Author Interviews, JAMA, OBGYNE, STD, USPSTF / 09.09.2018

MedicalResearch.com Interview with: Melissa A. Simon, M.D., M.P.H. Member, U.S. Preventive Services Task Force George H. Gardner professor of clinical gynecology, Vice chair of clinical research Department of Obstetrics and Gynecology Professor of preventive medicine and medical social sciences Northwestern University Feinberg School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of babies born with syphilis is increasing, mirroring the recent increase of syphilis among women. Syphilis infection passed from a pregnant woman to her baby, also known as congenital syphilis, can lead to serious health complications for the baby including premature birth, low birthweight, birth defects, and even death. The Task Force recommends that all pregnant women be screened for syphilis as early in pregnancy as possible to prevent congenital syphilis.  (more…)
Author Interviews, Cost of Health Care, JAMA, University of Pennsylvania / 09.09.2018

MedicalResearch.com Interview with: Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients. Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched. The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  (more…)
Author Interviews, JAMA, Pain Research, Surgical Research / 09.09.2018

MedicalResearch.com Interview with: David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids. In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons. Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills. We believe patients experienced less pain than surgeons anticipated. (more…)
Author Interviews, JAMA, Outcomes & Safety / 07.09.2018

MedicalResearch.com Interview with: Dr Maria Panagioti, Senior Research Fellow Division of Population Health Health Services Research & Primary Care University of Manchester Manchester  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have shown that the demanding work environment has alarming consequences on the well-being of physicians. Over 50 percent of physicians experience significant signs of burnout across medical specialities. However, the consequences of burnout on patient care are less well-known. This is the largest meta-analysis to date which pooled data from 43,000 doctors to examine the relationship between burnout in physicians and patient safety, professionalism and patient satisfaction. We found that burnout in physicians is associated with two times increased risk for patient safety incidents, reduced professionalism and lower patient satisfaction. Particularly in residents and early career physicians, burnout was associated with almost 4 times increased risk for reduced professionalism.  (more…)
Author Interviews, CDC, Cost of Health Care, JAMA, OBGYNE / 07.09.2018

MedicalResearch.com Interview with: Michelle H. Moniz, MD, MSc Assistant Professor Department of Obstetrics and Gynecology Ann Arbor, MI 48109-2800 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to examine whether Medicaid expansion in Michigan was associated with improved access to birth control/family planning services in our state.  We conducted a survey of enrollees in the Michigan Medicaid expansion program (called "Healthy Michigan Plan"). We found that 1 in 3 women of reproductive age reported improved access to birth control/family planning services after joining HMP.  Women who were younger, who were uninsured prior to joining HMP, and those who had recently seen a primary care clinician were most likely to report improved access.  (more…)
Author Interviews, Gastrointestinal Disease, Infections, JAMA, Pediatrics, Vaccine Studies / 07.09.2018

MedicalResearch.com Interview with: Chuanxi Fu, MD.PhD. Professor of Epidemiology, School of Public Health Zhejiang Chinese Medical University Associate editor, Human Vaccines & Immunotherapeutics  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Since 2000, the Lanzhou lamb rotavirus vaccine has been exclusively licensed in China for voluntary rotavirus gastroenteritis prevention, however, the effects of the vaccination on population health, including any indirect impact to unvaccinated individuals have not been evaluated. In the study enrolled 33 407 patients with rotavirus gastroenteritis from 2007 to 2015 seasons in southern China shows vaccination effects in which the median age at onset increased by 4 months, and onset, peak, and cessation of incidence were delayed. The incidence rate ratio among children younger than 4 years and among children ineligible for vaccination decreased as citywide vaccination coverage increased, and the adjusted odds ratio for rotavirus gastroenteritis among unvaccinated infants decreased in areas with higher vaccination coverage.  (more…)
Author Interviews, JAMA, Pain Research, Technology / 06.09.2018

MedicalResearch.com Interview with: Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  The study was designed to address tso problems. The first is that many patients with chronic pain struggling to find a workable regimen. The second is more general. Patient sometimes I hesitate to participate in clinical research because they right away do not see the relevance I directly to them selves. And have one trials are away I’m addressing both problems.  (more…)
Author Interviews, JAMA, Smoking, Tobacco, Tobacco Research / 06.09.2018

