Author Interviews, Brigham & Women's - Harvard, Cancer Research, Dermatology, JAMA / 07.07.2017 Interview with: Dr. Chrysalyne D. Schmults, MD, MSCE Associate Professor of Dermatology, Harvard Medical School Director, Mohs and Dermatologic Surgery Center and Mr. Pritesh S. Karia, MPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Dermatology Brigham and Women's Faulkner Hospital Harvard Medical School, Boston, Massachusetts Jamaica Plain, MA 02130-3446 What is the background for this study? Response: Perineural nerve invasion (PNI) is a well-recognized risk factor for poor prognosis in patients with cutaneous squamous cell carcinoma (CSCC). Most cases of CSCC with PNI are identified on histologic examination at the time of surgery and the patient has no clinical symptoms or radiologic evidence of PNI. These cases are classified as incidental PNI (IPNI). However, some patients with PNI present with clinical symptoms and/or radiologic evidence of PNI. These cases are classified as clinical PNI (CPNI). A few studies have shown differences in disease-related outcomes between CSCC patients with IPNI and CPNI but consensus regarding adjuvant treatment and detailed guidelines on follow-up schedules have not yet materialized. (more…)
Author Interviews, Cancer Research, Dermatology, JAMA, University of Pennsylvania / 06.07.2017 Interview with: Mackenzie R. Wehner, MD, MPhil Department of Dermatology University of Pennsylvania Philadelphia, PA What is the background for this study? Response: For some diseases, we have national registries, in which information about every person with that disease is entered for research purposes. For other diseases, unfortunately, we do not have such registries. There are growing opportunities to use information like internet searches to better understand behaviors and diseases, however. Our study was a proof-of-concept: we aimed to find out whether internet searches for diseases correlated with known incidence (how many people are diagnosed with the disease) and mortality (how many people die of the disease) rates. E.g. does the number of people who searched 'lung cancer' online correlate with the number of people who we know were diagnosed with or who died of lung cancer during that same time period? This is important to know if researchers in the future want to use internet search data for diseases where we lack registry information. (more…)
Author Interviews, Depression, JAMA / 06.07.2017 Interview with: Robb B. Rutledge, PhD Max Planck University College London Centre for Computational Psychiatry and Ageing Research University College London London, England What is the background for this study? What are the main findings? Response: Depression is associated with deficits in how the brain responds to rewards, something the neurotransmitter dopamine is strongly implicated in. Dopamine represents what is called a reward prediction error, the difference between experienced and predicted reward. This error signal is used for learning. For example, if the outcome of a decision is better than expected, you can update your expectations using this error signal and you should expect more next time. Previous research has shown that depression reduces these signals in the brain when people are learning about the world around them. We designed a task where participants did not have to learn anything during the experiment and we found that in this situation reward prediction error signals were not affected by depression. The signals we measured in the ventral striatum, a brain area with a lot of input from the dopamine neurons, looked the same in depressed and non-depressed individuals. We also found that the emotional impacts of reward prediction errors were similar in depressed and non-depressed individuals when we eliminated the need for learning during the task in both the lab and using a smartphone experiment with 1833 participants. (more…)
Author Interviews, JAMA, Pediatrics / 06.07.2017 Interview with: Seetha Shankaran, M.D. Professor, Neonatology Wayne State University School of Medicine What is the background for this study? What are the main findings? Response: The study was performed because infants with moderate or severe hypoxic-ischemic encephalopathy (abnormal neurological exam within 6 hours of birth due to lack of blood and oxygen supply to the brain at birth) have rates of death or survival with disability that were still high in spite of current intensive care including hypothermia. Whole-body hypothermia, cooling the infant for 72 hours at a depth of 33.5°C that was performed by the Neonatal Research Network funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development was the first trial of this therapy in the USA. We found that hypothermia therapy did decrease the rate of death or survival with disability from 62 to 44%. Since 44% is still high we wanted to see if longer cooling or deeper cooling or both would reduce this rate. This was a randomized controlled clinical trial to examine whether longer cooling or deeper cooling or both reduced the rate of death or survival with disability among full term neonates with hypoxic-ischemic encephalopathy. The study lasted from October of 2010 to January 2016. 364 infants were enrolled. Neonates were randomly assigned to 4 groups of cooling therapy and the major findings were that neither longer cooling nor deeper cooling nor both were more superior to cooling for 72 hours at 33.5°C. Our results were surprising because at the time we planned this study there were reports from animal model studies that longer/deeper cooling were more protective to the brain. (more…)
