Author Interviews, CDC, Dermatology, Environmental Risks, JAMA / 15.03.2018

MedicalResearch.com Interview with: “Sunburn” by Beatrice Murch is licensed under CC BY 2.0Dawn Holman, MPH Behavioral Scientist Division of Cancer Prevention and Control CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sunburn at any age increases a person’s chances of developing skin cancer in the future. Using a combination of strategies including staying in the shade, wearing clothing that covers the arms and legs, wearing a hat with a wide brim, and wearing sunscreen (SPF 15+) on exposed skin can protect skin from sun damage and reduce risk of sunburn. This study used national data to examine how often US adults used these sun protection strategies when outdoors in the sun for an hour or longer and how many US adults got sunburned in 2015. Among adult women, staying in the shade and using sunscreen were the most common sun protection methods. About 40% of women regularly used these strategies. Women were less likely to wear a wide-brimmed hat (14%) or wear clothing covering their arms (11%) and legs (23%). Among adult men, wearing pants or other clothing covering their legs and staying in the shade were the most common sun protection methods. Just over 30% of men regularly used these strategies. Men were less likely to use sunscreen (22%), wear a wide-brimmed hat (14%) or wear a shirt with long sleeves (13%). About one-third of US adults got sunburned in 2015. Sunburn was even more common among certain groups. For example, about half of individuals with sun-sensitive skin and about half of adults aged 18-29 got sunburned. Certain behaviors and health conditions were related to sunburn. For example, adults who used sunless tanning products to darken their skin, binge drank, engaged in aerobic activity, or were overweight or obese were more likely to get sunburned compared to other adults. Adults who regularly stayed in the shade when outdoors or avoided long periods of time in the sun were slightly less likely to get sunburned compared to other adults. Adults who regularly used sunscreen were slightly more likely to get sunburned. (more…)
Aging, Alcohol, Author Interviews, JAMA, Stanford / 15.03.2018

MedicalResearch.com Interview with: alcohol-cdc-imageEdith V. Sullivan, Ph.D. Professor Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford, CA 94305-5723  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Alcohol misuse is a major public health problem worldwide with profound health consequences on the body, brain, and function. Our research group has conducted naturalistic yet controlled studies of alcohol dependence for several decades to further our understanding of when and how alcohol misuse affects specific parts of the brain.  In addition, we wanted to know how alcohol misuse interacts with the typical changes in the brain as we grow older.  The studies are controlled in that we recruit healthy, non-alcohol dependence men and women from the community to undergo the same screening and neuroimaging procedures as our alcoholic recruits.  The studies are quantitative because we use neuroimaging methods (Magnetic Resonance Imaging) that enable us to measure specific regions of brain structural volumes.  Consistent collection of such data over the years positioned us to ask whether age and alcohol dependence interact to produce regional brain volume loss beyond the loss that occurs in normal aging. A number of cross-sectional studies pointed to the likelihood that the effects of alcohol dependence on brain structure would be exacerbated by normal aging, which we do know from longitudinal neuroimaging studies results in shrinkage of cortical gray matter volume and thinning of the cortex. What was particularly striking about our longitudinal study of men and women with alcohol dependence was the acceleration of the aging of brain structure that was especially prominent in the frontal cortex.  Critically, even those who initiated dependent drinking at an older age showed accelerated loss. Because our study sample was large enough, we could also test whether our findings were attributable to conditions that commonly co-occur with alcohol dependence, namely, illicit drug use and hepatitis C.  Although both drug use and hepatitis C infection may have exacerbated brain volume loss, these factors did not fully account for the alcoholism-aging interaction we identified. (more…)
Accidents & Violence, Addiction, Author Interviews, JAMA / 14.03.2018