MedicalResearch.com Interview with: Dorothy K. Hatsukami, Ph.D. Forster Family Professor in Cancer Prevention Professor of Psychiatry Associate, Director Masonic Cancer Center University of Minnesota  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The U.S. Food and Drug Administration is considering a rule that would reduce nicotine in all cigarettes and possibly other burned tobacco products sold in the U.S. to minimally addictive levels.   Reducing nicotine in cigarettes does not make the cigarette safer, but because nicotine is the addictive chemical in tobacco, nicotine reduction would reduce the progression towards tobacco dependence and make it easier for smokers to quit smoking.  We recently published a study in JAMA that adds to the accumulating evidence to support reducing nicotine in cigarettes and addresses if a gradual reduction or a targeted immediate reduction in nicotine in cigarettes is the best approach. In a large clinical trial involving 1,250 smokers across 10 academic institutions, immediate reduction of nicotine was compared to a gradual nicotine reduction approach. These two groups were also compared to smokers who continued to smoke usual nicotine content cigarettes. Key findings showed that immediate nicotine reduction is likely to result in more rapid positive public health effects.  That is, smokers in the immediate reduction group experienced significantly less exposure to toxic cigarette smoke chemicals and reported smoking fewer cigarettes per day, less dependence on cigarettes and greater number of days that they were smoke-free compared to the other two groups. On the other hand, smokers in the immediate nicotine reduction group experienced more severe but transient withdrawal symptoms and greater drop-outs.  (more…)
Author Interviews, Brain Injury, CDC, JAMA, Pediatrics / 05.09.2018

MedicalResearch.com Interview with: Matt Breiding, PhD Team Lead, Division of Unintentional Injury Prevention Center for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Caused by a bump, blow or jolt to the head or body, a mild traumatic brain injury (mTBI) can lead to short- or long-term problems that can affect how a child thinks, acts, feels, and learns. CDC’s Pediatric mTBI Guideline is based on the most comprehensive review of the science on pediatric mTBI diagnosis and management to date—covering 25 years of research. The guideline consists of 19 sets of clinical recommendations that cover diagnosis, prognosis, and management and treatment. These recommendations are applicable to healthcare providers who care for pediatric patients with mTBI in all practice settings and outline actions healthcare providers can take to improve the health of their patients with this injury. The CDC Pediatric mTBI Guideline outlines specific actions healthcare providers can take to help young patients and includes 5 key recommendations.  Specifically, they recommend that physicians:
  1. Refrain from routinely imaging pediatric patients to diagnose mTBI.
  2. Use validated, age-appropriate symptom scales to diagnose mTBI.
  3. Assess for risk factors for prolonged recovery, including: history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).
  4. Provide patients with instructions on returning to activity customized to their symptoms.
  5. Counsel patients to return gradually to non-sports activities after no more than a 2-3 days of rest.
(more…)
Author Interviews, Dermatology, Education, Gender Differences, JAMA / 03.09.2018

MedicalResearch.com Interview with: Lia E. Gracey, MD, PhD Department of Dermatology Baylor Scott & White Health Austin, Texas  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The co-authors and I were interested in this issue as new parent leave (or the lack thereof) is increasingly being examined in many professions.  As a mother who had children during dermatology residency, I felt the pressure to take a short new parent leave to avoid having to make up time at the end of my training. I came back to work only 3 ½ weeks after having my first baby. Anecdotally, other new parent residents (both men and women) reported similar concerns and we noticed a lack of data about new parent leave policies in dermatology residency training programs. We distributed surveys to dermatology residency program directors and residents and were struck by a basic lack of awareness by residents for whether their institution even offered new parent leave.  Less than 50% of surveyed residents were aware of a written new parent leave policy for their residency program, yet over 80% of program directors stated they had a policy in place. We also found discrepancies between resident and program director perceptions of sufficiency of new parent leave and the availability of pumping facilities for breastfeeding mothers.  (more…)
Author Interviews, Cost of Health Care, JAMA, Surgical Research, Technology / 03.09.2018

MedicalResearch.com Interview with: A robotically assisted surgical system: WikipediaChris Childers, M.D. Division of General Surgery David Geffen School of Medicine at UCLA 10833 Le Conte Ave., CHS 72-247 Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The robotic surgical approach has gained significant traction in the U.S. market despite mixed opinions regarding its clinical benefit. A few recent randomized trials have suggested there may be no clinical benefit of the robotic approach for some surgical procedures over the more traditional open or laparoscopic (“minimally-invasive”) approaches. Previous studies have also suggested the robotic approach is very expensive, but until our study, there was no benchmark for the true costs (to the hospital) of using the robotic platform. Our study analyzed financial statements from the main supplier of robotic technology. We found that the use of robotic surgery has increased exponentially over the past decade from approximately 136 thousand procedures in 2008 to 877 thousand procedures in 2017. The majority of these procedures were performed in the United States. While most people think of the robotic approach in urologic and perhaps gynecologic surgery, the fastest growing segment has been general surgery, for procedures such as colorectal resections, hernia repairs and gallbladder removals. In total, over 3 billion dollars was spent by hospitals to acquire and use robotic platforms in 2017 with 2.3 billion dollars in the United States. This equates to nearly $3,600 per procedure performed. (more…)
Anesthesiology, Author Interviews, ENT, Heart Disease, JAMA / 03.09.2018

