Author Interviews, Cost of Health Care, Heart Disease, JAMA / 17.02.2017 Interview with: James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine What is the background for this study? What are the main findings? Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation” (more…)
Author Interviews, JAMA, Surgical Research / 17.02.2017 Interview with: Brian J. F. Wong, MD, PhD Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology–Head and Neck Surgery Beckman Laser Institute and Medical Clinic Department of Biomedical Engineering University of California, Irvine What is the background for this study? What are the main findings? Response: Research in facial attractiveness is difficult because of the inherent subjectivity of rating. Most people can look at a face and instinctively tell you whether that face is attractive or not, by subconsciously picking up on biologic cues like fertility, coloration, and proportions. (more…)
Author Interviews, Depression, JAMA, OBGYNE / 17.02.2017 Interview with: Lisa Underwood, PhD Research Fellow| Centre for Longitudinal Research Growing Up in New Zealand | Who are Today’s Dads? School of Population Health, Faculty of Medical & Health Sciences University of Auckland  Auckland What is the background for this study? What are the main findings? Response: This study is part of the contemporary, longitudinal study Growing Up in New Zealand, which is tracking the development of more than 6000 children born in 2009 and 2010. In previous reports we investigated antenatal and postnatal depression symptoms among the mothers of our cohort children. In this study we looked at the partners of those mothers to explore whether men and women have different risks for depression in each perinatal period. Our main findings were that expectant fathers were at risk if they felt stressed or were in poor health. Elevated depression symptoms following their child’s birth, were also linked to social and relationship problems. The strongest predictor of postnatal paternal depression was no longer being in a relationship with the child’s mother. (more…)
Allergies, Author Interviews, Immunotherapy, Imperial College, JAMA / 16.02.2017 Interview with: Stephen R. Durham, MD Imperial College, London, and Royal Brompton and Harefield Hospitals NHS Foundation Trust London, United Kingdom What is the background for this study? What are the main findings? Response: Allergic rhinitis affects 1 in 4 the UK population and may compromise sleep and work/school performance and be associated with bronchial asthma. When nasal steroids and antihistamines do not work or cause side effects, allergen immunotherapy is an alternative. Immunotherapy using high doses of grass pollen allergen as monthly injections or daily tablets under the tongue are highly effective. Treatment for 3 years not only gives sustained improvement on treatment but also long-term benefits and disease remission for at least 2-3 years after stopping treatment. This single centre study at Imperial College London and Royal Brompton Hospital London included 106 adults with severe Hayfever followed up for 3 years, 2 years on treatment and 1 year after stopping treatment. In this double-blind trial, 3 randomised groups took sublingual immunotherapy, subcutaneous immunotherapy and placebo treatment. 92 completed the trial. Results showed that 2 years treatment with both modalities did not result in persistent benefit at year 3, although the researchers found that both treatments were effective compared to placebo during years 1 and 2. (more…)
Author Interviews, Baylor College of Medicine Houston, Breast Cancer, Dermatology, JAMA / 15.02.2017 Interview with: Julie Rani Nangia, M.D. Assistant Professor Breast Center - Clinic Baylor College of Medicine Houston, TX, US What is the background for this study? What are the main findings? Response: This study was fueled by the feedback from women undergoing chemotherapy treatment for breast cancer. One of the most distressing side effects of their treatment is hair loss. It robs them of their anonymity and, for many, their femininity. Scalp cooling therapy has been available for a few years in the UK, but has faced obstacles in FDA clearance in the states. The makers of the scalp cooling device used in this study, Paxman Coolers Ltd., have a personal connection to breast cancer, as the company founder’s wife passed away from the disease. This was the first randomized scalp cooling study, and it shows that the Paxman Hair Loss Prevention System is an effective therapy for reducing chemotherapy-induced alopecia. The results show a 50% increase in hair preservation of grade 0 or 1, meaning use of a scarf or wig is not necessary, in patients who received the scalp cooling therapy as opposed to those who did not. (more…)