MedicalResearch.com Interview with: Dr. Laura Dwyer-Lindgren PhD Assistant Professor at IHME Institute for Health Metrics and Evaluation  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study in the latest in a series of studies IHME has conducted on health and disease on the county level in the United States. We analyzed data provided by the National Center for Health Statistics, the U.S. Census Bureau, and other sources. Main findings include:
  • Nearly 550,000 deaths were attributed to drug use over the 35 years. Nationally, the age-standardized death date increased 238% between 1980 and 2000, and 112% between 2000 and 2014. The death rate from drug use disorders increased in every county, but some counties in Kentucky, West Virginia, Ohio, Indiana, and eastern Oklahoma has increases exceeding 5000%.
  • There were more than a quarter million deaths in the U.S. due to alcohol use; Western counties generally has higher levels than those in other parts of area of the nation, with especially high death rates in Wisconsin, North Dakota, South Dakota, Nebraska, Montana, New Mexico, Arizona, Utah, and Alaska.
  • Neatly 1.3 million suicides were recorded, with especially high rates in Alaska, Nevada, South Dakota, Utah, New Mexico, Arizona, Montana, North Dakota, Oregon, Wyoming and one county in Maryland. While the national death rate due to suicide decreased between 1980 and 2014, there was an increase in the death rate due to suicide in most counties.
  • More than three quarters of a million deaths by homicide occurred in the US between 1980 and 2015. Nationally, the age-standardized death rate due to homicide decreased by about 35% between 1980 and 2000, and by nearly 16% between 2000 and 2014. Counties with the largest decreases were found in Virginia, Florida, Texas, California and New York. 
(more…)
Author Interviews, Breast Cancer, JAMA, Schizophrenia / 13.03.2018

MedicalResearch.com Interview with: Chuanjun Zhuo, MD, PhD Department of Psychiatric Laboratory Department of Psychiatric Neuroimaging Faculty Tianjin Mental Health Center Tianjin, China  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: According to previous epidemiological studies, women with schizophrenia may be associated with significantly increased risk of breast cancer. However, the results of these studies were not always consistent. In view of the fact that medical care for patients with schizophrenia is becoming multidisciplinary, we aimed to evaluate the risk of breast cancer in women with schizophrenia via a meta-analysis of relevant cohort studies. We included twelve cohorts and adopted the recently proposed prediction interval to evaluate the heterogeneity among the included studies. We found that schizophrenia was associated with about 30% increased risk of breast cancer incidence in women. However, significant heterogeneity existed of the included studies, which indicates that more extensive researches into the potential mechanisms underlying the associations between schizophrenia and breast cancer risk are needed. (more…)
Author Interviews, Brain Injury, JAMA / 12.03.2018

MedicalResearch.com Interview with: Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning. However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering). As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years. We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one.  (more…)
Author Interviews, JAMA, University of Michigan, Urinary Tract Infections / 12.03.2018

MedicalResearch.com Interview with: Keith S. Kaye, MD, MPH Professor of Medicine, Division of Infectious Diseases University of Michigan Medical School Ann Arbor MI  MedicalResearch.com: What is the background for this study? Response: Complicated complicated urinary tract infections (cUTI), including acute pyelonephritis, are a major cause of hospital admissions, and are associated with significant morbidity and mortality and can be difficult to treat. While the most common pathogen is Escherichia coli, the more problematic pathogens are multidrug-resistant (MDR) gram-negative organisms including other Enterobacteriaceae species. The prevalence of cUTI due to MDR gram-negative bacteria has risen. In some instances, MDR gram-negative bacteria isolated from the urinary tract can cause bacteremia. Vabomere was approved by the U.S. Food and Drug Administration (FDA) in August 2017 for the treatment of adult patients with cUTI, including pyelonephritis, caused by designated susceptible Enterobacteriaceae: Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae species complex.   Vabomere is a fixed-dose (2g/2g) combination product of a carbapenem and a β-lactamase inhibitor with potent in vitro activity against Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE), an important MDR organism associated with serious infections. The Targeting Antibiotic Non-susceptible Gram-negative Organisms (TANGO I) trial was the pivotal Phase 3 study that compared the efficacy and safety of Vabomere to piperacillin-tazobactam in the treatment of patients with cUTI and acute pyelonephritis. (more…)
Author Interviews, Dermatology, JAMA, Melanoma / 11.03.2018

MedicalResearch.com Interview with: Aimilios Lallas, PhD First Department of Dermatology, School of Medicine Aristotle University Thessaloniki, Greece MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Our goal today is to recognize melanoma at the earliest stage, ideally before it invades the dermis and acquires metastatic potential. Melanoma-specific dermoscopic criteria have been tested mainly in the context of invasive melanoma. Although they were proven valid melanoma predictors, the question still remains if they are strong enough to diagnose melanoma in situ (MIS). Our aim was to investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of melanoma in situ. We identified 5 main positive dermoscopic indicators of MIS: atypical network, regression, irregular hyperpigmented areas, prominent skin markings and angulated lines.  (more…)
Author Interviews, JAMA, Prostate Cancer / 10.03.2018

