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Author Interviews, Diabetes, JAMA, Lifestyle & Health / 09.11.2017

MedicalResearch.com Interview with: Dr. Karla Galaviz PhD Hubert Department of Global Health Rollins School of Public Health Emory University Sonya Haw, MD| Assistant Professor Division of Endocrinology, Metabolism & Lipids Emory University, School of Medicine Grady Memorial Hospital Atlanta, GA MedicalResearch.com: What is the background for this study? What are the main findings?
  • Diabetes affects 1 in 11 adults worldwide and though there is evidence that lifestyle modification (eating healthier diets and exercising about 150 mins a week) and certain medications can prevent or delay diabetes onset, it is not clear which of these strategies offers long-term benefits.
  • To answer this question, we compiled all available randomized controlled trials of lifestyle programs and medications to prevent diabetes and analyzed the data to see if the diabetes prevention effects persisted in the long-term. We specifically compared studies where the lifestyle or drug interventions were discontinued to see if the effect was long lasting or diminished when the intervention was stopped.
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Author Interviews, Gastrointestinal Disease, JAMA, Lymphoma / 08.11.2017

MedicalResearch.com Interview with: ANSMRosemary Dray-Spira, MD, PhD Department of Epidemiology French National Agency for Medicines and Health Products Safety (ANSM) Saint-Denis, France MedicalResearch.com: What is the background for this study? What are the main findings? Response: Anti-tumor necrosis factor (anti-TNF) agents are increasingly used for the management of inflammatory bowel diseases (IBD), either alone or in combination with thiopurines. Their clinical benefits have been largely assessed, however they may expose to potentially serious adverse effects. While an increased risk of lymphoma has been established with thiopurines, up to now such a risk of lymphoma remained uncertain with anti-TNF agents. In this study based upon a large, nationwide cohort of 189,289 patients with IBD, the use of anti-TNF agents alone was found associated with a 2 to 3 fold increase in the risk of lymphoma, similarly to thiopurines alone. In addition, the combination of these two treatments was associated with a 6 fold increase in the risk of lymphoma, ie a higher risk than with each treatment used alone. Although these differences are statistically significant, the risk of lymphoma among patients exposed to anti-TNF agents is less than 1 case per 1000 person-years. (more…)
Author Interviews, Cannabis, JAMA / 08.11.2017

MedicalResearch.com Interview with: Marcel Bonn-Miller, PhD Adjunct assistant professor Department of Psychiatry Leader of the Substance Abuse and Anxiety Program U.S. Veterans Affairs Department  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A 2015 study found that edible cannabis products (e.g., brownies, cookies, drinks) are often mislabeled.  The FDA has also sent warning letters to a handful of companies selling cannabidiol extracts because of inaccurate labeling of content. This led us to conduct a systematic evaluation of the label accuracy of all cannabidiol extracts sold online.  We tested 84 products from 31 different companies. The primary take-home of this study is that nearly 70 percent of all cannabidiol extracts sold online had over 10% more or less cannabidiol than advertised; 26% of products were over-labeled (less cannabidiol than indicated) and 42% of products were under-labeled (more cannabidiol than indicated). (more…)
Author Interviews, CDC, Dermatology, Environmental Risks, JAMA, Pediatrics / 08.11.2017

MedicalResearch.com Interview with: “Dymchurch Beach - May 2012 - Sunburn with Matching Bikini” by Gareth Williams is licensed under CC BY 2.0Dawn M. Holman, MPH Behavioral Scientist Division of Cancer Prevention and Control Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? Response: Scientific evidence clearly shows that even one sunburn during adolescence can increase a person’s chances of developing skin cancer as an adult. Surprisingly, little research has been done to understand the factors associated with sunburn during this phase of life. The CDC wanted to examine beliefs, behaviors, and demographic characteristics that might be associated with adolescent sunburns in hopes that the findings could inform future intervention efforts. We used data from the 2015 YouthStyles survey (adolescents aged 12 to 17 years) to explore this research question (more…)
Accidents & Violence, Author Interviews, Exercise - Fitness, Frailty, Geriatrics, JAMA, Osteoporosis / 07.11.2017