MedicalResearch.com Interview with: Henry E. Wang, MD, MS Professor and Vice Chair for Research University of Texas Health Science Center at Houston Department of Emergency Medicine Houston, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Response: For over three decades, paramedics have performed endotracheal intubation (ETI) as the standard advanced airway management strategy in cardiac arrest. However, intubation is a difficult and error-prone intervention. Newer supraglottic airways such as the laryngeal tube (LT) offer easier insertion technique with comparable ventilation. However, intubation and laryngeal tubes have not been tested head-to-head in a randomized trial. Our study - the Pragmatic Airway Resuscitation Trial (PART) - tested intubation vs laryngeal tube for airway management in adult out-of-hospital cardiac arrests. The trial included 27 EMS agencies from the Birmingham, Dallas-Fort Worth, Milwaukee, Portland and Pittsburgh communities. The trial randomized a total of 3,004 adult cardiac arrests to airway management with ETI or LT. We found that compared with traditional ETI, LT was associated with almost 3% better survival. Out-of-hospital cardiac arrest survival in the US is less than 10%, so the observed difference is important.  (more…)
Author Interviews, Cancer Research, JAMA, OBGYNE, UCLA / 29.08.2018

MedicalResearch.com Interview with: Dr. Carol Mangione, M.D., M.S.P.H., F.A.C.P. Division Chief of General Internal Medicine and Health Services Research Professor of Medicine Barbara A. Levey, MD, and Gerald S. Levey, MD, endowed chair in Medicine David Geffen School of Medicine University of California, Los Angeles (UCLA) professor of public health at the UCLA Fielding School of Public Health. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Screening for cervical cancer saves lives by identifying cervical cancer early when it is treatable. Most cases of cervical cancer occur in women who have not been regularly screened or treated, which is why it’s important for women to get screened regularly throughout their lifetime with one of several effective options. Women ages 21 to 29 should get a Pap test every three years. Women ages 30-65 can choose between three approaches, depending on their preferences: a Pap test every three years, an HPV test every five years, or a combination of a Pap test and an HPV test every five years. There are some women who don’t need to be screened for cervical cancer including women younger than 21, women older than 65 who have been adequately screened in the past and are not at high risk, and women who have had a hysterectomy.  (more…)
Author Interviews, JAMA, Stroke / 29.08.2018

MedicalResearch.com Interview with: Larry B. Goldstein, MD, FAAN, FANA, FAHA Ruth L. Works Professor and Chairman, Department of Neurology Co-Director, Kentucky Neuroscience Institute KY Clinic - University of Kentucky Lexington, KY 40536 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Extensive work in laboratory models over several decades show that d-amphetamine, combined with task-relevant experience, can facilitate recovery after stroke and traumatic brain injury affecting the cerebral cortex. Results from clinical trials have been inconsistent, in part because preclinical data indicate that the effect of amphetamines as part of a regimen for stroke recovery is biologically complex.  We conducted this multicenter pilot study to explore some of that complexity. (more…)
Author Interviews, Environmental Risks, JAMA, Pediatrics, Toxin Research / 29.08.2018

MedicalResearch.com Interview with: Joseph M. Braun, MSPH, PhD Associate Professor of Epidemiology Epidemiology Master's Program Director Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: Childhood lead poisoning continues to be a problem in the United States and residential lead hazards are the major source of Pb exposure in young children. However, no studies have attempted to prevent exposure to lead hazards through primary prevention. Thus, we randomized 355 pregnant women to a comprehensive residential intervention and followed their children for up to 8 years to determine if childhood lead poisoning and associated cognitive deficits and behavior problems can be prevented. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 27.08.2018

MedicalResearch.com Interview with: Amine Mazine, MD, MSc Associate Editor, BMC Surgery PGY-4 Cardiac Surgery PhD Candidate, Institute of Biomaterials and Biomedical Engineering McEwen Center for Regenerative Medicine Surgeon-Scientist Training Program University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure). The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival. (more…)
Author Interviews, Heart Disease, Infections, JAMA / 27.08.2018

