Author Interviews, Cost of Health Care, JAMA, Ophthalmology, Surgical Research, UCSF / 23.01.2018

MedicalResearch.com Interview with: Catherine L. Chen, MD, MPH Assistant Professor UCSF Department of Anesthesia & Perioperative Care MedicalResearch.com: What is the background for this study? What are the main findings? Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient's blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported. In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing. In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery. We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually. (more…)
Author Interviews, JAMA, Johns Hopkins, Kidney Disease, Transplantation / 23.01.2018

MedicalResearch.com Interview with: Tanjala S. Purnell, PhD MPH Assistant Professor of Surgery, Epidemiology, and Health Behavior and Society Core Faculty, Epidemiology Research Group in Organ Transplantation Johns Hopkins University Associate Director for Education and Training, Johns Hopkins Center for Health Equity Member, OPTN/UNOS Minority Affairs Committee  MedicalResearch.com: What is the background for this study?
  • Our study was motivated by the fact that we know live donor kidney transplants are associated with longer life expectancy and higher quality of life than deceased donor kidney transplants or long-term dialysis treatment. We also know that Black and Hispanic adults are more likely than White adults to have end-stage kidney disease but are less likely than White patients to receive live donor kidney transplants.
  • Over the last 2 decades, there have been several transplant education programs implemented within transplant centers and dialysis centers, and legislative policies enacted to improve overall access to live donor kidney transplants for patients. We wanted to see whether these programs and policies resulted in narrowed racial and ethnic disparities in access to live donor kidney transplants in the United States. 
(more…)
Author Interviews, Dermatology, JAMA, Microbiome / 19.01.2018

MedicalResearch.com Interview with: Maja-Lisa Clausen MD, Ph.D.-fellow Department of Dermatology Copenhagen University Hospital Bispebjerg  MedicalResearch.com: What is the background for this study? Response: ​The human microbiome seems to play an important role in health and disease, by influencing host cells and contributing to host immunity. A balanced interplay between host cells and resident bacteria is important, and dysbiosis is linked to several diseases, including skin diseases like atopic dermatitis. Patients with atopic dermatitis suffer from ​frequent skin infections, and their skin microbiome is dominated by S. aureus. Frequent skin infections lead to frequent use of antibiotics, and with worldwide increase in resistant bacteria, a better understanding of the interplay between host and bacteria is paramount in order to develop new treatment strategies. (more…)
Anesthesiology, Author Interviews, JAMA, Stroke / 18.01.2018

MedicalResearch.com Interview with: Dr. Claus Z. Simonsen, MD, PhD Department of Neurology Aarhus University Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Retrospective studies find worse outcome when performing (Endovascular Therapy) EVT under General Anesthesia (GA). The main finding is that infarct growth in the Conscious Sedation (CS) and GA are not different. And that patients who had EVT under GA had a better outcome after 90 days. This is probably explained by better reperfusion rates under GA which was another part of the study that was surprising. Our neurointerventionalist are comfortable performing EVT under CS, but our study indicates that maybe it is easier to achieve reperfusion it the patient is anesthesized. (more…)
Author Interviews, JAMA, Pediatrics / 17.01.2018

MedicalResearch.com Interview with: James L. Wynn, MD Department of Pediatrics, Department of Pathology, Immunology, and Laboratory Medicine University of Florida, Gainesville MedicalResearch.com: What is the background for this study? Response: Reports from the National Institutes of Health show a reduction in physician-scientists. Objective data on R01 funded pediatric physician-scientists, including the number of R01 awards, individuals awarded an R01, as well as their institutions, subspecialty, academic rank, leadership status, and sex are unknown. (more…)
Author Interviews, JAMA, Mental Health Research / 17.01.2018

MedicalResearch.com Interview with: Michael S. Okun, M.D. Adelaide Lackner Professor and Chair of Neurology Fixel Center for Neurological Diseases Gainesville FL 32607 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Deep brain stimulation is a promising therapy for carefully selected Tourette syndrome patients who fail medication and behavioral therapy. This study draws data from 31 institutions and 10 countries and shows a significant improvement of motor and vocal tics across multiple brain targets.  Because even expert DBS centers only perform 1-2 surgeries a year this type of database and registry will be critical to move the field forward.  (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 17.01.2018