Author Interviews, Electronic Records, JAMA, UCSF / 05.07.2017 Interview with: Neda Ratanawongsa, MD, MPH Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network Associate Professor, Division of General Internal Medicine UCSF Center for Vulnerable Populations Physician, Richard H. Fine People's Clinic (RHPC) Zuckerberg San Francisco General Hospital San Francisco, CA 94110 What is the background for this study? What are the main findings? Response: U.S. federal incentives allowed many safety net healthcare systems to afford fully functional electronic health record systems (EHRs). Although EHRs can help clinicians provide care to vulnerable populations, clinicians may struggle with managing the EHR workload, particularly in resource-limited settings. In addition, clinicians’ use of EHRs during clinic visits may affect how they communicate with patients. There are two forms of EHR use during clinic visits.  Clinicians can multitask, for example, by ordering laboratory tests while chatting with a patient about baseball.  However, like distracted driving, using EHRs while talking with increases risks – in this case, the risk of errors in patient-provider communication or in the EHR task. Alternatively, clinicians can use EHRs in complete silence, which may be appropriate for high-risk tasks like prescribing insulin. However, silence during visits has been associated with lower patient satisfaction and less patient-centered communication. So we studied how primary and specialty care clinicians used EHRs during visits with English- and Spanish-speaking patients in a safety net system with an EHR certified for Centers for Medicare & Medicaid Services meaningful use incentive programs. We found that multitasking EHR use was more common than silent EHR use (median of 30.5% vs. 4.6% of visit time). Focused patient-clinician talk comprised one-third of visit time. We also examined the transitions into and out of silent EHR use. Sometimes clinicians explicitly stated a need to focus on the EHR, but at times, clinicians drifted into silence without warning. Patients played a role in breaking silent EHR use, either by introducing small talk or by bringing up their health concerns. (more…)
Author Interviews, Diabetes, JAMA, Pharmacology / 05.07.2017 Interview with: Wendy Lane MD Director of Clinical Research Mountain Diabetes and Endocrine Center Asheville, NC What is the background for this study? What are the main findings? Response: The SWITCH1 trial was the first double blinded insulin trial to compare the rate of severe, nocturnal severe and symptomatic blood glucose-confirmed hypoglycemia between two basal insulins, insulin glargine U100 and insulin degludec U100, in patients with type 1 diabetes. The trial design (double blinded crossover treat-to-target) eliminated any bias in the results, which showed clear-cut reductions in all categories of hypoglycemia with insulin degludec compared to insulin glargine. Severe hypoglycemia has dangerous and greatly feared consequences including cognitive impairment, seizures, coma and death, and it is the main barrier to effective use of insulin in the treatment of type 1 diabetes. Insulin degludec, which was shown to reduce the risk of hypoglycemia compared to insulin glargine in the SWITCH1 trial, should be viewed by clinicians as an advancement in insulin therapy which will increase its safety and improve the quality of life of our patients with type 1 diabetes. (more…)
Author Interviews, CDC, Exercise - Fitness, JAMA / 04.07.2017 Interview with: Emily Neusel Ussery, MPH PhD Epidemiologist, Physical Activity and Health Branch CDC What is the background for this study? What are the main findings? Response: Walking is an easy way for most people to start and maintain a physically active lifestyle. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities identifies walking as an important public health strategy to increase physical activity levels in the U.S. A previous report found that the percentage of adults who reported walking for transportation or leisure increased by 6 percentage points between 2005 and 2010, but it is unknown if this increase has continued. This report examined trends in the proportion of U.S. adults who reported walking for transportation or leisure for at least one 10-minute period in the past week, using nationally representative data from the 2005, 2010, and 2015 National Health Interview Surveys. We also examined differences in walking trends by sociodemographic characteristics. If you take walking seriously, make sure you invest in some custom boots to make sure you don't damage your feet. (more…)