ALS, Author Interviews, Genetic Research, JAMA / 15.02.2017 Interview with: Prof. Dr. Christine Van Broeckhoven PhD DSc Professor in Molecular Biology and GeneticsUniversity of Antwerp Science Director, VIB Center for Molecular Neurology Research Director, Laboratory for Neurogenetics, Institute Born-Bunge Senior Group Leader, Neurodegenerative Brain Diseases University of Antwerp and Dr. Sara Van Mossevelde, MD Center for Molecular Neurology, VIB Institute Born-Bunge, University of Antwerp Department of Neurology and Memory Clinic Hospital Network Antwerp Middelheim and Hoge Beuken Antwerp, Belgium What is the background for this study? What are the main findings? Response: Patients with frontotemporal dementia (FTD) and/or amyotrophic lateral sclerosis (ALS) and a C9orf72 repeat expansion present with highly variable onset ages of disease. In the Belgian patient cohort the onset ages ranged from 29 to 82 years of age. This high variability suggested the influence of modifying factors on disease expression. As in other repeat expansion diseases, repeat length is the prime candidate as genetic modifier. In a molecular study (Gijselinck et al., Molecular psychiatry 2016), we were able to provide evidence for an inverse correlation of repeat length with onset age in affected parent – affected children in a C0orf72 families. Also, the degree of methylation of the C9orf72 repeat correlated with repeat size. In this clinical study of affected parent – affected children pairs we provided additional evidence for the occurrence of disease anticipation in C9orf72 pedigrees by analyzing age at onset, disease duration and age at death in successive generations. Within 36 C9orf72 pedigrees with available age data of patients in two to four generations, we observed a significant decrease in age at onset across successive generation while no generational effect was seen on disease burden, disease duration or age at death. (more…)
Author Interviews, JAMA, Pain Research / 14.02.2017 Interview with: Dan Cherkin PhD Emeritus Senior Investigator Group Health Research Institute Seattle, WA 98101 What is the background for this study? What are the main findings? Response: We previously reported the results of a randomized trial examining the effectiveness of Mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) for persons with chronic low back pain (Cherkin et al, JAMA, March 22, 2016). The current report examines whether the relative effectiveness of these approaches compared with usual care that we found after one year were still evident after two years. We found that there was little decrease in the magnitude of the effects of both MBSR and CBT between one and two years, but the two-year outcomes were statistically significant only for chronic low back pain. As previously reported for outcomes up to one year, there were no significant differences in outcomes between CBT and MBSR. (more…)
Author Interviews, JAMA, Pain Research, Radiation Therapy / 14.02.2017 Interview with: Rachel McDonald, MD(C) Department of Radiation Oncology Odette Cancer Centre Sunnybrook Health Sciences Centre Toronto, Ontario, Canada What is the background for this study? What are the main findings? Response: Radiation treatment has been demonstrated in numerous studies to provide effective and timely pain relief to those suffering from painful bone metastases. However, as a palliative treatment, the goal should be not only to reduce pain but also to maintain and even improve quality of life. To date, studies have not effectively demonstrated this; most of these have included either small sample sizes or utilize questionnaires that aren’t tailored to the palliative cancer population with bone metastases. We aimed to determine how soon after radiation treatment one can expect an improvement in quality of life. Our results showed that patients who had a pain response to radiation also had significantly greater improvements in pain, pain characteristics, functional interference, and psychosocial aspects of well-being at day 10 post-treatment. Further improvements in most domains of quality of life were found for responders at day 42. (more…)
Author Interviews, Heart Disease, JAMA, Neurological Disorders, Stroke / 13.02.2017

  Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands Interview with: Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands What is the background for this study? Response: Cerebral microinfarcts (CMIs) are defined as small (usually <1 mm) regions of ischemic change found in the brain which are not readily visible on gross examination or on standard 1.5-T magnetic resonance imaging (MRI). On microscopy they appear as foci of neuronal loss, gliosis, pallor, or cysts. Previous post mortem studies have shown that the presence of CMIs is relatively common in elderly individuals without dementia (24%) but more common in patients diagnosed with Alzheimer disease (43%) or vascular dementia (62%). Whilst a single CMI is likely to be “silent” as the region of brain affected is probably too small to produce symptoms or neurologic deficits, however, as a large number of CMIs exist in many individuals, especially in the cerebral cortex and watershed areas, the overall effect has clinical importance – as shown by neuropathologic studies which demonstrate an important role of CMIs in cognitive dysfunction and dementia. However in vivo studies have been hampered by the inability to detect CMIs reliably on neuroimaging, leading to CMIs being termed “invisible” during life. The advent of high spatial-definition 7-T MRI enabled the identification of cortical  Cerebral microinfarcts in-vivo and importantly a study that directly compared 7-T and 3-T MRIs in the same patients reported that 3-T MRI detected about 1/3 of the lesions found on 7-T MRIs, suggesting that 3-T MRIs, which are more accessible than 7-T, may be able to detect larger cortical CMIs with a lower limit of approximately 1 mm in diameter. Our group has made major contributions recently on the clinical associations of 3T MRI detected cortical CMIs in patients from memory clinics as well as in community based subjects. Associations were found with age, vascular risk factors, other MRI markers of cerebrovascular disease as well as cognition. However, the causes of CMIs remain unclear and may be heterogeneous with microembolism, microthrombosis, and foci of inflammation as possible causative factors. (more…)
Author Interviews, Cancer Research, Immunotherapy, JAMA / 12.02.2017 Interview with: Michael C. Heinrich, MD Professor of Medicine and Cell and Developmental Biology Oregon Health & Sciences University What is the background for this study? What are the main findings? Response: Prior to 2000, there were no effective medical treatments for advanced GI stromal tumor and patients faced an average life expectancy of 18 months or less.  In our study of the  long-term treatment results using imatinib (Gleevec),  we found that approximately 7% of patients were still on front-line therapy at 10 years without any evidence of tumor progression.  More importantly, the estimated 10 year survival was 23%.   Progression-free and overall survival rates were significantly higher for patients with KIT exon 11-mutant GIST when compared with patients with KIT exon 9-mutant or “wild-type” GIST (no KIT/PDGFRA mutations). (more…)
Author Interviews, Cancer Research, JAMA, MD Anderson, Orthopedics / 12.02.2017 Interview with: Gabriel N. Hortobagyi, MD, FACP, FASCO Professor, Department of Breast Medical Oncology Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston, TX 77230-1439 What is the background for this study? What are the main findings? Response: Bisphosphonates have been commercially available for several decades as supportive care for patients with bone metastases. They reduce the frequency and severity of bone-related complications. While the optimal dose and short-term scheduling of zoledronic acid (and previously, pamidronate) have been determined, there has been no research to determine how long these drugs need to be maintained nor the optimal dose and schedule beyond the first year of therapy. These questions are particularly important for this family of drugs, since they are incorporated into bone and not excreted from the body for many years. We set out to determine whether a reduction in the frequency of administration of zoledronic acid (every 12 weeks) was able to maintain the therapeutic efficacy of this intervention when compared to the “standard” schedule of administration (every 4 weeks). It was a prospective, randomized, non-inferiority trial that recruited patients with metastatic breast cancer with bone metastases and who had previously received 9 or more doses of zoledronic acid or pamidronate. The primary endpoint was the proportion of patients with one or more skeletal-related events. Four hundred and sixteen patients were randomized in a 1:1 ratio. The two groups were comparable at baseline. After the first year of follow-up, there was no statistically significant difference in SRE rate between the two arms, confirming the non-inferiority fo the every-12-week schedule of zoledronic acid. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 12.02.2017 Interview with: Frederick L. Ruberg, MD Director, Cardiovascular Medicine Fellowship Training Program Director, Pilot Grants Program, Boston University Clinical and Translational Science Institute Director, Advanced Cardiac Imaging Program Section of Cardiovascular Medicine Department of Medicine Department of Radiology Boston Medical Center What is the background for this study? What are the main findings? Response: ATTR cardiac amyloidosis is an under-recognized cause of congestive heart failure in older adults that results from the deposition of misfolded TTR protein in the heart. One cause of ATTR cardiac amyloidosis is a genetic abnormality, inherited from an affected patient’s parent, that causes the protein TTR to misfold. The most common genetically inherited cause of ATTR amyloidosis in the US is called Val122Ile (V122I), named for the specific mutation in the TTR gene, that is seen in approximately 3.5% of US African Americans. ATTR cardiac amyloidosis was once an untreatable disease, but now new drugs are in different stages of clinical trial testing. Thus, recognition is important to get patients on the right treatments. One of the principal reasons why the disease is under-recognized is that doctors don’t have proven and available diagnostic tests that can be applied in the outpatient clinic. This study demonstrated that a new point-of-care diagnostic test, using measurement of a blood protein called retinol binding protein 4 (RBP4) and other standard of care test information, can accurately diagnose ATTR cardiac amyloidosis. We demonstrated the validity of this test in two separate cohorts of patients with proven ATTR cardiac amyloidosis due to the Val122Ile mutation and control patients with heart failure but without amyloidosis. (more…)
Author Interviews, End of Life Care, JAMA / 08.02.2017 Interview with: Nathan A. Gray, M.D. Duke Palliative Care Durham, NC 27710 What is the background for this study? What are the main findings? Response: The estimated number of undocumented immigrants living in the United States has been stable in recent years, but lengths of residence in the country are rising. This aging population of undocumented immigrants can expect to face an increasing burden of chronic disease and end-of-life needs, but may experience challenges in obtaining hospice care in the last months of life as many are uninsured and none are eligible for the Medicare Hospice Benefit. While hospice agencies do provide charity care, little is known about hospice agency approaches to caring for undocumented immigrants. We surveyed a national sample of hospice agencies and found that many hospice agencies do not enroll undocumented immigrants or place restrictions on the number enrolled. More than half of agencies sampled had received requests for enrollment of undocumented immigrants in the past year. Offering unrestricted enrollment was more common among larger, not-for-profit hospices in our sample. (more…)
Author Interviews, Diabetes, Genetic Research, JAMA, Race/Ethnic Diversity / 07.02.2017 Interview with: Mary E. Lacy, MPH Department of Epidemiology Brown University School of Public Health Providence, RI What is the background for this study? What are the main findings? Response: Hemoglobin A1c (A1C) is a blood test that is used to screen for and monitor diabetes. It measures average blood sugar control over the past 2-3 months. A person with sickle cell trait is a carrier for sickle cell disease but often doesn’t have any clinical symptoms. African Americans are more likely than Whites to have diabetes and are more likely to have sickle cell trait. In this article we examined if A1C can be interpreted in the same way in people with and without sickle cell trait. We found that, despite similar results on other measures of blood sugar control, people with sickle cell trait had lower A1C results than people without sickle cell trait. This means that A1C may underestimate diabetes risk in people with sickle cell trait. We also found that, when using standard A1C cutoffs to screen for disease prevalence, we identified 40% fewer cases of prediabetes and 48% fewer cases of diabetes in individuals with sickle cell trait than in those without sickle cell trait. To me, this finding really underscores the potential clinical impact that the observed underestimation of A1C in those with sickle cell trait could have. (more…)
Author Interviews, Depression, JAMA / 07.02.2017 Interview with: Prof. Dr. phil. Elisabeth Schramm Klinik für Psychiatrie und Psychotherapie What is the background for this study? What are the main findings? Response: Chronic depression is a highly prevalent and disabling disorder. As compared to acute episodically depressed patients, chronic depressives benefit less from psychological and pharmaceutical treatment. Prior investigations suggest that these patients need longer treatment duration for symptom improvement. In this randomized clinical trial including 268 adults with early onset chronic depression not taking antidepressant medication, patients treated with a disorder-specific psychological treatment (Cognitive Behavioral Analysis System of Psychotherapy; CBASP) reported significantly less severe depressive symptoms after 20 and 48 weeks as compared to a nonspecific supportive therapy. CBASP patients were also more likely to reach remission and showed significant advantages in global functioning and quality of life. (more…)