MedicalResearch.com Interview with: Oma Reges, PhD Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel Department of Health Systems Management, Ariel University, Ariel, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: Israel, based on the most recently published data (2015), performs more per-capita bariatric surgery than the U.S.A (about 9,000 to 9,500 procedures annually, which is 1.8 times higher rate per capita than the U.S.A, where there are about 200,000 procedures a year). It is important to evaluate the impact of these procedures on health status, as there is a lack of data of the effectiveness of these procedures over time. We were able to document lower mortality rates, of up to 50%, in the obese patient undergoing surgery as opposed to matched obese patients who continue with usual care.  (more…)
Author Interviews, Diabetes, JAMA, OBGYNE, Surgical Research / 16.01.2018

MedicalResearch.com Interview with: Charles Billington MD Chief, Section of Endocrinology and Metabolism Minneapolis VA Health Care System Professor of Medicine, University of Minnesota  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We wanted to know if adding gastric bypass to intense lifestyle and medical therapy would improve overall diabetes treatment as represented by the triple endpoint of blood sugar, blood pressure and cholesterol control. We found that adding gastric bypass did provide significant benefit at five years after surgery, but that the size of the benefit declined substantially from the first to the fifth year. We also found that gastric bypass did provide significantly better blood sugar control throughout the five years, but the rate of diabetes remission at five years was low. There were many more adverse events in the gastric bypass group.  (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 15.01.2018

MedicalResearch.com Interview with: Jøran Hjelmesæth MD, PhD Professor, Head Morbid Obesity Centre and Section of Endocrinology Department of Medicine Vestfold Hospital Trust Tønsberg, Norway Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo, Norway MedicalResearch.com: What is the background for this study? What is known?  Some previous studies have shown beneficial long-term effects of bariatric surgery on the remission and incidence of diabetes, hypertension and dyslipidemia, whilst high quality data on the long-term incidence of adverse effects, mental health conditions and complications after bariatric surgery are sparse or lacking. In addition, the control groups in previous studies of the effect of bariatric surgery seldom or never received any specific specialist based non-surgical treatment alternative. The present pragmatic real world study was performed at a publicly funded single tertiary care obesity center in Norway where patients could choose between bariatric surgery and specialized medical treatment (voluntarily and free of charge). Nearly complete short- and long-term (≤ 10 years) data on beneficial and detrimental outcomes were retrieved from national registries (Norwegian Prescription Database and Norwegian Patient Registry).  The results confirm the beneficial long-term effects of bariatric surgery (gastric bypass) on the remission and incidence of diabetes, hypertension and dyslipidemia, as demonstrated in some previous studies. (more…)
Author Interviews, JAMA, Ophthalmology, Pediatrics / 14.01.2018

MedicalResearch.com Interview with: Prof. Dr. Andreas Stahl Geschäftsführender Oberarzt Leiter Arbeitsgruppe Angiogenese Universitätsaugenklinik Freiburg | University Eye Hospital Freiburg Freiburg, Germany MedicalResearch.com: What is the background for this study? Response: Retinopathy of prematurity (ROP) is a sight-threatening disease and one of the main reasons for irrreversible bilateral blindness in children. Particularly infants born at very early gestational ages or with very low birth weight are affected. In these infants, vascularization of the retina is unfinished at the time of birth. Severeal weeks into the life of these very prematuerly born infants, angiogenic growth factors, mainly vascular endothelial growth factor (VEGF), become upregulated in the avascular parts of the retina, leading to a re-activation of physiologic vascular growth. If all goes well, these re-activated retinal blood vessels progress towards the periphery and lead to a fully vascularized and functional retina. If, however, the vascular activation by VEGF is too strong, then vascular growth becomes disorganized and vessels are redirected away from the retina and into the vitreous. If left untreated, these eyes can then proceed towards tractional retinal detachment and blindness. Since the 1990s, the standard method of treating ROP has been laser photocoagulation of avascular parts of the retina. This treatment is sensible because VEGF as the main angiogenic driver of pathologic blood vessel growth is expressed in these avascular parts of the retina. The downside of laser treatment, however, is that treated retinal areas are turned into functionless scar tissue and are lost for visual function. In addition, infants treated with laser need to be under general anesthesia for hours during treatment which can be troublesome in very young and fragile preterm infants. And in the long run, infants treated with laser have a high risk of developing high myopia in later life. (more…)
Author Interviews, Cancer Research, JAMA, Stroke / 13.01.2018