MedicalResearch.com Interview with: Pr. Didier Raoult Directeur de l'IHU Méditerranée-Infection Marseille  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This work represents the sum of data accumulated over several decades of studies on Q fever. Our reference center contacts each of the physicians in charge and ensures patient follow-up, which allows obtaining data, that is not comparable to those used automatically in databanks. Four people exclusively dedicated their time to manage these specific data on Q fever. The main data confirm the need to perform a cardiac ultrasound for all patients with Q fever and acute endocarditis (to detect valvulopathy) and to give a prophylactic treatment to avoid fixation on the heart in patients with valvulopathy. This work helps clarify the evolution of Q fever by eliminating the term of chronic Q fever, which is based on non-clinical elements, and defining persistent Q fever for which there is an identifiable focus of infection. Furthermore, this work makes it possible to recommend systematic detection of antiphospholipid antibodies in order to limit the risk of thrombosis and the risk of cardiac fixation. (more…)
Aging, Author Interviews, Genetic Research, JAMA / 27.08.2018

MedicalResearch.com Interview with: Yi Zeng, Ph.D.| Professor, Center for Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University Professor, National School of Development, Chief Scientist of Raissun Institute for Advanced Studies, Peking University Distinguished Research Scholar, Max Planck Institute for Demographic Research Foreign member of the Royal Netherlands Academy of Arts and Science MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sex differences in genetic associations with human longevity remain largely unknown; investigations on this topic are important for individualized healthcare. (more…)
Author Interviews, Compliance, JAMA, Macular Degeneration, Ophthalmology / 25.08.2018

MedicalResearch.com Interview with: Jason Hsu, MD Retina Service, Wills Eye Hospital Associate Professor of Ophthalmology Thomas Jefferson University Mid Atlantic Retina Anthony Obeid MD MPH School of Public Health The University of Sydney · MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Neovascular age-related macular degeneration (nAMD) is a vision-threatening disease that often afflicts elderly patients. The introduction of intravitreal anti-vascular endothelial growth factor treatment drastically improved the prognosis of eyes with nAMD. Despite its efficacy, patients require consistent follow-up (sometimes as often as monthly), with ongoing injections to maintain the visual benefits of the drug. Unfortunately, few studies have reported the number of patients that do not follow-up with recommended guidelines. Moreover, there remains limited evidence on the risk factors associated with loss to follow-up. Our study, consisting of 9007 patients with a history of nAMD receiving treatment between 2012 and 2016, evaluated both these parameters. We defined loss to follow-up as having at least one injection without a subsequent follow-up visit within 12 months post-treatment. Using this definition, we found that over 20% of patients are lost to follow-up over the entire study period. We further identified key risk factors associated with loss to follow-up, which included patients of older age, race, patients residing in a region of a lower average adjusted gross income, patients living at greater distances from clinic, patients with active nAMD in only one eye, and patients with worse visual acuity. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, Mammograms / 25.08.2018

MedicalResearch.com Interview with: Lisa A Newman, MD Director of the Breast Oncology Program for the multi-hospital Henry Ford  Health System MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In 2009 the United States Preventive Services Task Force published a guideline recommending that American women at average risk for breast cancer defer undergoing screening mammography until they reach the age of 50 years. Prior to this publication, women were widely-encouraged to initiate annual mammography at age 40 years. Women that have a history of breast cancer are automatically considered to be at increased risk for developing a new breast cancer, and so routine screening mammography guidelines do not apply to them. These women require annual mammography regardless of age, unless they have undergone a bilateral mastectomy. We utilized data from Michigan Blue Cross/Blue Shield to evaluate patterns of mammography utilization among women age 40-49 years, comparing rates before versus after 2009, when the USPSTF guideline was published. We analyzed women that had a prior history of breast cancer separately from those that had no history of breast cancer, and we excluded women that underwent bilateral mastectomy. Disturbingly, we found that mammography utilization rates declined among women with a history of breast cancer as well as among those with no history of breast cancer in the post-2009 timeline. This suggested to us that changes in screening recommendations may have had the unintended consequence of generating confusion and misunderstandings regarding the value of mammography among women that undeniably benefit from this imaging, such as those with a history of breast cancer.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 22.08.2018

MedicalResearch.com Interview with: Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications. Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products. For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen. The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. (more…)
Author Interviews, JAMA, Mental Health Research, Pediatrics / 22.08.2018

