able to distinguish an object against its background.  Tests of CS determine how faint a visual signal can be identified.  CS can be diminished even in those with appropriately corrected visual acuity, has been shown to have effects on daily activities (including near vision tasks), risk of falls, and driving ability.  The causes of and risks for CS impairment are understudied.  Cadmium (Cd) and Lead (Pb) are known neurotoxins that have been shown to accumulate in the retina.  Both Cd and Pb have common sources of exposure in the general population.  Our studied aimed to investigate risk factors for incident CS impairment, including Cd and Pb exposure. (more…)
Author Interviews, JAMA, Opiods, Social Issues / 14.09.2018

MedicalResearch.com Interview with: Hanna Grol-Prokopczyk PhD Assistant Professor, Department of Sociology University at Buffalo, SUNY MedicalResearch.com: What is the background for this study? Response: Studies examining predictors of prescription opioid use often have limited information about users’ socioeconomic status, their level of pain, and their opinions of opioids.  Using unique data from the Health and Retirement Study’s 2005-2006 Prescription Drug Study—which includes information about older adults’ education, income, wealth, insurance type, pain level, and opinions of prescription drugs used—I was able to explore how socioeconomic factors shaped prescription opioid use in the 2000s, when U.S. opioid use was at its peak.  I was also able to present a snapshot of how users of prescription opioids felt about these drugs before the declaration of an opioid epidemic. (more…)
Author Interviews, JAMA, Outcomes & Safety, Surgical Research / 14.09.2018

MedicalResearch.com Interview with: Tanya L. Zakrison, MHSc MD FRCSC FACS MPH Associate Professor of Surgery University of Miami Miller School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 2 million people in the United States are incarcerated, the highest rate in the entire world.  To date no national statistics on surgical outcomes have been reported in this vulnerable patient population.  We examined 301 medical examiner’s reports from prisoner deaths in Miami-Dade County.  Excluding those with confounding medical conditions such as cirrhosis and cancer, we still found that one in five deaths were being attributed to trauma and reversible surgical diseases.    (more…)
Addiction, Author Interviews, JAMA / 13.09.2018

MedicalResearch.com Interview with: Ti-Fei YuanPhD School of Social and Behavioral Sciences, Nanjing University, Nanjing, China Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China School of Psychology, Nanjing Normal University, Nanjing, China MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Addiction is causing serious challenge to public health. Few drugs can treat or even alleviate addiction. In recent years, non-invasive brain stimulation has been used to modulate craving responses in different types of drug addicts (heroin, methamphetamine, cocaine), and to prevent smoking or alcohol abuse. However it is unknown if brain stimulation can also help addicts get rid of the aversive symptoms in the early withdrawal period. The present study is to our knowledge, the first trial to alleviate drug withdrawal symptoms and associated insomnia with non-invasive transcranial magentic stimulation.  (more…)
Author Interviews, Cancer Research, Immunotherapy, JAMA, Vanderbilt / 13.09.2018

MedicalResearch.com Interview with: Douglas B. Johnson, M.D. Assistant Professor of Medicine Clinical Director, Melanoma Research Program Melanoma, clinical and translational studies Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Immune checkpoint inhibitors produce long-lasting responses in patients with many different types of cancer. However, they may cause serious autoimmune-like side effects that may affect any organ. We used several large databases to determine how often these side effects were fatal, when they occurred, and which types of side effects were responsible. We found that overall, fatal side effects were uncommon, ranging from 0.3 – 1.3%. However, they tended to occur early on treatment (on average within the first 6 weeks), and affected a variety of organs, including the heart, lungs, colon, liver, and brain. There was a dramatic increase in reporting of fatal toxicities since 2017, likely reflecting the increased use of immune checkpoint inhibitors.  (more…)
Author Interviews, Depression, JAMA, Rheumatology / 13.09.2018

MedicalResearch.com Interview with: Andrea L. Roberts, MPH, PhD Research Associate, Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: There is some evidence that depression may increase risk of autoimmune diseases. For example, among people with autoimmune diseases, more people have depression than in the general population. Also, people who have autoimmune diseases who also have depression have more severe disease symptoms. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA / 12.09.2018

MedicalResearch.com Interview with: Patrick Harris FRACP Staff Specialist Microbiology | Pathology Queensland | Health Support Queensland Postdoctoral Research Fellow University of Queensland, UQ Centre for Clinical Research (Paterson Group MedicalResearch.com: What is the background for this study? Response: Increasingly, common bacterial pathogens such as E. coli or Klebsiella have acquired genes known as extended-spectrum beta-lactamases (ESBLs), which mediate resistance to many of our most important antibiotics. Despite their clinical importance, we have limited information derived from randomised clinical trials on the best antibiotic treatments for life-threatening infections caused by these ESBL-producers. We aimed to compare two readily available antibiotics, meropenem (a carbapenem drug, as the “standard of care”) and piperacillin-tazobactam (which may be an alternative to meropenem). Many ESBL-producing bacteria test susceptible to piperacillin-tazobactam in the laboratory, yet clinical efficacy has been uncertain.  Some observational studies have suggested that piperacillin-tazobactam may be effective against ESBL-producers, but the data have been contradictory.  The theory has been that piperacillin-tazobactam may be less likely to select for resistance to carbapenems - which, when it occurs, can result in infection with bacteria that are almost untreatable. (more…)
Accidents & Violence, Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Surgical Research / 12.09.2018