MedicalResearch.com Interview with: Babak B. Navi MD, MS Department of Neurology Weill Cornell Medicine New York, New York MedicalResearch.com: What is the background for this study? Response: About 10% of patients with ischemic stroke have comorbid cancer and these patients face an increased risk of stroke recurrence. Many strokes in patients with cancer are attributed to unconventional mechanisms from acquired hypercoagulability. Therefore, many physicians recommend anticoagulation, especially low molecular weight heparins, for the treatment of cancer-associated stroke. However, hypercoagulable stroke mechanisms, such as nonbacterial thrombotic endocarditis, are rarely definitively diagnosed in cancer patients antemortem; while atherosclerosis, which is generally treated with antiplatelet medicines such as aspirin, is common in cancer patients. In addition, many historic indications for anticoagulation in ischemic stroke have been disproven by randomized trials because any reductions in stroke risk were offset by increased risks of bleeding. Given these considerations, we believed that a randomized trial comparing anticoagulation with enoxaparin to antiplatelet therapy with aspirin was necessary to determine the superior strategy, prompting implementation of the TEACH pilot randomized trial. The primary aim of TEACH was to determine whether the random assignment of different antithrombotic strategies to cancer patients with acute ischemic stroke would be sufficiently feasible and safe to proceed with a larger efficacy trial.  (more…)
Author Interviews, JAMA, Neurology / 13.01.2018

MedicalResearch.com Interview with: Fredrik Piehl MD PhD, prof. of Neurology Neuroimmunology Unit. Dept Clinical Neuroscience Neurology Dept. Karolinska University Hospital (Solna) Stockholm MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years we have seen a drastic increase in treatment options for relapsing-remitting multiple sclerosis (RRMS). However, it is difficult to deduce long term performance of different drugs based only on data from randomized controlled trials, since such trials are performed in selected patients without major co-morbidities and perhaps also enriched for those with a milder disease course. In addition, most trials only last for two years and lack relevant comparators. This lack of knowledge makes it difficult to predict if a drug will work or not for a given patient, in turn leading to frequent treatment switches but also different treatment practices across countries, regions or even between centers. This is also the case in Sweden, but with the additional aspect that some regions have opted to treat most newly diagnosed RRMS patients with rituximab (Rituxan/Mabthera), a drug not formally approved for RRMS, but with extensive safety data from other indications. (more…)
Alzheimer's - Dementia, Author Interviews, Biomarkers, JAMA, MRI / 12.01.2018

MedicalResearch.com Interview with: Miguel ASantos-SantosMD Department of Neurology, Memory and Aging Center University of California San Francisco Autonomous University of Barcelona, Cerdanyola del Valles, Spain MedicalResearch.com: What is the background for this study? Response: Primary progressive aphasia (PPA) is a clinically and pathologically heterogeneous (generally Frontotemporal lobar degeneration [FTLD, generally tau or tdp proteinopathies] or Alzheimer’s disease [AD] pathology) condition in which language impairment is the predominant cause of functional impairment during the initial phases of disease. Classification of PPA cases into clinical-anatomical phenotypes is of great importance because they are linked to different prevalence of underlying pathology and prediction of this pathology during life is of critical importance due to the proximity of molecule-specific therapies. The 2011 international consensus diagnostic criteria established a classification scheme for the three most common variants (the semantic [svPPA], non-fluent/agrammatic [nfvPPA], and logopenic [lvPPA]) of PPA and represent a collective effort to increase comparability between studies and improve the reliability of clinicopathologic correlations compared to the previous semantic dementia and progressive non-fluent aphasia criteria included in the 1998 consensus FTLD clinical diagnostic criteria. Since their publication, a few studies have reported amyloid imaging and pathological results in PPA, however most of these studies are retrospective in nature and the prevalence of FTLD and Alzheimer’s disease pathological findings or biomarkers in each variant has been inconsistent across the literature, therefore prospective validation with biomarker and autopsy data remains scarce and highly necessary. (more…)
Author Interviews, CDC, JAMA, Weight Research / 12.01.2018