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? Response: Patients with high risk prostate cancer have several curative treatment options: radical prostatectomy, external beam radiotherapy with androgen deprivation therapy, and external beam radiotherapy with a brachytherapy boost, also with androgen deprivation therapy (so-called extremely dose-escalated radiotherapy). Prior attempts at comparing long-term clinical outcomes between these treatment options have been hampered by the fact that standards of care have changed significantly with respect to the appropriate dose of radiation and the usage of androgen deprivation therapy. Therefore, many comparative effectiveness reports are in essence comparing apples with rotten oranges. Further, not all high risk prostate cancers are the same. Gleason score 9-10 disease is a particularly aggressive form of prostate cancer that is much more likely to metastasize and potentially cause death. Thankfully, this is a rarer type of prostate cancer -- but this also means that not much data are available specifically for this type of disease. Therefore, we launched a multi-institutional study of men with Gleason score 9-10 disease, including 1809 men treated across 12 institutions. All men were treated between 2000 and 2013 and therefore were more likely to have treatments that would be commensurate with modern standards.  (more…)
Author Interviews, JACC, JAMA, Weight Research / 05.03.2018

MedicalResearch.com Interview with: “physical-activity-120112-M-2021D-019” by MilitaryHealth is licensed under CC BY 2.0Trine Moholdt, PhD Research Fellow Department of Circulation and Medical Imaging | Exercise, Cardiometabolic Health and Reproduction Norwegian University of Science and Technology MedicalResearch.com: What is the background for this study?   Response: Although obese individuals have an increased risk of cardiovascular disease, evidence from many observational studies shows that in those who already have cardiovascular disease, being overweight or obese is associated with lower risk of mortality compared to their normal weight counterparts. This phenomenon is often called the “obesity paradox”. Recently we observed that in individuals who have a high physical activity level, there is no such obesity paradox and body mass index did not associate with survival time in those who with high physical activity (Moholdt et al, American Journal of Medicine, 2017).  (more…)
Allergies, Author Interviews, Dermatology, JAMA, Stanford, Technology / 03.03.2018

MedicalResearch.com Interview with: Kavita Sarin, M.D., Ph.D. Assistant Professor of Dermatology Stanford University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Drug reactions occur in the majority of patients undergoing cancer therapies. Half of serious drug reactions are detected after market approval which can result in painful complications and interruption in therapy. Post-market drug surveillance platforms such as FDA monitoring rely on medical publications and physician reporting and take time to identify trends. We sought to determine if we could identify trends in patient discussions in internet health forums to more rapidly identify chemotherapeutic drug reactions. We chose skin reactions as a proof-of-principle because patients can more easily describe what they see on their skin. Julia Ransohoff, a medical student, and Azadeh Nikfarham, an informatics postdoctoral fellow trained a computer to recognize when a patient undergoing anti-cancer treatment with PD-1 antagonists or EGFR-inhibitors described a drug reaction in their internet forum posts. (more…)
Author Interviews, JAMA, Occupational Health, PTSD / 02.03.2018

MedicalResearch.com Interview with: Dr. Lori Davis, MD Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa Tuscaloosa, Alabama MedicalResearch.com: What is the background for this study? What are the main findings? Response: Symptoms of posttraumatic stress disorder (PTSD) interfere with a person’s ability to function at work, making it harder to stay employed and establish oneself in a career.  Veterans with PTSD are uniquely challenged given their motivation to serve others, be leaders and not be generally receptive to reaching out for help. Conventional wisdom about PTSD and employment has traditionally been to first commit to treatment, learn coping skills, manage one’s symptoms and then reintegrate into mainstream employment. However, this view is being transformed by our research that suggests a more assertive recovery-oriented approach to the treatment of PTSD that involves returning to meaningful competitive employment as soon as possible. This study compared Evidence-based Supported Employment (also known as Individual Placement and Support or IPS) integrated within PTSD treatment teams to the treatment as usual Transitional Work model offered within the VA. This multisite trial demonstrated significantly greater effectiveness of the IPS-supported employment over stepwise, transitional work vocational rehabilitation for Veterans living with chronic PTSD. (more…)
Author Interviews, ENT, JAMA, Surgical Research / 02.03.2018