Author Interviews, JAMA, Pain Research / 04.07.2017 Interview with: Esther Maas, PhD Postdoctoral Research Fellow Partnership for Work, Health and Safety School of Population and Public Health University of British Columbia Vancouver, BC What is the background for this study? Esther Maas, PhD Chronic low back pain causes more disability than any other condition, and has major social and economic consequences. Radiofrequency denervation is a commonly used treatment in pain clinics for a subgroup of patients with chronic low back pain resulting from anatomical structures such as facet joints, sacroiliac joint and intervertebral disc. Radiofrequency denervation uses an electric current that damages the innervating nerve of the painful structure. Despite its frequent application, until now, there was only very low quality and conflicting evidence for its effectiveness. The aim of this study was to establish whether radiofrequency denervation in addition to a standardized exercise program is more effective than the standardized exercise program alone in the selected subgroup of patients with chronic low back pain. (more…)
Abuse and Neglect, Hearing Loss, JAMA, Johns Hopkins / 04.07.2017 Interview with: Nicholas S. Reed, AuD Instructor | Department of Otolaryngology-Head/Neck Surgery PhD Candidate  | Graduate Training Program in Clinical Investigation Center on Aging and Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health What is the background for this study? What are the main findings? Response: Hearing Aids are medical devices regulated by the FDA which must be purchased through a licensed individual while personal sound amplification products (PSAPs) are essentially unregulated devices some of which can manipulate and increase sound similar to a hearing aid but cannot market themselves are devices for hearing loss. PSAPs can be purchased online or in the back of a store and are generally less expensive than hearing aids. We aimed to explore a select group of PSAPs to see if they helped someone with mild to moderate hearing loss improve speech understanding (i.e. ability to repeat back sentences) in the presence of mild background noise (think a lunch crowd at a restaurant) as well as a hearing aid. We selected four PSAP devices that were technologically strong (i.e. meet many standards a hearing aid might be asked to meet) and one PSAP that was technologically fairly poor (i.e. lots of sound distortion) after an in-house electroacoustic analysis of devices. Our hearing aid was selected because it was a popular choice at a university audiology clinic. Forty-two people completed the speech testing unaided (i.e. with no device) and then with each of the five PSAPs and one hearing aid (order of devices was randomized). We looked at improvement with the devices from unaided. We found that some PSAPs help people understand speech about as well as a hearing aid in this controlled environment while one PSAP actually hindered participants’ ability to understand speech due to sound distortion – imagine how difficult it can be when listening on a poor cell phone signal. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 29.06.2017 Interview with: Suzanne J. Baron, MD, MSc Saint Luke’s Mid America Heart Institute School of Medicine University of Missouri, Kansas City What is the background for this study? What are the main findings? Response: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis in patients at high and intermediate surgical risk.  Prior studies have demonstrated that both TAVR and surgical AVR (SAVR) results in substantial quality of life benefit in patients at high surgical risk. Whether these results applied to an intermediate risk population was unknown and so we performed a prospective study alongside the PARTNER 2A trial to compare both short- and long-term health status outcomes in intermediate-risk patients with AS treated with either TAVR or SAVR.   The analysis included 1833 patients (950 TAVR, 833 SAVR), who were evaluated at 1 month, 1 year and 2 years post procedure.  By 1 month, quality of life had improved in both the TAVR and SAVR groups, although the gain was significantly greater in patients treated with TAVR via the transfemoral approach as opposed to patients treated with SAVR or with TAVR via the transthoracic approach (i.e. direct aortic access or transapical access).   At 1 and 2 years, both TAVR (via either approach) and SAVR were associated with similarly large, clinically meaningful improvements from baseline in both disease-specific and generic health status scales at 2 years. (more…)
Author Interviews, JAMA, Urology / 28.06.2017 Interview with: Baoyan Liu, MD Guang’an Men Hospital China Academy of Chinese Medical Sciences Beijing, China What is the background for this study? What are the main findings? Response: The prevalence of stress urinary incontinence(SUI) is as high as 49% and varies according to the population studied and the definition of stress urinary incontinence. SUI causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. Yet, few effective therapies are available for treating stress urinary incontinence. In this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference. (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA, Stanford / 27.06.2017 Interview with: Alexander Sandhu, MD MS Cardiology Fellow Stanford University What is the background for this study? What are the main findings? Response: Millions of patients present to the emergency department with chest pain but most do not have lab or EKG findings that indicate the patient is having a heart attack. In patients without signs of a heart attack, stress testing is frequently used to determine the need for further workup and treatment. However, there is limited evidence regarding the benefit of stress testing in these patients. We evaluated how cardiac