MedicalResearch.com Interview with: Liping Pan, MD, MPH Epidemiologist, Epidemiology & Surveillance Team Obesity Prevention and Control Branch Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention & Health Promotion CDC  MedicalResearch.com: What is the background for this study? Response: Children with severe obesity face significant health and social challenges. Children with obesity and severe obesity are at higher risk for having other chronic health conditions and diseases, such as asthma, sleep apnea, bone and joint problems, and type 2 diabetes. They also have more risk factors for heart disease like high blood pressure, impaired glucose tolerance, and high cholesterol than their normal weight peers. These lifelong health risks associated with severe obesity during early childhood indicate the importance of preventing and identifying severe obesity. Childhood obesity disproportionately affects children living in low-income families. However, no recent trends on severe obesity in this population have been reported. (more…)
Author Interviews, JAMA, Pediatrics, Smoking, Tobacco, Tobacco Research, UCSF / 07.01.2018

MedicalResearch.com Interview with: “hookah” by Ksenia M is licensed under CC BY 2.0Benjamin Chaffee, DDS MPH PhD UCSF School of Dentistry San Francisco, CA 94118 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Non-cigarette tobacco products, which include electronic cigarettes, hookah (tobacco waterpipe), smokeless tobacco, and non-cigarette combustibles, like cigars, are increasingly popular among young people. Considerable debate surrounds whether use of these non-cigarette products encourages youth to begin smoking conventional cigarettes. Several previous studies have shown associations between non-cigarette tobacco use and youth smoking. These studies had largely looked at only one type of tobacco product at a time. This study included more than 10,000 adolescents from all over the United States, surveyed at two time points one year apart. Therefore, this study featured enough participants and detailed information about tobacco behaviors to consider all types of tobacco products in a comprehensive way. We found that each type of non-cigarette tobacco product (i.e., e-cigarettes, hookah, combustibles, or smokeless tobacco) added to smoking risk. Among youth who had never smoked a cigarette at the start of the survey, use of any of the non-cigarette products approximately doubled the odds of cigarette smoking within a year, after adjusting for multiple smoking-related risk factors. Each product independently increased risk. The adolescents most susceptible to future smoking to were those who had tried two or more types of non-cigarette tobacco. (more…)
Author Interviews, Calcium, Geriatrics, JAMA, Vitamin C / 05.01.2018

MedicalResearch.com Interview with: “ZMA och D-vitamin. Intages med dubbelsidig C-brus. #placebomannen” by Robin Danehav is licensed under CC BY 2.0Dr Jia-Guo Zhao Tianjin Hospital Department of Orthopaedic Surgery Tianjin, China MedicalResearch.com: What is the background for this study? Response: The increased social and economic burdens for osteoporotic-related fractures worldwide make its prevention a major public health goal. Calcium and vitamin D supplements have long been considered a basic intervention for the treatment and prevention of osteoporosis. Survey analysis showed that 30–50% of older people take calcium or vitamin D supplements in some developed countries. Many previously published meta-analyses, from the high-ranking medical journals, concluded that calcium and vitamin D supplements reduce the incidence of fracture in older adults. And many guidelines regarding osteoporosis recommend calcium and vitamin D supplements for older people. The final aim for these supplements is to prevent the incidence of osteoporotic-related fracture in osteoporosis management. (more…)
Author Interviews, Cost of Health Care, JAMA / 05.01.2018