MedicalResearch.com Interview with: Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews MedicalResearch.com: What is the background for this study? Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people. MedicalResearch.com: What are the main findings? Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care. (more…)
Author Interviews, Heart Disease, JAMA, Mental Health Research / 07.11.2017

MedicalResearch.com Interview with: Dr. Keun-Hwa Jung MD PhD Program in Neuroscience, Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University First author: Dr. Woo-Jin Lee MD Department of Neurology Seoul National University Hospital Seoul, South Korea  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cerebral white matter hyperintensity is a prevalent consequence of brain aging process and associated with various complications. One of the main mechanisms underlying the progression of white matter hyperintensity is chronic dysfunction of the glymphatic system which maintains metabolic homeostasis in brain. Glymphatic system is the route where the cerebrospinal fluid enters into the brain parenchyma and is cleared out with soluble wastes to the perivascular space of the cerebral small veins, peri-meningeal lymphatic vessels, deep cervical lymph nodes, and finally to the right atrium. Although the integrity of the glymphatic system is dependent on the adequate drainage of cerebral veins and lymphatics to the downstream chamber, the right atrium, the impact of hemodynamic changes in right-sided cardiac chambers on the development of white matter hyperintensity have not been elucidated. (more…)
Author Interviews, JAMA, Smoking, Tobacco Research / 07.11.2017

MedicalResearch.com Interview with: “Stop smoking!” by Emil_95 is licensed under CC BY 2.0Dr. Man Ping Wang, PhD School of Nursing University of Hong Kong Hong Kong MedicalResearch.com: What is the background for this study? What are the main findings? Response: Smoking cessation (SC) services can effectively increase the chance of abstinence, but few smokers proactively seek help from these services worldwide. Smoking cessation guidelines recommend referring smokers to SC services, but such referrals were usually conducted in a passive way (e.g. providing contacts of these services and asking smokers to use them). Actively referring smokers may increase use of smoking cessation services and abstinence rates. Previous studies were mostly conducted in clinical settings. We investigated the efficacy of using trained volunteers to actively refer smokers recruited in the community to smoking cessation services in this cluster randomized control trial. We found that smokers who received a brief cessation advice and active referral had significantly higher abstinence rate and smoking cessation service use rate at 6-month follow-up, compared with smokers who received a minimal advice and a self-help booklet. (more…)
Author Interviews, JAMA, Pediatrics / 06.11.2017

MedicalResearch.com Interview with: Sally H. Adams, PhD, RN Specialist, Division of Adolescent and Young Adult  Medicine Adolescent and Young Adult Health National Resource Center University of California, San Francisco Benioff Children’s Hospital San Francisco, CA 94118 MedicalResearch.com: What is the background for this study? Response: Major causes of adolescent illness and mortality are preventable. To address this, in the 1990s, professional medical organizations developed healthcare provider guidelines for the delivery of adolescent preventive healthcare. These include the receipt of anticipatory guidance and risk screening services in the effort to promote healthy behaviors and avoid risky behaviors that are intended to be covered within a preventive care visit, but could be addressed in other healthcare visits. The adolescent developmental period is an important time for adolescents to be engaged with the healthcare system. Transitioning from childhood to adulthood, adolescents are becoming increasingly independent - having more responsibility and freedom for decision making in many areas, including healthy choices in behaviors and activities. While families and community settings (schools, churches) play strong roles in this process, the healthcare system also plays an important role. (more…)
Author Interviews, Cancer Research, JAMA / 06.11.2017

MedicalResearch.com Interview with: Gry Haaland, MD James Lorens PhD, Professor The Department of Biomedicine University of Bergen  MedicalResearch.com: What is the background for this study? Response: Antitumor activity of the common blood thinner warfarin has been reported in several experimental cancer model systems. We therefore considered whether warfarin is cancer protective. Using the comprehensive national health registries in Norway, we examined cancer incidence among a large number of people taking warfarin (92,942) and compared to those not taking warfarin (more than 1.1 million). (more…)
Author Interviews, Dermatology, JAMA / 01.11.2017