testing - stress testing and coronary angiography - in these low-risk patients was associated with clinical outcomes. We used a statistical approach that took advantage of the fact that testing is more available on weekdays than weekends. We found that testing was associated with more angiography and revascularization (coronary stenting or coronary artery bypass surgery) but was not associated with a reduction in future heart attacks. (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 22.06.2017 Interview with: David C. Grossman, M.D., M.P.H. US Preventive Services Task Force Chair Senior Investigator, Kaiser Permanente Washington Health Research Institute Senior Associate Medical Director, Market Strategy & Public Policy Kaiser Permanente Washington Physician, Washington Permanente Medical Group, Pediatrics What is the background for this recommendation? Response: Recognizing that obesity is a nation-wide health problem, affecting approximately 17% of 2-to 19-year-old children and adolescents in the U.S., the Task Force finalized its recommendation on screening for obesity in children and adolescents and the benefits and harms of weight management interventions. The Task Force found sufficient evidence to recommend screening for obesity in children and adolescents age 6 years and older and then offering or referring those who are found to be obese comprehensive, intensive behavioral interventions to manage their weight and improve overall health. What are the potential benefits and harms of early screening and intervention for obesity in children? Response: The Task Force found that intensive behavioral interventions for children and adolescents who have obesity can result in benefits of improvement in weight status for up to 12 months’ post-intervention. Additionally, the evidence indicated very little harm from screening and comprehensive, intensive behavioral interventions. This is due to likely minimal harms of using BMI (body mass index), the absence of reported harms of behavioral interventions, and the noninvasive nature of the programs. (more…)
Author Interviews, Biomarkers, Colon Cancer, JAMA / 19.06.2017 Interview with: Anastasia Katsoula, MD MSc Aristotle University of Thessaloniki Greece What is the background for this study? Response: Early detection of colorectal cancer (CRC) has proven to be effective in reduction of cancer-related mortality. Fecal immunochemical testing (FIT) has been recently advocated for population-based screening for CRC in average-risk individuals due to its high accuracy and potential for adherence, based on results from previous systematic reviews and meta-analyses in average-risk populations. However, the potential role of FIT for screening of subjects at increased risk for CRC has not yet been elucidated, hence colonoscopy is currently the only recommended screening option for subjects at increased risk of CRC. We performed a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in patientswith personal or familial history of CRC, using colonoscopy as the reference standard. (more…)
Addiction, Author Interviews, JAMA, Opiods, Pediatrics / 19.06.2017 Interview with: Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine Director, Urban Health and Advocacy Track, Boston Children’s Hospital and Boston Medical Center Associate Program Director, Boston Combined Residency Program in Pediatrics, Boston Medical Center What is the background for this study? What are the main findings? Response: Almost no data have been available on this topic to date.  A recent study showed that teens in subspecialty treatment for opioid addiction were significantly less likely than adults to receive a medication.  Our study was the first to comprehensively look across the health care system, including looking at adolescents and young adults diagnosed with opioid use disorder in outpatient clinics, emergency departments, and inpatient hospitals. We had three important findings.  First, looking at a large sample of 9.7 million adolescents and young adults between the age of 13 and 25 years, we found that the number of youth diagnosed with opioid use disorder increased six-fold from 2001 to 2014.  This is perhaps not surprising given the national opioid crisis we know to be occurring. Second, we found that only a minority of youth (1 in 4) received buprenorphine or naltrexone, the two medications available for opioid addiction that can be prescribed in usual medical settings.  These two medications are evidence-based and their use is recommended by the American Academy of Pediatrics.  Utilizing them is critical to ensure that we offer effective treatment early in the life course of addiction, which can help prevent the long-term harms of addiction. Third, we found significant differences in who received medications.  Whereas approximately 1 in 3 young adults in our study received a medication, only 1 in 10 of the 16- and 17-year-olds we studied received one, and among adolescents under 15 years of age, 1 in 67 received a medication.  Females were less likely than males to receive medications, as were black youth and Hispanic youth relative to white youth. (more…)