MedicalResearch.com Interview with: Boris Paskhover, MD Rutgers New Jersey Medical School Adjunct Instructor,Department of Otolaryngology-Head and Neck Surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Patient's and the general public routinely mention that their nose appears large, especially when they look at photos taken with their phone. I realized that patients in general are taking selfies more often nowadays. In my training, we routinely would tell patient’s not to use selfies as a marker of how they look, and we instead would take a 5ft distance photograph since we knew that is more realistic. I looked through the medical literature, and it appeared to me that no one had thoroughly discussed why selfies are a bad when evaluating the nose. I contacted a colleague at Stanford who has a PhD with interest in computer graphics and we developed a model for the face/nose. (more…)
Author Interviews, Cost of Health Care, JAMA, Surgical Research / 28.02.2018

MedicalResearch.com Interview with: Dr. Chris Childers, M.D. Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 20 million Americans undergo a surgical procedure each year with a price tag over $1 trillion.  The operating room (OR) is a particularly resource dense environment, yet little is known about the actual costs of running an OR.  Most previous efforts focusing on OR costs have come from single-site studies with little detail about the drivers of OR costs. Using financial statements from all California hospitals we estimated that the average cost to the hospital for one minute of OR time was between $36 and $37. Perhaps more notable was the composition of these costs.  Almost two-thirds ($20-21) was attributable to “direct costs” - those generated by the OR itself - including $14 for the wages and benefits of staff, $2.50-3.50 for surgical supplies, and $3 for “other” costs such as equipment repair and depreciation. Interestingly, the remainder ($14-16) was dedicated to “indirect costs” such as the costs associated with hospital security and parking.  While these indirect costs are necessary for a hospital to run, they are not under the purview of the operating room. Finally, we also learned that OR costs have increased quickly over the past 10 years – faster than other sectors of healthcare as well as the rest of the economy. (more…)
Author Interviews, Depression, Heart Disease, JAMA / 27.02.2018

MedicalResearch.com Interview with: David Bekelman, MD, MPH  Associate Professor of Medicine and Nursing Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, CO University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many of the 5.8 million Americans with heart failure live with bothersome symptoms, reduced function and poor quality of life.  Improving their care is important because many people with heart failure live with these challenges for years.

This study evaluated the effect of a team intervention, Collaborative Care to Alleviate Symptoms and Adjust to Illness, also called CASA, on several aspects of quality of life in 314 patients with heart failure.  The patients, who received care at diverse health systems in Colorado, were randomized to receive usual care or usual care supplemented with the CASA intervention, which included a nurse and a social worker who collaborated with a primary care provider, cardiologist, and palliative care physician to address the patients’ needs.

The study found that the CASA intervention did not influence the primary outcome of heart failure health status, yet did improve patients’ depression and fatigue.  CASA did not influence number of patient hospitalizations or mortality. (more…)

Author Interviews, Circulation Issues, Clots - Coagulation, JAMA / 27.02.2018

MedicalResearch.com Interview with: Shyueluen Chang MD Phlebologist with Dermatologist background Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital Taoyuan, Taiwan MedicalResearch.com: What is the background for this study?   Response: Varicose veins are common, with about 23 percent of U.S. adults having the condition, but they are rarely thought to be associated with serious health risks. In contrast, venous thrombosis (DVT), pulmonary embolism (PE), and peripheral artery disease (PAD) are also vascular diseases that are associated with serious systemic effects. Not much is known about varicose veins and the risk of other vascular diseases. Elucidating potential associations between varicose veins and health-threatening diseases is important. Partner's note: Understanding the broader impact of vascular diseases can provide valuable insights into the risks associated with varicose veins. (more…)
Author Interviews, End of Life Care, Heart Disease, JAMA, Technology / 27.02.2018

MedicalResearch.com Interview with: Larry A. Allen, MD, MHS Associate Professor, Medicine Associate Head for Clinical Affairs, Cardiology Medical Director, Advanced Heart Failure Aurora, CO 80045 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Deciding whether or not to get a left ventricular assist device (LVAD) is one of the most challenging medical decisions created by modern medicine. LVADs improve overall survival but also come with serious risks and lifestyle changes. Particularly for older patients with multiple medical problems, this is a complex choice. Our research group at the University of Colorado spent years systematically developing unbiased pamphlet and video decision aids for patients and caregivers. We also developed a clinician-directed decision support training for LVAD program staff. The DECIDE-LVAD trial studied the implementation and effectiveness of this decision support intervention with patients and their caregivers in 6 hospitals in the U.S. When compared to previously used education materials, the decision aids appeared to improve patients’ decision quality and lowered the total number of patients getting LVADs. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 26.02.2018