MedicalResearch.com Interview with: Eliot N. Mostow, MD, MPH Professor & Chair, Dermatology Section Department of Internal Mediciine Northeast Ohio Medical University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for the study is my continued interest in what is sometimes called health services research. That is, how do we improve our ability to deliver optimal medical care from a healthcare system perspective? Simply put, one of the most frequent criticisms about getting a dermatologist to see if patient is that there are delays in scheduling (wait times are too high). I’m not sure this is really justified, as it seems to take a long time to get into psychiatrists, gynecologists, and other specialists in our community as well. That being said, since I’m in the dermatology community and our community has been utilizing physician assistants and nurse practitioners more frequently for many years now, we thought it was worthwhile to explore whether this was having an impact on wait times to get a visit in a dermatologist’s office. (more…)
Author Interviews, Brigham & Women's - Harvard, Environmental Risks, JAMA, OBGYNE / 01.11.2017

MedicalResearch.com Interview with: Yu-Han Chiu, M.D., M.P.H., Sc.D Department of Nutrition Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Animal experiments suggest that ingestion of pesticide mixtures at environmentally relevant concentrations decreases the number of live-born pups. However, it is unclear whether intake of pesticide residues has any adverse effects in humans, especially for susceptible populations such as pregnant women and their fetuses. Therefore, in this study we examined the association of preconception intake of pesticide residues in fruits and vegetables with pregnancy outcomes among 325 women undergoing assisted reproduction. A pesticide is far cheaper than pest control services, like termite control los angeles, so it makes sense why most farmers choose to use pesticide for their farmhouse and crops. However, this isn't necessarily the best procedure for human health, or consumption! We found that intake of high pesticide residue fruits and vegetables were associated with higher risks of pregnancy loss, while low pesticide residue fruit and vegetable intake was associated with lower risks of early pregnancy loss. These data suggest dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences (more…)
Author Interviews, JAMA, Menopause, Ophthalmology, UCLA / 31.10.2017

MedicalResearch.com Interview with: Anne L. Coleman, MD, PhD Center for Community Outreach and Policy, Stein Eye Institute David Geffen School of Medicine Director, UCLA Mobile Eye Clinic Department of Epidemiology, Fielding School of Public Health UCLA MedicalResearch.com: What is the background for this study? Response: Cataracts are a leading cause of vision loss worldwide, and cataract surgery is an intervention that is known to be extremely effective to address the vision loss related to cataract. However, it is unclear if there are benefits of cataract surgery beyond vision improvement in people with cataracts. Previous studies have suggested that in addition to improving vision, cataract surgery may decrease the risk of fractures and accidents, improve mental health, and improve overall quality of life. The purpose of the present study was to further investigate the potential benefits of cataract surgery and to determine if cataract surgery was associated with increased survival in people with cataracts. (more…)
Author Interviews, Heart Disease, JAMA, Pulmonary Disease, Vanderbilt / 27.10.2017

MedicalResearch.com Interview with: Dr. Evan L. Brittain, MD Assistant Professor of Medicine Vanderbilt University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The purpose of this study was to determine whether pulmonary pressure values below the diagnostic threshold for pulmonary hypertension (25mmHg) are associated with an increased risk of mortality. We studied over 4,000 consecutive individuals referred for right heart catheterization, the “gold-standard” procedure for measuring pulmonary pressure. We found that borderline levels of mean pulmonary pressure (19-24mmHg) were common, representing 18% of all patients referred for this procedure. Borderline mean pulmonary pressure values were also associated with 31% increase in mortality after accounting for many other clinical factors. Finally, we found that most of the patients with borderline pulmonary hypertension who underwent repeat catheterization often progressed to overt pulmonary hypertension. This study suggests that patients with borderline pulmonary hypertension should be considered an at-risk group. (more…)
Author Interviews, Heart Disease, JAMA / 27.10.2017