MedicalResearch.com Interview with: “Doctors” by Tele Jane is licensed under CC BY 2.0Kathryn R. Tringale, MAS Department of Radiation Medicine and Applied Sciences University of California San Diego, La Jolla MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial relationships between biomedical industry and physicians are common, and previous work has investigated the potential conflicts of interest that can arise from these interactions. Data show that even small payments in the form of industry sponsored lunches can influence physician prescribing patterns. Given the concern for the potential influence of biomedical industry over practice patterns and potentially patient care, the Open Payments program was implemented under the Affordable Care Act to shed light on these interactions and make reports of these financial transactions publicly available. We recently published a paper in JAMA on industry payments to physicians that found that men received a higher value and greater number of payments than women physicians and were more likely to receive royalty or licensing payments when grouped by type of specialty (surgeons, primary care, specialists, interventionalists). The purpose of the Research Letter discussed here was to further examine differences in the value of payments received by male and female physicians within each individual specialty. The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships. Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry. With this being said, whether male or female, everyone needs a bit of help sometimes. The use of loans is a possibility for many people who need a little financial assistance. Regardless of whether men are getting paid a little more than women, they may all need help just as equally. The type of loans that would be worth looking into if this is your current situation is physician loans, which basically allows medical professionals to purchase a home with a low/little down payment while avoiding mortgage insurance. A little bit of help goes a long way, especially when it involves your future. (more…)
Allergan, Author Interviews, JAMA, Ophthalmology / 05.01.2018

MedicalResearch.com Interview with: Steven Woloshin, MD MS Professor of The Dartmouth Institute Professor of Medicine Professor of Community and Family Medicine The Center for Medicine in the Media Dartmouth Institute for Health Policy and Clinical Practice Lebanon, New Hampshire MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a lot of debate about the legal maneuvers (ie, transferring patents to the Mohawk Indians) Allergan has employed to delay marketing of generic alternatives to Restasis (cyclosporine ophthalmic emulsion 0.05%).   But there is a more fundamental question that has received little attention:  Does Restasis work?  It is not approved in the European Union, Australia or New Zealand where registration applications were "withdrawn prior to approval due to insufficient evidence of efficacy" in 2001.   Although Canada approved Restasis, its national health technology assessment unit, unconvinced of meaningful benefit, recommended Canada not pay for it - according to our research, no Canadian provincial or federal drug plan currently does.   Nevertheless, Americans have spent $8.8 billion in total sales between 2009 and 2015 on Restasis, including over $2.9 billion in public monies through Medicare Part D. (more…)
Author Interviews, JAMA, Multiple Sclerosis, Radiology / 04.01.2018

MedicalResearch.com Interview with: Netta Levin MD PhD fMRI lab Neurology Department Hadassah Hebrew University Medical Center Jerusalem  MedicalResearch.com: What is the background for this study? Response: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, manifesting with episodes of local inflammatory processes, called relapses. The most useful surrogate laboratory test for MS is magnetic resonance imaging (MRI), in which dissemination of demyelinating lesions in space and time are the hallmark of the disease. However, there is a discrepancy between the lesion load - the number, size, and location of the lesions - and the clinical state of the patients, reflected in their disability. This discrepancy is known as the “clinico-radiological paradox” and suggests that something other than the well-known mechanisms of demyelination, remyelination, and axonal loss may tip the scale of recovery from an acute episode. Global effects of the local damage and compensatory mechanisms were suggested as an explanation to this paradox. In this study, we compared the visual system of patients with clinically isolated syndrome optic neuritis (ON) to patients with clinically isolated episodes in other functional systems, exploring changes, both anatomical and functional, caused to the system following the demyelinating episode. Optic neuritis was deemed a good in vivo model for studying the pathophysiology of tissue damage and repair in MS due to its characteristic clinical manifestation and to the visual pathways’ amenability to investigation using various techniques. To assess anatomical wiring ,i.e the white matter fibers themselves , we used diffusion tensor imaging (DTI). To assess functional networking as reflected by signal synchronization between distinct brain regions, we used resting state fMRI. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 04.01.2018

MedicalResearch.com Interview with: Edward L. Hannan, PhD, MS, MS, FACC Distinguished Professor and Associate Dean Emeritus University at Albany School of Public Health Rensselaer, NY 12144     MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have done a lot of work on complete revascularization (CR) vs. incomplete revascularization (IR) already, and as a follow-up it seemed as if there may be different types of IR that are associated with even worse outcomes relative to CR and other IR. Incomplete revascularization is associated with worse outcomes if it involves multiple vessels, vessels with severe stenosis, or significant proximal left anterior descending artery vessel (PLAD) stenosis. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 03.01.2018