Addiction, Author Interviews, JAMA / 07.02.2017 Interview with: Lin Lu, M.D. Ph.D. Director/Professor, Institute of Mental Health and Peking University Sixth Hospital Director/Professor, National Institute on Drug Dependence, Peking University Beijing China What is the background for this study? Response: Nicotine addiction is the leading preventable cause of mortality, and causes over 6 million deaths each year. One fundamental mechanism that maintain smoking relapse in smokers is the persistence of memories of both nicotine reward and nicotine-associated conditioned stimulus (CS, e.g. ashtray,cigarette lighters, etc.).Preclinical studies suggest that the drug reward memories can be reactivated by nicotine-associated CS undergo an unstable stage, named memory reconsolidation, and that pharmacological or behavioral manipulations that interfere with reconsolidation inhibit subsequent drug relapse. However, most of the translational studies targeting reconsolidation stages of the drug reward memory have not been successful.One important reason is that when participants were exposed to nicotine-associated CS to induce memory reconsolidation, the pharmacological or behavioral manipulations only interfere with the reconsolidation of memories selectively associated with the reactivated CS, without affecting other CSs. However, in real life, smoking is associated with multiple CSs that vary across individuals. Thus, a key question is how to interfere with reconsolidation of multiple nicotine-associated memories . In the present study, we introduce a novel memory reconsolidation interference procedure in which we reactivated multiple nicotine reward memories in rats and human smokers by acute exposure to nicotine (the UCS) and then interfered with memory reconsolidation using the noradrenergic blocker propranolol, an FDA-approved drug. (more…)
Author Interviews, Breast Cancer, JAMA, UCSF / 06.02.2017 Interview with: Natalie Engmann, MSc PhD Candidate, Epidemiology and Translational Science Department of Epidemiology & Biostatistics University of California, San Francisco What is the background for this study? Response: Breast density is well-established as a strong risk factor for breast cancer. Our study looked at what proportion of breast cancer cases in the entire population can be attributed to risk factors routinely collected in clinical practice, including breast density, measured using the clinical Breast Imaging and Reporting Scale (BI-RADS) categories. (more…)
Author Interviews, C. difficile, Hospital Acquired, JAMA / 06.02.2017 Interview with: Vanessa W. Stevens, PhD IDEAS 2.0 Center, Veterans Affairs (VA) Salt Lake City Health Care System Division of Epidemiology, Department of Internal Medicine University of Utah School of Medicine Salt Lake City, Utah What is the background for this study? What are the main findings? Response: Although metronidazole remains the most commonly used drug to treat Clostridium difficile infection (CDI), there is mounting evidence that vancomycin is a better choice for some patients. Most previous studies have focused on primary clinical cure, but we were interested in downstream outcomes such as disease recurrence and mortality. We found that patients receiving metronidazole and vancomycin had similar rates of recurrence, but patients who were treated with vancomycin had lower risks of all-cause mortality. This was especially true among patients with severe Clostridium difficile. (more…)
Addiction, Author Interviews, JAMA / 06.02.2017 Interview with: Guillaume Sescousse, PhD Senior post-doc Donders Centre for Cognitive Neuroimaging The Netherlands with collaborators Maartje Luijten, PhD, and Arnt Schellekens, MD PhD What is the background for this study? What are the main findings? Response: People with an addiction process rewards in their brain differently from people who are not addicted. However, whether this is associated with “too much” or “too little” brain activity is an open question. Indeed, past research has produced conflicting findings. In order to get a reliable answer, we have combined 25 studies investigating brain reward sensitivity in more than 1200 individuals with and without addiction to various substances such as alcohol, nicotine or cocaine but also gambling. By analyzing the brain images from these studies, we have discovered an important difference in brain activity between expecting a reward and