MedicalResearch.com Interview with: Elad Asher, M.D, M.H.A Interventional Cardiologist, Director Intensive Cardiac Care Unit Deputy Director Heart Institute Assuta Ashdod Medical Center MedicalResearch.com: What is the background for this study? Response: Dual antiplatelet therapy represents the standard care for treating ST elevation myocardial infarction (STEMI) patients. Given the higher risk of peri-procedural thrombotic events in patients undergoing primary percutaneous coronary intervention (PPCI), there is a need to achieve inhibition of platelet aggregation (IPA) more promptly. Although chewing ticagrelor has been shown to be more efficient for IPA in stable coronary disease and in patients with acute coronary syndrome (ACS)/non-ST elevation myocardial infarction (NSETMI), there are no studies that have specifically assessed the efficacy and safety of chewing ticagrelor in STEMI patients. Therefore, the aim of our study was to investigate whether chewing ticagrelor (180mg) loading dose is associated with more favorable platelet inhibitory effects compared with the conventional way of swallowing whole tablets loading dose in STEMI patients undergoing PPCI. (more…)
Author Interviews, Heart Disease, JAMA / 25.10.2017

MedicalResearch.com Interview with: Hawkins C. Gay, MD, MPH Resident Physician, Internal Medicine Feinberg School of Medicine Northwestern University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The National Academy of Medicine and other leading institutions have highlighted clinical trial data sharing as an important initiative for enhancing trust in the clinical research enterprise. More recently, the International Committee of Medical Journal Editors stipulated that manuscripts published in their journals must clearly state plans for data sharing in the trial’s registration, and the National Institutes of Health now requires a data sharing plan as part of new grant applications. Many clinical trialists rightly debate the costs and time required to curate their data into a format that is usable by third part data analysts. Similarly, there has been debate about the most efficient platforms from which to distribute this data, and different models exist, including governmental (NIH BioLINCC), commercial (ClinicalStudyDataRequest.com), and academic (Yale Open Access Data Project [YODA]) platforms. Our study sought to explore these questions by conducting a reproduction analysis of the Thermocool Smarttouch Catheter for Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial (NCT01385202), which is the only cardiovascular clinical trial available through the YODA platform. Reproduction analyses represent a fundamental approach for and outcome from data sharing but are uncommonly performed even though results change more than one-quarter of the time in reproduction analyses. SMART-AF was a multicenter, single-arm trial evaluating the effectiveness and safety of an irrigated, contact force-sensing catheter for ablation of drug refractory, symptomatic paroxysmal atrial fibrillation in 172 participants recruited from 21 sites between June 2011 and December 2011. The time from our initial proposal submission to YODA and the final analysis completion was 11 months. Freedom from atrial arrhythmias at 12 months post-procedure was similar compared with the primary study report (74.0%; 95% CI, 66.0-82.0 vs 76.4%; 95% CI, 68.7-84.1). The reproduction analysis success rate was higher than the primary study report (65.8%; 95% CI 56.5-74.2 vs 75.6%; 95% CI, 67.2-82.5). Adverse events were minimal and similar between the two analyses. We could not reproduce all analyses that were conducted in the primary study report; specifically, the analyses relating to contact force range and regression models. The primary reason for non-reproducibility was missing or un-locatable data in the analyzable dataset. (more…)
Author Interviews, JAMA, Kidney Disease, Surgical Research / 25.10.2017

MedicalResearch.com Interview with: In Gab Jeong, MD Associate Professor Department of Urology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea MedicalResearch.com: What is the background for this study? What are the main findings? Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown. We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519). (more…)
Accidents & Violence, Author Interviews, JAMA / 20.10.2017

MedicalResearch.com Interview with: Michael Siegel, MD, MPH Professor, Department of Community Health Sciences Boston University School of Public Health Boston, MA 02118 MedicalResearch.com: What is the background for this study? Response: A central question in the debate about public policies to reduce firearm violence is whether easier access to concealed handguns increases or decreases the rate of firearm-related homicides. Previous studies on the impact of concealed carry permitting laws have yielded inconsistent results. Most of these studies were conducted more than a decade ago. This study provided a reexamination of this research question with more recent data, up to and including the year 2015. While all states allow certain persons to carry concealed handguns, there are 3 major variations in permitting policy. In 9 states, law enforcement officials have wide discretion over whether to issue concealed carry permits; these are referred to as “may issue” states because police chiefs can deny a permit if they deem the applicant to be at risk of committing violence, even if there is not a criminal history. In 29 states, there is little or no discretion; these are referred to as “shall-issue” states because permits must be issued if requisite criteria are met. In an additional 12 states, no permit is necessary to carry a concealed handgun. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 20.10.2017