MedicalResearch.com Interview with: Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization. Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care. (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA / 26.02.2018

MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaDaniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California  MedicalResearch.com: What is the background for this study? What are the main findings? Response: When people talk about medical error, they are usually referring to treatment error—giving the wrong medication, operating on the wrong side of the body, etc.  But many believe that diagnostic error—the failure to diagnose a condition when a patient seeks care—is at least as widespread and consequential a problem.  However, diagnostic errors are intrinsically difficult to measure, since one can rarely prove that a condition was present at the time it was not diagnosed. In this study, we introduce a novel method for measuring how often patients who come to the emergency room with symptoms of an imminent cardiovascular emergency such as acute myocardial infarction (heart attack) are discharged home without a diagnosis. We find that among Medicare patients whose ER visits were attributable to symptoms of an imminent infarction, only about 2.3% were discharged home, and that the figure was under 5% for each of the other four conditions we studied.    However, we also found that these relatively low rates did not improve between 2007 and 2014. (more…)
Author Interviews, Cognitive Issues, JAMA, Pediatrics / 26.02.2018

MedicalResearch.com Interview with: Sabrina Twilhaar, MS, PhD candidate Child Study Group, sectie Klinische Neuropsychologie Vrije Universiteit Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings?  Response: It is well-known that preterm birth has negative consequences for cognitive development. During the early 1990s important progress in neonatal health care resulted in a considerable increase in the survival of preterm infants. Earlier meta-analyses showed large differences in intelligence between very preterm and full-term born children. However, these meta-analyses included mostly studies on children born before 1990. Because of the advances in neonatal health care since that time, it was important to update our knowledge on the outcomes of more recently born preterm infants. We combined the results of 71 studies, together including 7752 very preterm and 5155 full-term born children, and found a difference in intelligence between very preterm and full-term children that was still large. Interestingly, despite advancing neonatal health care, we also found no indication of improvement in the cognitive outcomes of very preterm born children during the period from 1990 to 2008. In addition, we searched for factors that increase the risk for poor cognitive outcomes in these children and we found that children with a chronic lung disease that is amongst others caused by mechanical ventilation of the immature lungs are even more at risk for poor cognitive outcomes. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Ovarian Cancer / 22.02.2018

MedicalResearch.com Interview with: Michael J. Barry, M.D., Task Force member Director of the Informed Medical Decisions Program Health Decision Sciences Center Massachusetts General Hospital. Professor of Medicine Harvard Medical School and Physician at Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Ovarian cancer is the fifth leading cause of cancer death among women in the United States. It is hard to detect, and many women diagnosed with ovarian cancer do not show signs or symptoms early on. As a result, ovarian cancer is often diagnosed at a late stage, when it is hard to treat successfully. The U.S. Preventive Services Task Force looked at the latest evidence to see if screening women who do not have signs or symptoms of ovarian cancer can prevent them from dying of the disease. Unfortunately, we found that screening for ovarian cancer does not decrease the number of women who die, but it does lead to some women having unnecessary surgery to remove their ovaries. As a result, we are recommending against ovarian cancer screening in women who are not at high risk. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Mental Health Research / 22.02.2018

MedicalResearch.com Interview with: “hospital.” by Bethany Satterfield is licensed under CC BY 2.0Mark van den Boogaard, PhD, RN, CCRN Assistant Professor Department of Intensive Care Medicine Radboud University Medical Center Nijmegen Netherlands  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Delirium is affecting many of our intensive care unit (ICU) patients which is impacting their recovery on the short-term as well as on the long-term. Therefore we were very interested to investigate if the use prophylactic haloperidol would be beneficial for the ICU patients. Especially because there were indications that it would be effective in ICU delirium prevention and also because this drug is being used in daily practice to prevent ICU delirium although there is no clear evidence. The overall finding of our large-scale well designed study is that we didn’t find any beneficial effect of prophylactic haloperidol in ICU patients. Moreover, this finding is very consistent over all groups of patients.  (more…)
Author Interviews, Cost of Health Care, Duke, Electronic Records, JAMA / 21.02.2018