MedicalResearch.com Interview with: “Breastfeeding welcome here” by Newtown grafitti is licensed under CC BY 2.0Clare Relton, PhD School of Health and Related Research University of Sheffield, Sheffield, England MedicalResearch.com: What are the key findings of your report? Response: Our five year research project explored whether offering financial incentives (shopping vouchers) for breastfeeding increased breastfeeding. We studied what happened to breastfeeding rates at 6 to 8 weeks post-partum in areas in England with low (<40%) breastfeeding prevalence. Our cluster randomized clinical trial (which included 10 010 mother-infant dyads) showed that areas with the financial incentive had significantly higher rates of breastfeeding at 6 to 8 weeks (37.9% vs 31.7%) compared to usual care. The financial incentive scheme was widely acceptable to healthcare providers (midwives, health visitors, doctors) and mothers. The financial incentives made it easier for everyone to discuss breastfeeding and mothers reported feeling valued (supported and rewarded) for breastfeeding. (more…)
Author Interviews, Diabetes, JAMA, Race/Ethnic Diversity, Weight Research / 02.01.2018

MedicalResearch.com Interview with: Michael P. Bancks, PhD Northwestern University Chicago, Illinois  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that the disparity in diabetes between black and white youth and young adults is growing, but the reasons why are unclear. We also know that traditional risk factors for diabetes, such as obesity and low socioeconomic status, are more common among blacks as compared with whites. Our study describes how the unequal rates of these traditional diabetes risk factors explain or account for the higher rates of diabetes among blacks. (more…)
Author Interviews, Diabetes, JAMA, Nutrition, Pediatrics / 02.01.2018

MedicalResearch.com Interview with: “Baby Bottle” by brokinhrt2 is licensed under CC BY 2.0Mikael Knip, MD, PhD Professor of Pediatrics TRIGR PI  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Experimental studies have indicated that the avoidance of early exposure to cow's milk proteins reduces the cumulative incidence of autoimmune diabetes in animal models of human type 1 diabetes, e.g. BB rats and NOD mice. Epidemiological studies in humans have suggested that there may be a link between type 1 diabetes and short breastfeeding or early introduction of infant formulas. All regular infant formulas contain intact cow's milk proteins. The main finding was that weaning to an extensively hydrolyzed formula did not reduce the cumulative incidence of Type 1 diabetes in at-risk children by the mean age of 11 years. The extensively hydrolyzed formula did not contain any intact cow's milk proteins but only small peptides (maximal size 2000 daltons). (more…)
Author Interviews, Bipolar Disorder, Depression, JAMA / 01.01.2018

MedicalResearch.com Interview with: Andre Russowsky Brunoni, MD, PhD Coordinator, Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences  Department and Institute of Psychiatry Coordinator, Interdisciplinary Center for Applied Neuromodulation, University Hospital University of São Paulo São Paulo, Brasil  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study, our aim was to evaluate the safety and efficacy of transcranial direct current stimulation (tDCS) as an add-on treatment for patients with bipolar depression. There are a only few treatment alternatives for bipolar depression, which often have important side effects. Thus, we wanted to evaluate the efficacy of this non-pharmacological treatment. We found that active vs. sham tDCS effected greater response and remission for patients with bipolar depression. The frequency of adverse effects was similar, including treatment-emergent affective switches. However, higher rates of skin redness were observed in the active group. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, End of Life Care, JAMA / 01.01.2018

MedicalResearch.com Interview with: Dr. Laura A. Petrillo MD Instructor in Medicine Harvard Medical School, and Palliative Care Physician Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospice is end-of-life care focused on maximizing quality of life. Hospice often involves reducing or stopping treatments that are unlikely to have short-term benefit in order to avoid uncomfortable side effects. About a quarter of Americans die in nursing homes, and some of them receive hospice care in their final days. We looked at whether adults with type 2 diabetes experience low blood sugar while on hospice in veterans’ nursing homes, since low blood sugar signals inappropriately aggressive diabetes treatment in patients close to death and contributes to unnecessary discomfort. We found that one in nine people experienced low blood sugar at least once while receiving hospice care. Among people who were on insulin, the number was one in three. (more…)
Author Interviews, Autism, JAMA, Nutrition, OBGYNE / 27.12.2017