MedicalResearch.com Interview with: Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured. One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer. Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014. (more…)
Author Interviews, C. difficile, Critical Care - Intensive Care - ICUs, Infections, JAMA, Outcomes & Safety / 18.10.2017

MedicalResearch.com Interview with: Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai. MedicalResearch.com: What is the background for this study? What are the main findings? Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines. Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 18.10.2017

MedicalResearch.com Interview with: Prof. Dr. med. Reinhard Holl Division of Endocrinology and Diabetes, Medical Faculty Aachen University, Aachen, Institute of Epidemiology and Medical Biometry University of Ulm, Ulm Germany  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Today there are two accepted strategies to treat type-1 diabetes: pump or multiple daily injections. In a large group of patients we compared both strategies, and our results indicate advantages for pump therapy with fewer severe hypos, fewer events of diabetic ketoacidosis, and better metabolic control. (more…)
Author Interviews, CDC, JAMA, Neurological Disorders, Zika / 17.10.2017

MedicalResearch.com Interview with: Emilio Dirlikov, PhD Epidemic Intelligence Service Officer CDC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In December 2015, Puerto Rico Department of Health (PRDH) reported its first confirmed locally acquired case of Zika virus disease. In February 2016, PRDH reported the first person diagnosed with Guillain-Barré syndrome (GBS) who also had evidence of Zika virus infection. At the time, scientific evidence of the potential association between Zika virus infection and GBS was lacking, and rigorous studies were needed. Through a collaboration between PRDH, CDC, and the University of Puerto Rico (UPR), we conducted a case-control study to determine risk factors for GBS during the 2016 Zika virus epidemic. By prospectively enrolling case-patients, we shortened the time to enrollment, increasing the likelihood of detecting Zika virus nucleic acids to confirm Zika virus infection. As a result, we found that an acute Zika virus infection confirmed by laboratory testing is a risk factor for developing Guillain-Barré syndrome. This is the first case-control study to find laboratory evidence showing this given the difficulty of confirming Zika virus infection among people diagnosed with GBS. (more…)
Author Interviews, Gender Differences, Hematology, JAMA / 17.10.2017

MedicalResearch.com Interview with: Rutger Middelburg, PhD Assistant Professor in clinical epidemiology Sanquin Research and LUMC  MedicalResearch.com: What is the background for this study? Response: Six years ago we found transfusions from female donor to be associated with increased mortality among male recipients, especially under 50 years of age. This was an unexpected observation and we considered the probability of a false positive finding (i.e. a chance association) to be relatively high. We therefore immediately started a follow-up study with two main objectives. First, we wanted to confirm our findings in an independent and much larger cohort. Second, since some complications of blood transfusion are known to be related to pregnancy history of the donor, we wanted to study a possible relationship with previous pregnancy of the blood donors. (more…)
Author Interviews, Depression, Diabetes, JAMA, Pediatrics, Pharmacology / 17.10.2017

MedicalResearch.com Interview with: Mehmet Burcu, PhD, MS Department of Pharmaceutical Health Services Research University of Maryland, Baltimore  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Antidepressants are one of the most commonly used psychotropic medication classes in U.S. youth, with serotonin reuptake inhibitors representing a large majority of total antidepressant use in youth. The most interesting finding was that the current use of serotonin reuptake inhibitors in youth was associated with an increased risk of type 2 diabetes mellitus, and this increased risk intensified further with the increasing duration of use and with the increasing dose. A secondary analysis also revealed that the risk of incident type 2 diabetes was most apparent in youth who used serotonin reuptake inhibitors for longer durations AND in greater daily doses. (more…)
Alzheimer's - Dementia, Author Interviews, Biomarkers, JAMA, Personalized Medicine / 17.10.2017