MedicalResearch.com Interview with: Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US not only has the highest health care costs in the world, we have the highest administrative costs in the world. If we can reduce non-value added costs like the ones we document, we can make substantial changes in the affordability of health care without having to resort to more draconian policy solutions. Our paper finds that administrative costs remain high, even after the adoption of electronic health records.  Billing costs, for example, constituted 25.2% of professional revenue for ED departments and 14.5% of revenue for primary care visits.  The other numbers are captured below. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 20.02.2018

MedicalResearch.com Interview with: Guoqing Hu, PhD Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha, Hunan, China    On behalf of the authors MedicalResearch.com: What is the background for this study? What are the main findings? Response: We've known for some time that suffocation is a leading cause of death for American infants - in fact, it is the cause of over 3/4 of the injury deaths to babies under 12 months of age. We've also known that there are strategies, such as "safe sleeping", that can greatly reduce the risk of a baby suffocating to death. The surprise in our study is that the suffocation rate for infants under 12 months of age appears to be increasing in the United States over the past 15 years. More babies are dying from suffocation today than in the 1990s, and that is a significant public health concern. Think about the implications of each one of those deaths to the infant's parents and loved ones. There are few things more devastating than losing a baby to an unintentional, or "accidental" death. There are ways we can prevent unintentional suffocations, and we need to work together to inform parents and ensure babies are kept safe to reduce those deaths, especially as rates in the US appear to be increasing. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 16.02.2018

“Doctors” by Tele Jane is licensed under CC BY 2.0MedicalResearch.com Interview with: Dr. Apostolos Tsimploulis, Chief Medical Resident Dr. Phillip H. Lam, Chief Cardiology Fellow The Washington, DC Veterans Affairs Medical Center, Georgetown University, and MedStar Washington Hospital Center, Washington, DC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypertension is a major risk factor for the development of new heart failure (HF). Findings from multiple randomized controlled trials in hypertension have consistently demonstrated that controlling systolic blood pressure (SBP) to normal levels such as to SBP <120 mm Hg reduces the risk of developing new HF. However, interestingly, once patients develop heart failure, those with a normal SBP value such as SBP <120 mm Hg tend to have poor outcomes. This paradoxical association – also called reverse epidemiology – although poorly understood – has been described with other HF risk factors such as smoking and obesity. Regarding poor outcomes associated with lower SBP in HF patients with reduced ejection fraction (HFrEF – pronounced Hef-ref), it has been suggested that it may be a marker of weak heart muscle that is unable to pump enough blood. However, less is known about this association in patients with HF and preserved ejection fraction (HFpEF – pronounced Hef-pef) –– the heart muscle is not weak in the traditional sense. This is an important question for a number of reasons: nearly half of all heart failure patients have HFpEF which accounts for about 2.5 to 3 million Americans. These patients have a high mortality similar to those with HFrEF – but unlike in HFrEF few drugs have been shown to improve their outcomes. Thus, there is a great deal of interest in improving their outcomes. One of those approaches is to control . systolic blood pressure and the 2017 ACC/AHA/HFSA Focused Update of the HF guidelines recommend that SBP “should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity.” Thus, our study was designed to answer that simple question: do patients with HFpEF and SBP <120 mmHg, which is considered to be normal SBP, have better outcomes than those with SBP ≥120 mmHg. Using a sophisticated approach called propensity score matching we assembled two groups of patients with HFpEF – one group with SBP <120 mmHg and the other groups had SBP ≥120 mmHg – and patients in both groups were similar in terms of 58 key baseline characteristics. In this population of balanced patients with HFpEF, those with a normal systolic blood pressure had a higher risk of mortality – starting 30 days post-discharge up to about 6 years. Finding from our restricted cubic spline plots suggest that compared with SBP <120 mm Hg, SBP values ≥120 mm Hg (up to 200 mm Hg) was not associated with a higher risk of death. (more…)
Author Interviews, Education, JAMA, Occupational Health, UCSF / 13.02.2018

MedicalResearch.com Interview with: Christina Mangurian, MD, MAS Associate Professor of Psychiatry Vice Chair for Diversity, Department of Psychiatry UCSF Weill Institute for Neurosciences Director, UCSF Public Psychiatry Fellowship at ZSFG Core Faculty, UCSF Center for Vulnerable Populations MedicalResearch.com: What is the background for this study? What are the main findings? Response: We examined paid family and childbearing leave policies at top-10 medical schools across the US. Despite recommendation from national medical societies for 12 weeks paid childbearing leave because of the benefits to both infant and mother, the average leave at these top schools of medicine was only around 8 weeks. In addition, most policies are very difficult to understand, and are at the discretion of departmental leadership – both of which put women at a disadvantage at getting leave they deserve. Additionally, family leave was only available to the parent that identifies as the "primary caregiver" at five universities, disallowing cooperative parenting. (more…)
Accidents & Violence, Author Interviews, Cannabis, JAMA / 12.02.2018