MedicalResearch.com Interview with: Adil Haider, MD, MPH, FACS Kessler Director for the Center for Surgery and Public Health Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery MedicalResearch.com: What is the background for this study? Response: Firearm-related mortality is a public health issue. However, in the US, due in part to lack of funding, there is not enough research to inform the debate about firearms. The question our group sought to answer was to understand if the presence of a semi-automatic weapon increased the number of victims killed or hurt during an active shooter incident. We chose to focus on these incidents given the availability of an FBI database detailing these active shooter incidents based on a strict definition and the similarities between such incidents that make a comparison valid. (more…)
Author Interviews, Diabetes, JAMA, OBGYNE / 12.09.2018

MedicalResearch.com Interview with: Boyd E Metzger, MD Professor Emeritus of Medicine (Endocrinology) Feinberg School of Medicine Northwestern University MedicalResearch.com: What is the background for this study? Response: The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study showed that higher levels of a mother’s blood sugar during pregnancy are associated with higher risks of increased birthweight, fatter babies, delivery by Cesarean Section, low blood sugar in newborn babies and high levels of insulin in the cord blood at birth. It is not clear whether levels of a mother’s blood sugar during pregnancy are associated with risk obesity later in life as is known to occur in offspring or pre-existing maternal diabetes mellitus. With funding from the National Institutes of Health, the HAPO Follow Up Study addressed this in a subset of nearly 5,000 mothers and their children from the original HAPO Study 10-14 years later (average 11.4 years). (more…)
Author Interviews, JAMA, Ophthalmology, Primary Care, University of Michigan / 11.09.2018

MedicalResearch.com Interview with: Joshua Ehrlich, MD, MPH Assistant Professor of Ophthalmology and Visual Sciences University of Michigan  MedicalResearch.com: --Describe the “important role” that primary care providers play in promoting eye health? Response: Primary care is the entryway into the health system for many individuals. The poll suggests that when primary care providers discuss vision with their patients, they are more likely to get eye exams. It also suggests that primary care providers are having these conversations most often with those who have certain risk factors for eye disease, such as diabetes or a family history of vision problems, as well as those with fewer economic resources. Promoting these kinds of conversations could bolster this trend, increasing the number of diabetics and other high risk individuals who get appropriate eye care. (more…)
Aging, Author Interviews, Exercise - Fitness, Geriatrics, JAMA / 10.09.2018

MedicalResearch.com Interview with: Peter A. Harmer, PhD., MPH., ATC., FACSM Professor - Department of Exercise & Health Science Willamette University MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Falls in older adults have long been a significant healthcare problem associated with loss of independence, premature morbidity and mortality, and considerable financial strain on individuals and healthcare systems. With the demographic impact of the Baby Boom generation aging into retirement, this issue is becoming even more critical. Among potential prevention strategies, exercise has been proposed to be beneficial. However, establishing what types of exercise are suitable to the task has been problematic. More importantly, identifying differences in the effectiveness of various exercise approaches has been lacking. (more…)
Addiction, Author Interviews, JAMA, Mental Health Research, University of Michigan / 10.09.2018

MedicalResearch.com Interview with: Lauren B. Gerlach, D.O. Clinical Lecturer Department of Psychiatry University of Michigan MedicalResearch.com: What is the background for this study?  Response: In this study we used data from the Supporting Seniors Receiving Treatment and Intervention or SUSTAIN program. The program provides a supplement to a Pennsylvania medication coverage program for low-income older adults. It provides behavioral health and case management services by phone across the state. This included detailed interviews to screen for mental health issues including anxiety, depression, sleep issues, and pain, as well as analysis of prescription records and other clinical data. Among older adults prescribed a new benzodiazepine prescription by a non-psychiatric provider, we determined how many then went on to long-term use of the medication and what patient and clinical characteristics predicted long-term use over the following year. (more…)
Addiction, Author Interviews, JAMA, Opiods, Pediatrics / 10.09.2018

MedicalResearch.com Interview with: Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine MedicalResearch.com: What is the background for this study? Response: Amidst a worsening overdose epidemic in the United States, adolescents and young adults have not been spared. Although evidence-based medications like buprenorphine, naltrexone, and methadone are recommended for adolescents and young adults, the extent to which youth receive these medications — and whether these medications help retain youth in addiction treatment — isn’t yet known. (more…)
Author Interviews, Cancer Research, Dermatology, Heart Disease, JAMA, Vaccine Studies / 10.09.2018

MedicalResearch.com Interview with: Dr. Jeffrey Rapaport MD, PA Emeritus head of Dermatology Teaneck's Holy Name Hospital. Dr. Rapaport discusess a case recently reported in JAMA: In 2016: A 97-year-old female patient was suffering from multiple squamous cell carcinomas varying from small to incredibly large in size on both of her legs. She was injected with the HPV vaccine commonly known as Gardasil, which is also used to treat warts and oral papilloma. She was first injected in her arm, and then after a period of six weeks, the vaccine was directly injected into her tumors. It was observed that this treatment eventually killed off almost all the tumors on her legs. According to recent press coverage, she is now looking forward to celebrating her 100th birthday in fall 2018. MedicalResearch.com: What is the background for this study?Is HPV thought be a trigger for some cutaneous squamous cell carcinomas? Response: The link between skin cancers and HPV vaccinations has normally been investigated in patients who have received organ transplants. Due to the immune-suppressant drugs these patients must take, it is incredibly common to find cases of skin cancer in patients who have undergone transplants. The relaxed immune system, which would normally eliminate cancers caused by the HPV virus, would open the floodgates for multiple skin tumors to emerge. In this case of the 97 year old, I would assume her immune system was healthy. There is, however, growing evidence that receiving multiple vaccines for the HPV virus is necessary even in patients with healthy immune systems. So, regardless of immune health, I believe we need to expand the frequency of the HPV vaccine, even beyond the current three-tiered system for women below 26 and men below 21. (more…)