MedicalResearch.com Interview with: Ingrid S. van Maurik, MSc Department of Neurology and Alzheimer Center Department of Epidemiology and Biostatistics Amsterdam Neuroscience VU University Medical Center Amsterdam, the Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: CSF and MRI biomarkers are increasingly used in clinical practice, but their diagnostic and prognostic value is not perfect. Furthermore, criteria do not specify how to deal with conflicting or borderline results, or how to take patient characteristics into account. Therefore, optimal use of these biomarkers in clinical practice remains challenging. As part of the ABIDE project, we constructed biomarker-based prognostic models (CSF, MRI and combined) that enable prediction of future Alzheimer’s disease, or any type of dementia, in individual patients with mild cognitive impairment. When using these models, any value can be entered for the variables, resulting in personalized probabilities with confidence intervals. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, OBGYNE / 17.10.2017

MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health. Bethesda, MD 20817 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gestational diabetes (GDM) is a common pregnancy complication. The American Heart Association identifies gestational diabetes as a risk factor for cardiovascular disease (CVD) in women, based on consistent evidence for the relationships between gestational diabetes and subsequent hypertension, dyslipidemia, type 2 diabetes, vascular dysfunction and atherosclerosis. Also, previous studies identify GDM as a risk factor for intermediate markers of CVD risk; however, few are prospective, evaluate hard cardiovascular disease end points, or account for shared risk factors including body weight and lifestyle. (more…)
Author Interviews, ENT, JAMA, Stanford, Surgical Research / 12.10.2017

MedicalResearch.com Interview with: David Schoppy, MD PhD Resident, Division of Head and Neck Surgery Department of Otolaryngology Stanford University School of Medicine Stanford, Palo Alto, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type). This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery - achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached. This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs. (more…)
Author Interviews, Cost of Health Care, JAMA, PTSD / 06.10.2017

MedicalResearch.com Interview with: Gregory H. Cohen, MPhil, MSW Statistical Analyst Department of Epidemiology School of Public Health Boston University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy. Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care. Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. (more…)
Author Interviews, Dermatology, JAMA, Melanoma, Surgical Research / 05.10.2017

MedicalResearch.com Interview with: Adewole Adamson, MD, MPP Department of Dermatology UNC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgery is the primary intervention for the treatment of melanoma. Little is known about how delays for surgery, defined as the time between diagnosis and surgical treatment, among melanoma patient differ by insurance type. After adjustment of patient-level, provider-level, and tumor-level factors we found that Medicaid patients experience a 36% increased risk of delays in surgery for melanoma. These delays were 19% less likely in patients diagnosed and 18% less likely in patients surgically treated by dermatologists. Non-white patients also had a 38% increased risk of delays. (more…)
Author Interviews, Clots - Coagulation, Genetic Research, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Anne R. Bass, MD Associate Professor of Clinical Medicine Weill Cornell Medical College Rheumatology Fellowship Program Director Hospital for Special Surgery New York, NY 10021 MedicalResearch.com: What is the background for this study? Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient. In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Marc D. Basson, MD, PhD, MBA Professor of Surgery, Pathology, and Biomedical Science Senior Associate Dean for Medicine and Research University of North Dakota School of Medicine & Health Sciences Grand Forks, ND 58202  MedicalResearch.com: What is the background for this study? What are the main findings? Response: I and other surgeons have previously had the experience of caring for patients with appendicitis who had recently undergone colonoscopy, and wondered if there might be a connection.  However, colonoscopy and appendicitis are both common events, and so it would be difficult to tell whether they are linked or just coincidences from scattered occurrences. After obtaining appropriate regulatory approvals, we identified almost 400,000 veterans from the US Department of Veterans Affairs database who had undergone screening colonoscopy and compared their rates of appendectomy and acute appendicitis in the week following colonoscopy to rates of appendectomy and appendicitis over each of the following 51 weeks.  We asked the question in several different ways and verified our results by examining surgical and pathology reports.  Depending on how the question was asked and appendicitis or appendectomy defined, rates of appendectomy and appendicitis were clearly 4-9 times higher in the first week after diagnostic colonoscopy.  This wasn’t true when we asked whether appendectomy was more common after several other procedures that also required sedation and contact with the medical system. (more…)