MedicalResearch.com Interview with: Dr. John A Staples, MD, FRCPC, MPH Scientist, Centre for Health Evaluation and Outcome Sciences Clinical Assistant Professor University of British ColumbiaDr. John A Staples MD, FRCPC, MPH Scientist, Centre for Health Evaluation and Outcome Sciences Clinical Assistant Professor University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Around 64 million Americans live in states that have legalized recreational marijuana. Many policymakers are trying to figure out what that means for traffic safety. On April 20th, some Americans participate in an annual "4/20" counterculture holiday that celebrates and promotes the use of cannabis. Some 4/20 events such as those in Denver and San Francisco involve thousands of participants. Much like celebrations at midnight on New Year's eve, public 4/20 events sometimes mark 4:20 p.m. by a countdown followed by synchronized mass consumption of cannabis. We thought this was a perfect natural experiment to evaluate the influence that cannabis intoxication has on the risk of motor vehicle crash. To examine this question, we analyzed 25 years of data on all fatal traffic crashes in the United States. We compared the number of drivers in crashes between 4:20 p.m. and midnight on April 20th to the number of drivers in crashes during the same time interval on control days one week earlier and one week later. We found that the risk of crash involvement was 12% higher on April 20th than on control days. In the subgroups of drivers younger than 21 years of age, the risk of crash involvement was 38% higher on April 20th than on control days. Assuming fewer than 12% of Americans celebrate 4/20, our results suggest that substance use at April 20th celebrations more than doubles the risk of fatal crash. (more…)
Accidents & Violence, Author Interviews, Emergency Care, JAMA, Social Issues / 10.02.2018

MedicalResearch.com Interview with: Dr. Molly Jarman PhD Postdoctoral Research Fellow at Brigham and Womens Hospital  MedicalResearch.com: What is the background for this study? Response: Injuries are a leading cause of death and disability in the US, and there are well documented disparities in injury incidence and outcomes. Certain populations (i.e. rural, low income, people of color) experience more injury than others, and are more likely to die following and injury. Past studies focused on individual health and socioeconomic characteristics as the primary driving force behind these disparities, along with variation in the time required to transport an injured patient to the hospital. We wondered if geographic features of an injury incident location contributed to variation in injury mortality that was not explained by differences in individual patient characteristics. In other words, we know that who you are contributes to injury mortality, and we wanted to know if it also matters where you are when an injury occurs. (more…)
Author Interviews, Breast Cancer, JAMA, Surgical Research / 08.02.2018

MedicalResearch.com Interview with: Dr. Clara Nan-hi Lee, MD Comprehensive Cancer Center The Ohio State UniversityDr. Clara Nan-hi Lee, MD Comprehensive Cancer Center The Ohio State University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The decision about breast reconstruction is very challenging because it’s unfamiliar, involves complex risk information, affects very personal concerns, and happens at a stressful time. One of the challenges is to predict how one will feel after the surgery. We know from psychology research that people often mis-predict their future emotions. So we were interested to see how well women predict their future well being after surgery. The main findings are that patients having mastectomy without reconstruction believed they would be less satisfied than they turned out to be. And patients having mastectomy with reconstruction believed they would be more satisfied than they turned out to be. (more…)
Author Interviews, JAMA, Schizophrenia, Yale / 01.02.2018

MedicalResearch.com Interview with: Josephine Mollon PhD Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience King’s College London, London, England Currently with the Department of Psychiatry Yale University School of Medicine New Haven, Connecticut MedicalResearch.com: What is the background for this study? Response: Psychotic disorders, such as schizophrenia, are severe mental disorders that cause a range of abnormalities in perception and thinking. Individuals with psychotic disorders also experience severe impairments in IQ and there is evidence that these impairments begin many years before hallucinations and delusions first appear. Understanding how and when individuals with psychotic disorder experience a drop in IQ scores will help us better predict and treat poor cognition in these individuals, and perhaps even the disorder itself. (more…)