Author Interviews, ENT, Hearing Loss, JAMA, University of Michigan / 17.06.2017 Interview with: Aileen Wertz, MD Otolaryngology - Head and Neck Surgery University of Michigan What is the background for this study? What are the main findings? Response: The key finding of this study is: free, comprehensive audiologic care, including hearing aids and fitting, is feasible within a well-established free clinic model. We found that donated hearing aids and volunteer health care providers were able to run the clinic and that 20 patients have thus far been fit with hearing aids. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 15.06.2017 Interview with: Gregory Y. H. Lip, MD Professor of Cardiovascular Medicine University of Birmingham Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark National Institute for Health Research (NIHR) Senior Investigator. Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK Institute of Cardiovascular Sciences City Hospital Birmingham England UK What is the background for this study? What are the main findings? Response: The randomized clinical trials comparing non-Vitamin K antagonist oral anticoagulants (NOACs) vs warfarin largely focused on recruitment of high risk atrial fibrillation(AF) patients with >2 stroke risk factors, with only the trials testing dabigatran or apixaban including a minority of patients with 1 stroke risk factor. Despite this, regulatory approvals of all NOACs have been for stroke prevention in AF patients with ≥1 stroke risk factors. No difference between NOACs compared to warfarin in risk of ischemic stroke/systemic embolism, was seen but for ‘any bleeding’, this was lower for apixaban and dabigatran compared to warfarin. (more…)
Author Interviews, JAMA, Parkinson's / 15.06.2017 Interview with: Rajesh Pahwa MD Department of Neurology University of Kansas Medical Center, Kansas City, KS, What is the background for this study? What are the main findings? Response: Dyskinesia are one of the major unmet needs in Parkinson Disease patients. At the present time there are no approved medication for dyskinesia, however immediate release amantadine is used in PD patients with dyskinesia. ADS-5102 is a long acting, extended release capsule formulation of amantadine HCl administered once daily at bedtime. This study investigated the safety, efficacy and tolerability of ADS-5102 in Parkinson’s disease (PD) patients with levodopa-induced dyskinesia. This was a randomized, double-blind, placebo-controlled study of Parkinson’s disease patients with levodopa-induced dyskinesia. In total, 126 patients were randomized to placebo or 274 mg ADS-5102 administered orally at bedtime. ADS-5102 was associated with a significant reduction in dyskinesia at 12 weeks compared with placebo, as measured by the mean change in Unified Dyskinesia Rating Scale (treatment difference, –7.9; P =.0009). OFF time was significantly reduced in ADS-5102 patients compared to placebo (treatment difference -0.9 hours, p=.017). (more…)
Author Interviews, JAMA, Johns Hopkins, Outcomes & Safety / 14.06.2017 Interview with: Pranita Tamma, MD Assistant Professor Director, Pediatric Antimicrobial Stewardship Program Assistant Professor of Pediatrics Johns Hopkins Bloomberg School of Public Health Dr. Pranita D. Tamma Assistant Professor of Pediatrics Director, Pediatric Antimicrobial Stewardship Program The Johns Hopkins University School of Medicine What is the background for this study? What are the main findings? Response: A study examining the impact of antibiotics prescribed for nearly 1500 adult patients admitted to The Johns Hopkins Hospital found that adverse side effects occurred in a fifth of them, and that nearly a fifth of those side effects occurred in patients who didn’t need antibiotics in the first place. In the study, the researchers evaluated the electronic medical records of 1488 adults admitted to the general medicine services at The Johns Hopkins Hospital between September 2013 and June 2014. The patients were admitted for reasons ranging from trauma to chronic disease, but all received at least 24 hours of antibiotic treatment. The researchers followed patients for 30 days after hospital discharge to evaluate for the development of antibiotic-associated adverse events. To determine the likelihood that an adverse reaction was most likely due to antibiotics and to identify how many adverse reactions could be avoided by eliminating unnecessary antibiotic use, two infectious disease clinicians reviewed all of the data. (more…)
Author Interviews, Education, Heart Disease, JAMA, Social Issues / 14.06.2017 Interview with: Yasuhiko Kubota, MD, MPH Visiting Scholar Division of Epidemiology and Community Health School of Public Health University of Minnesota, Minneapolis, MN What is the background for this study? Response: Educational inequality is one of the most important socioeconomic factors contributing to cardiovascular disease. Since education is usually completed by young adulthood, educational inequality may affect risk of cardiovascular disease early in the life course. We thought it would be useful to calculate the lifetime risk of cardiovascular disease according to educational levels in order to increase public awareness of the importance of education. Thus, our aim was to evaluate the association of educational attainment with cardiovascular disease risk by estimating the lifetime risks of cardiovascular disease using a US. biracial cohort. Furthermore, we also assessed how other important socioeconomic factors were related to the association of educational attainment with lifetime risk of cardiovascular disease. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, JAMA, Pediatrics, Surgical Research / 13.06.2017 Interview with: Mackenzie M. Herzog, MPH PhD Candidate, Injury Epidemiology The University of North Carolina at Chapel Hill What is the background for this study? Response: In 1999, a study by Arendt et al. reported that women were more likely to tear their ACL than men while playing the same sport. Since then, numerous studies have investigated this sex difference in ACL injury, and many prevention programs targeting youth athletes have been developed and tested. Although randomized trials have demonstrated the value of injury prevention programs in reducing the risk of ACL injury, the overall impact of these programs has not been examined in the general population. Our study investigated the net impact of research and prevention efforts over nearly 20 years in reducing ACL injuries by assessing time trends of ACL reconstruction, a consequence of ACL injury, among commercially-insured individuals in the United States. (more…)
Author Interviews, Cancer Research, Geriatrics, JAMA, Johns Hopkins / 12.06.2017 Interview with: Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine What are the main findings? Response: A lot of cancer screenings are not expected to save lives until up to 10 years later; however, the side effects of the test happen right away. Because of this, clinical guidelines have recommended against routine screening for those patients who will not live long enough to benefit but may experience the potential harm of the test in the short term. However, many patients with limited life expectancy still receive screening and clinicians are worried about how patients would react if they recommended that patients stop screening. This research is important because it is the first study that explores how patients think about the decision of stopping cancer screening and how patients want to talk to their doctors about this issue. Understanding patient perspectives would help improve screening practices and better align recommendations and patient preference. (more…)
Author Interviews, JAMA, Nutrition, Stanford / 12.06.2017 Interview with: Bradley P. Turnwald MS Stanford University, Department of Psychology Stanford, California What is the background for this study? Response: This study tested an intervention to encourage people to consume healthier foods. Encouraging healthy eating is difficult because many people think that healthy foods do not taste good, and most people prioritize taste over health when choosing what to eat. In fact, lab studies suggest that people rate foods as less tasty, less enjoyable, and less filling when they are labeled as healthy compared to when the same foods are not labeled as healthy. A recent study from the Stanford Mind & Body Lab published last month in Health Psychology showed that healthy foods are even described with less tasty, exciting, and indulgent descriptions compared to standard items on the menus of top-selling chain restaurants in America. This led us to ask the question, what if healthy foods were described with the tasty and indulgent descriptions that are typically reserved for the more classic, unhealthy foods? (more…)
Author Interviews, JAMA, Surgical Research / 12.06.2017 Interview with: Virginia Sun, RN, PhD Assistant Professor Division of Nursing Research and Education Department of Population Sciences Cancer Control and Population Sciences Program City of Hope Duarte, CA 91010 What is the background for this study? Response: Surgery is one of the most effective and important treatment strategies for cancer. Surgical procedures are by definition invasive, and patients are at risk for unpleasant symptoms, impaired functional status, and poor quality of life. Traditionally, mortality has been the sole measure to assess the risk of most surgical procedures. However, as surgical mortality has sharply declined, focus has shifted toward other endpoints, including patient-centered outcomes. There are critical gaps to assessing and integrating patient-centered outcomes into the surgical oncology workflow. We conducted this proof-of-concept study to assess the feasibility and acceptability of a wireless monitoring approach for patient-centered outcomes before and after a major abdominal cancer surgery. (more…)
Author Interviews, Breast Cancer, JAMA, Surgical Research / 10.06.2017 Interview with: Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan Kettering What is the background for this study? Response: Although we know that bigger surgery does not result in better patient outcomes in breast cancer, since 2005 rates of lumpectomy have been decreasing accompanied by an increase in bilateral mastectomy for unilateral cancer. High rates of second surgery after initial lumpectomy are one deterrent for patients. In 2013 the SSO and ASTRO developed an evidence based consensus guideline endorsing no ink on tumor as the standard negative margin width for women with stage 1 and 2 cancer having breast conserving surgery with whole breast irradiation. The purpose of our study was to examine time trends in the use of additional surgery after lumpectomy before and after guideline dissemination and to determine the impact of these trends on final rates of breast conservation. (more…)