receiving a reward. Compared with non-addicted individuals, individuals with substance or gambling addiction showed a weaker brain response to anticipating monetary rewards. This weaker response was observed in the striatum, a core region of the brain reward circuit, possibly indicating that individuals with an addiction have relatively low expectations about rewards. In contrast, this same region showed a relatively stronger response to receiving a reward in individuals with substance addiction compared with non-addicted individuals. Many addiction rehab centres, such as Avante, offer targeted addiction relief strategies to help a specific person with their addiction. This stronger response possibly indicates a stronger surprise to getting the reward, and is consistent with low expectations. This same effect was not found among people addicted to gambling. (more…)
Author Interviews, Cancer Research, CT Scanning, JAMA, Lung Cancer / 02.02.2017 Interview with: Ahmedin Jemal, DVM, PHD Vice President, Surveillance and Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 What is the background for this study? Response: In December 2013, the United States Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low dose computed tomography (LDCT) for current or former heavy smokers who quit within the past 15 years. A previous study estimated that only 2-4% of heavy smokers received LDCT for lung cancer screening in 2010 in the United States. We sought to determine whether lung cancer screening among high risk smokers increased in 2015, following the USPSTF recommendation in 2013. (more…)
Author Interviews, Frailty, JAMA, Outcomes & Safety, Surgical Research / 01.02.2017 Interview with: Margaret L Schwarze, MD, MPP Associate Professor Division of Vascular Surgery University of Wisconsin What is the background for this study? Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values. Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness.  Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes. (more…)
Author Interviews, Heart Disease, JAMA, Tobacco Research, UCLA / 01.02.2017 Interview with: Holly R. Middlekauff, MD Professor UCLA Division of Cardiology David Geffen School of Medicine UCLA What is the background for this study? What are the main findings? Response: E-cigarettes are the fastest rising tobacco product in the US today, but almost nothing is known about their cardiovascular effects. Rather than wait decades for epidemiological data in e-cigarette users to become available, we reasoned that investigations into the known mechanisms by which tobacco cigarettes increase heart disease would provide insights into the health risks of e-cigarettes. We focused on 2 critical mechanisms: 1) cardiac adrenaline activity, and 2) oxidative stress, measured in chronic e-cigarrete users compared to matched, healthy controls. The major findings were that, compared to healthy controls, e-cig users had increased cardiac adrenaline activity (measured by a technique called "heart rate variability"). Furthermore, compared to healthy controls, the e-cig users had increased susceptibility to oxidative stress. (more…)
Author Interviews, Endocrinology, JAMA, Kidney Disease / 31.01.2017 Interview with: Geoffrey A. Block, MD Director of Research at Denver Nephrology Denver, Colorado What is the background for this study? Response: Secondary hyperparathyroidism is a chronic and progressive disorder characterized by elevations in parathyroid hormone (PTH). It is seen in most patients with advanced chronic kidney disease and has been associated with a number of important adverse health effects such as bone pain, fracture, premature cardiovascular disease, abnormal heart enlargement, pathologic calcium accumulation in blood vessels and tissues and premature death. Currently there are several classes of drugs used to treat high PTH but each are associated with challenging side effects which limit their effectiveness. Active vitamin D compounds are effective in lowering PTH but do so at the expense of causing elevations in other minerals such as calcium and phosphorus which are felt to be harmful. An oral drug known as cinacalcet (Sensipar®) is in the class of medicine known as ‘calcimimetics’ and reduces PTH and simultaneously reduces calcium and phosphorus however it must be taken daily due to its short half-life and is commonly associated with nausea when first initiated or the dose is increased. Clinical trials with cinacalcet are suggestive though not conclusive of a beneficial effect on improving cardiovascular events and prolonging life. (more…)