MedicalResearch.com Interview with: Dr Alexandra Rouquette MD PhD Center for Research in Epidemiology and Population... French Institute of Health and Medical Research Paris MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a growing number of clues in the literature that suggest that the onset of adult psychopathologic disorders can be traced back to behavioral or emotional symptoms observed in childhood or adolescence. Targeting early childhood symptoms might thus be effective in preventing future mental disorders. However, these interventions are challenging to implement because we lack knowledge on which specific childhood symptoms have predictive associations with adult psychopathologic disorders. In our study, we used a novel methodologic approach, the network perspective, in which symptoms are conceptualized as distinct entities that can causally influence each other, be self-reinforcing and are thus part of causal chains which can culminate in disorders. We investigated longitudinally the network structure among a broad range of emotional and behavioral symptoms (symptoms of attention deficit, symptoms of hyperactivity, disruptive symptoms, internalizing symptoms, prosocial symptoms) collected in elementary school girls (6-10 years) included in the Quebec Longitudinal Study of Kindergarten Children. We showed that symptoms “irritable”, “blames others”, “not liked by other children”, “often cries”, and “solitary” retained a distinctive position in the network because most of the direct relationships between the disruptive and internalizing symptom clusters transited through them. These symptoms have been termed bridge symptoms in the network perspective, as they constitute pathways that can connect different disorders. We then investigated the relationships between this emotional and behavioral symptoms network in childhood and the occurrence of anxiety disorders at age 15 and 22 years. Importantly, the bridge symptoms (particularly “not liked by other children” and “irritable”) exhibited the strongest relationships with future anxiety disorders. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare, NYU, Prostate Cancer / 22.08.2018

MedicalResearch.com Interview with: Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement. In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer. We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA. Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.  (more…)
Author Interviews, Breast Cancer, Cancer Research, Genetic Research, JAMA, Ovarian Cancer / 21.08.2018

MedicalResearch.com Interview with: Ambry GeneticsShuwei Li, PhD Principal Statistical Geneticist Ambry Genetics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Breast cancer is the most commonly diagnosed cancer, while ovarian cancer is the fifth leading cause of death due to cancer, in US women. Since the discovery of BRCA1 and BRCA2, multiple genes have been reported as risk factors; however, it is still unclear whether the known findings represent the complete genetic landscape of breast and ovarian cancers. Our team performed exome sequencing on more than 10,000 breast and/or ovarian cancer patients and nearly 4,000 controls. We observed increased risk of breast cancer associated with PALB2, ATM, CHEK2 and MSH6 genes, and increased risk of ovarian cancer associated with MSH6, RAD51C, TP53 and ATM genes.   (more…)
Author Interviews, JAMA / 21.08.2018

MedicalResearch.com Interview with: Mehraneh Dorna Jafari, MD Assistant Professor Associate Program Director Colon and Rectal Surgery UC Irvine Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial ties between medical and surgical device companies and clinicians are very common. It has been shown that up to 94% of physicians in the United States receive a form of benefit from an external company. When we evaluate published works, it is important to assess the integrity and academic credentials of the authors. In 2013, the Centers for Medicare and Medicaid Services established the Open Payments Database to house industrial payments’ information and increase transparency into the reporting of payments. In our study, we found that in only 37% of their relevant 2016 publications were the Conflict of Interests declared by the authors. (more…)
Author Interviews, Cancer Research, JAMA, Pediatrics / 20.08.2018

MedicalResearch.com Interview with: Rebecca D. Kehm, PhD Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis, MN   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Racial and ethnic differences in childhood cancer survival have long been known, and there has been some research indicating that SES could explain disparities. However, our study is the first to use statistical methods that put numbers to the relative contribution of SES to survival disparities for different types of childhood cancer. We set out to investigate whether racial and ethnic disparities in childhood cancer survival are attributed to underlying differences in socioeconomic status, defined as one’s social and economic position in relation to others based on income, education, and occupation, which scientists abbreviate as SES. Our findings provide evidence that SES does in fact contribute to racial and ethnic disparities in survival for some types of childhood cancer. Specifically, we found that SES accounted for 28-73% of the racial and ethnic survival disparity for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma. However, SES did not significantly contribute to racial and ethnic disparities in survival for other types of childhood cancer including central nervous system tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor, and germ cell tumors. These tumor-specific results help inform where to place resources to best reduce racial and ethnic survival disparities for each of the major types of childhood cancer. (more…)