Author Interviews, JAMA, Karolinski Institute, Pharmacology, Schizophrenia / 09.06.2017 Interview with: Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden What are the limitations of existing analyses of the comparative effectiveness of antipsychotics? Response: It has remained unclear if there are clinically meaningful differences between antipsychotic treatments in relapse prevention of schizophrenia, due to the impossibility of including large unselected patient populations in randomized controlled trials, and due to residual confounding from selection biases in observational studies. (more…)
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity, Social Issues / 09.06.2017 Interview with: Dr. Ayodele Odutayo MD MSc DPhil(pending) Centre For Statistics in Medicine, University of Oxford Resident Physician (PGY1), Post-Doctoral Fellow, Applied Health Research Centre St. Michael’s Hospital, University of Toronto What is the background for this study? What are the main findings? Response: Previously published studies have reported increasing gaps in life expectancy among adults belonging to different socioeconomic strata and suggested that much of this gap was mediated through behavioural and metabolic risk factors. In this study, we found that from 1999-2014, there was an increasing gap in the control of cardiovascular risk factors between high income adults compared to adults with incomes at or below the poverty line. The proportion of adults at high cardiovascular risk (predicted risk of a cardiovascular event ≥20%), the mean systolic blood pressure and the percentage of current smokers decreased for high income adults but did not change for adults with incomes at or below the poverty line. Notably, the income disparity in these cardiovascular risk factors was not wholly explained by access to health insurance or educational attainment. Trends in the percentage of adults with diabetes and the average total cholesterol level did not vary by income. (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 07.06.2017 Interview with: Elsie M. Taveras, MD, MPH Ofer and Shelly Nemirovsky MGH Research Scholar Chief, Division of General Academic Pediatrics, Department of Pediatrics Mass General Hospital for Children Professor of Pediatrics, Harvard Medical School Professor in the Department of Nutrition, Harvard T.H. Chan School of Public Health Boston, MA What is the background for this study? Response: We designed this study to test the effectiveness of two interventions that linked clinical and community approaches in improving childhood body mass index (BMI) and obesity prevalence. Another important question we set out to understand was whether there were outcomes aside from BMI and obesity that mattered most to families of children with obesity. (more…)
Author Interviews, JAMA, Lifestyle & Health, OBGYNE, Weight Research / 07.06.2017 Interview with:   Professor Helena Teede MBBS, FRACP, PhD Executive Director Monash Partners Academic Health Research Translation Centre Director Monash Centre for Health Research and Implementation Monash University What is the background for this study? What are the main findings? Response: Reproductive aged women are gaining weight rapidly both before and during pregnancy. Here in 1.3 million pregnancies internationally we show that almost 3 in 4 have unhealthy weight gain (half with excess weight gain and one quarter with inadequate gain) What should readers take away from your report? Response: For women establish your healthy weight for your height and try to stay within this for better fertility, pregnancy and for your and your child's health. Regardless of your starting weigh,  aim to gain within targets in pregnancy. Seek help to do so. For health professionals: unhealthy weight gain in pregnancy is now the norm, we must monitor women in pregnancy wand support them to gain healthy weight for better health outcomes. Weighing is not enough with health professionals needing skills in healthy conversations and support strategies for women. For governments and policy makers this life stage around pregnancy is an optimal time to tackle obesity prevention and is targeted by WHO. (more…)
Author Interviews, Cost of Health Care, JAMA, Nursing, University of Pittsburgh / 06.06.2017 Interview with: Kristin Ray, MD, MS Assistant Professor Health Policy Institute University of Pittsburgh School of Medicine What is the background for this study? What are the main findings? Response: We were interested in understanding how nurse practitioners and physician assistants are working with specialist physicians to provide specialty care. Much has been described and studied about nurse practitioners and physician assistants providing primary care, but the literature about their role in specialty care is more sparse. There have been many concerns over time about the supply of specialist physicians, heightening our interest in the role of nurse practitioners and physician assistants in working with specialist physicians. We focused on examining whether care to physician specialist's patients by nurse practitioners and physician assistants has increased over time as well as examining characteristics of patients seen by nurse practitioners and physician assistants. We found that visits with NPs and PAs for specialty care have increased over time, but remains a small fraction of specialty care overall. (more…)