MedicalResearch.com Interview with: Dr. Marte Bjørk, MD PhD Department of Clinical Medicine University of Bergen, Department of Neurology Haukeland University Hospital Bergen, Norway MedicalResearch.com: What is the background for this study? Response: In utero antiepileptic drug exposure are associated with neurodevelopmental problems in the child. We looked into if maternal folate during pregnancy could reduce the risk of autistic traits in children of women in need of antiepileptic drugs in pregnancy. The rationale for the hypothesis that folate could be beneficial, was that many antiepileptic drugs interact with folate metabolism. Folic acid supplement use is also associated with slightly reduced risk of autism in children of women from the general population. (more…)
Author Interviews, Chemotherapy, JAMA, Ovarian Cancer / 26.12.2017

MedicalResearch.com Interview with: Debra Richardson, MD, FACOG, FACS Associate Professor, Section of Gynecologic Oncology, Oklahoma TSET Phase I Program Stephensen Cancer Center The University of Oklahoma MedicalResearch.com: What is the background for this study? What are the main findings? Response: Ovarian cancer is the leading cause of gynecologic cancer deaths. Pazopanib is an oral multitarget tyrosine kinase inhibitor of VEGF receptors 1, 2, and 3; platelet-derived growth factor (PDGF) receptors α and β and c-KIT. Weekly paclitaxel is an active agent for recurrent ovarian cancer. This was a national, randomized, double-blind, placebo controlled phase 2b trial of weekly paclitaxel with or without pazopanib for the treatment of recurrent ovarian cancer. The primary objective was to estimate the progression-free survival (PFS) hazard ratio (HR) of the combination of weekly paclitaxel (80mg/m2 D1, 8, 15 every 28 days) and pazopanib (800mg PO daily) compared with weekly paclitaxel and placebo in women with persistent or recurrent ovarian cancer. 106 women were enrolled. There was no difference in median PFS, overall survival (OS), or proportion responding. Severe hypertension was more common on the pazopanib plus paclitaxel arm. More patients discontinued treatment on the paclitaxel arm for disease progression, and more on the pazopanib plus paclitaxel arm for adverse events. Patients with VEGFA CC genotype may be more resistant to weekly paclitaxel than those with the AC or AA genotype. (more…)
Author Interviews, JAMA, OBGYNE / 26.12.2017

MedicalResearch.com Interview with: Gabriele Saccone, MD Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine University of Naples Federico II Naples, Italy MedicalResearch.com: What is the background for this study? Response: Preterm birth is a major cause of perinatal morbidity and mortality. About 15 million infants were born too soon every year, causing 1.1 million deaths. The cervical pessary is a silicone device that has been studied to prevent preterm birth. However, the efficacy of this device in preventing preterm birth is still subject of debate. (more…)
Author Interviews, Cancer Research, Esophageal, Gastrointestinal Disease, JAMA / 21.12.2017

MedicalResearch.com Interview with: Dr. Edward D. McCoul, MD, MPH Ochsner Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Population-level data suggests a link between gastroesophageal reflux disease and cancer of the throat and sinuses in adults over 65 years of age.  T he strength of association between reflux and cancer is strongest for anatomic sites closest to the esophagus, where acid and other stomach contents may have the greatest exposure. (more…)
Accidents & Violence, Author Interviews, Emergency Care, ENT, JAMA / 21.12.2017

“Qtip” by Rafael Castillo is licensed under CC BY 2.0MedicalResearch.com Interview with: Eric T. Carniol, MD, MBA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Tympanic membrane perforations (aka "popped" or "burst" ear drum) is a common complaint of patients presenting to the emergency room, primary care offices, and otolaryngologist (ENT doctors) offices. These may be caused by trauma, infections, or other causes. As well, many patients will use qtips (cotton-tipped applicators) to clean ears and remove ear wax and are unaware of the potential harms of doing so. This study was designed to examine the cause of ear drum perforations as diagnosed in emergency departments in the United States. Foreign body instrumentation of the ear (qtips, hair combs, hair pins, needles, etc) were the cause of 61.2% of perforations. Cotton tip applicators are the single leading cause of traumatic tympanic membrane perforation in all age groups except young adults (13-18) and 19-36 year olds, in which it is the second largest cause (behind water trauma). Children less than 18 years old constitute nearly 2/3 of all ear drum perforations in the emergency department. (more…)