Author Interviews, Cancer Research, CT Scanning, JAMA, Lung Cancer / 30.01.2017 Interview with: Linda Kinsinger, MD, MPH National Center for Health Promotion and Disease Prevention U.S. Department of Veterans Affairs NW Washington DC 20420 What is the background for this study?  Response: The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for current and former heavy smokers ages 55 to 80. However, clinicians have questioned the practical aspects of implementing lung cancer screening. VA provides care for 6.7 million Veterans each year, mostly older men – many of whom are current or former smokers – thus the implementation of a lung cancer screening program for VA patients would require substantial resources. In order to understand the feasibility and implications of this for patients and clinical staff, VA implemented a three-year Lung Cancer Screening Demonstration Project (LCSDP) in eight geographically-diverse VA hospitals. Investigators identified 93,033 primary care patients at eight sites who were assessed on screening criteria, of whom 2,106 patients were screened between July 2013 and June 2015. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 30.01.2017 Interview with: Dr. Hayley B. Gershengorn, MD Associate Professor of Clinical Medicine, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Montefiore Medical Center Bronx, NY What is the background for this study? What are the main findings? Response: The patient-to-intensivist ratio across intensive care units is not standardized and whether the patient-to-intensivist ratio impacts patient outcome is not well established. I n this study, we conducted a retrospective cohort analysis including 49,686 adults across 94 United Kingdom intensive care units. In this setting, a patient-to-intensivist ratio of 7.5 was associated with the lowest risk adjusted hospital mortality, with higher mortality at both higher and lower patient-to-intensivist ratios. (more…)
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity, Technology / 27.01.2017 Interview with: Lucas Marzec MD Instructor of Medicine Section of Cardiac Electrophysiology Division of Cardiology University of Colorado School of Medicine Aurora, CO 80045 What is the background for this study? What are the main findings? Response: The addition of cardiac resynchronization therapy (CRT) to an implantable cardioverter defibrillator (ICD) reduces the risk of mortality and heart failure events in select patients with left ventricular systolic dysfunction. Given these benefits, it is important to ensure patients who have a guideline recommendation for CRT are considered for this therapy at the time of ICD implantation. Previously, little data were available on the contemporary use of CRT among guideline eligible patients undergoing ICD implantation. Although ICDs alone reduce the risk of mortality in patients with heart failure and reduced systolic function, prior work shows these devices are not uniformly provided to eligible patients and that rates of ICD implantation vary widely by hospital. Prior to our study, it was unknown whether similar variation in the use of the combination of ICD and CRT (CRT-D) exists. We analyzed data from the National Cardiovascular Data Registry (NCDR) ICD Registry to identify patient, provider, and hospital characteristics associated with CRT-D use and to determine the extent of hospital level variation in the use of CRT-D among patients eligible for CRT undergoing implantation of an ICD. (more…)
Author Interviews, JAMA, Mental Health Research, PTSD / 27.01.2017 Interview with: David Mataix-Cols PhD Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council Stockholm, Sweden What is the background for this study? Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS). Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT. We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67. doi: 10.1001/jamapsychiatry.2015.0546). (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Sleep Disorders / 27.01.2017 Interview with: Dr. Alex Krist, MD MPH Task Force member Associate Professor Fairfax Family Medicine Residency Co-director, Ambulatory Care Outcomes Research Network Virginia Commonwealth University What is the background for this study? What are the main findings? Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, University of Pittsburgh / 26.01.2017 Interview with: Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh. Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion What is the background for this study? What are the main findings? Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body's response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs. (more…)
Author Interviews, Cancer Research, Colon Cancer, JAMA, Surgical Research / 25.01.2017 Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients.  To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years.  However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy. (more…)