Author Interviews, Breast Cancer, Heart Disease, JAMA / 12.10.2016

MedicalResearch.com Interview with: Husam Abdel-Qadir, MD, FRCPC, DABIM (Cardiology and Internal Medicine) Graduate student, Clinical Epidemiology and Health Care Research Elliot Philipson Clinician Scientist Training Program University of Toronto MedicalResearch.com: What is the background for this study? Response: Breast cancer is the most common malignancy among North American women. The successes of screening and treatment have led to a marked increase in the number of breast cancer survivors, whose cardiovascular health is becoming of prime concern. Many recent publications have raised alarm about the incidence of cardiovascular abnormalities after breast cancer treatment. However, there is a paucity of data about the frequency of death from cardiovascular disease rather than breast cancer. Contemporary estimates of the incidence of competing risks like cardiovascular disease are important to guide discussions about prognosis, subsequent follow-up, and survivorship plans. It is important that such incidence estimates are generated using methodology that appropriately accounts for competing risks to avoid providing results that are biased upwards. (more…)
Author Interviews, Cost of Health Care, Dermatology, JAMA, NYU / 12.10.2016

MedicalResearch.com Interview with: Hao Feng, M.D., M.H.S. Resident, Department of Dermatology NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Recently, there has been an increased scrutiny on industry-physician interactions and emphasis on disclosures of interactions. While we know about the types of interaction between dermatologists and industry, we wanted to understand that relationship more in depth by probing the Open Payment database. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Technology / 12.10.2016

MedicalResearch.com Interview with: Ateev Mehrotra, M.D. Associate Professor Department of Health Care Policy Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research has highlighted that physicians make diagnostic errors roughly 10 to 15 percent of the time. Over the last two decades, computer-based checklists and other “fail-safe” digital apps have been increasingly used to reduce medication errors or streamline infection-prevention protocols. Lately, experts have wondered whether computers might also help reduce diagnostic errors. In the study, 234 internal medicine physicians were asked to evaluate 45 clinical cases, involving both common and uncommon conditions with varying degrees of severity. For each case, physicians had to identify the most likely diagnosis along with two additional possible diagnoses. Each clinical vignette was solved by at least 20 physicians. The same cases were also evaluated using 19 symptom checkers, websites or apps that use computers that help patients determine potential diagnoses for what is wrong based on their symptoms. The physicians vastly outperformed the symptom-checker apps, listing the correct diagnosis 72 percent of the time, compared with 34 percent of the time for the digital platforms. Eighty-four percent of clinicians listed the correct diagnosis in the top three possibilities, compared with 51 percent for the digital symptom-checkers. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmacology / 12.10.2016

MedicalResearch.com Interview with: Dr. Sham Mailankody, MBBS Memorial Sloan Kettering Cancer Center MedicalResearch.com: What is the background for this study? Response: The high price of older drugs has been increasingly criticized in part because of recent dramatic price hikes. There are some well known examples like pyrimethamine and more recently EpiPen. Whether and to what degree examples like pyrimethamine represent a common problem or exceptional cases remains unknown. Using Medicare data available for Part B, we sought to analyze the change in average sales price of cancer drugs between January 2010 and January 2015, and whether older drugs were more likely to undergo price increases than newer drugs. (more…)
Author Interviews, C. difficile, Columbia, Hospital Acquired, JAMA / 12.10.2016

MedicalResearch.com Interview with: Dr. Daniel E. Freedberg MD MS Division of Digestive and Liver Diseases Columbia University Medical Center New York, New York MedicalResearch.com: What is the background for this study? Response: We conducted this study because previous studies indicate that the gastrointestinal microbiome is easily shared between people who co-occupy a given space (such as a hospital room).  We wondered if antibiotics might exert an effect on the local microbial environment. (more…)
Alzheimer's - Dementia, Author Interviews, Critical Care - Intensive Care - ICUs, End of Life Care, Geriatrics, JAMA / 12.10.2016

MedicalResearch.com Interview with: Joan M. Teno, MD, MS Department of Gerontology and Geriatrics, Cambia Palliative Care Center of Excellence University of Washington Medicine Seattle, Washington MedicalResearch.com: What is the background for this study? Response: An important challenge for our health care system is effectively caring for persons that high-need, high-cost — persons afflicted with advanced dementia and severe functional impairment are among these persons, with substantial need and if hospitalized in the ICU and mechanically ventilated are high cost patients, who are unlikely to benefit from this level of care and our best evidence suggest the vast majority of persons would not want this care. In a previous study, we interviewed families of advance dementia with 96% starting the goals of care are to focus comfort. Mechanical ventilation in some cases may be life saving, but in cases such as those with advanced dementia and severe functional impairment, they may result in suffering without an improvement in survival. (more…)
Author Interviews, Infections, JAMA, Pediatrics / 12.10.2016

MedicalResearch.com Interview with: Dr. Soren Gantt MD, PhD, MPH Investigator, BC Children's Hospital Associate Professor, Department of Infectious and Immunological Diseases (Pediatrics) Faculty of Medicine, University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cytomegalovirus (CMV) is a common virus that is usually transmitted through bodily fluids such as saliva, urine, blood, and breast milk, but it can also cause congenital infection (from a pregnant woman to her fetus). While it doesn’t usually cause problems for most children or adults, congenital CMV often causes serious problems. Congenital CMV causes 25 per cent of all childhood hearing loss and it’s the second most common cause of intellectual disability. Without screening, most infected newborns are not diagnosed in time to treat them with antivirals or provide other care that can make a big difference to improving their life-long outcomes. Our study showed that screening programs for congenital CMV infection are cost-effective. We found that the cost of identifying one case of congenital CMV ranges from US$2000 to US$10,000 through universal screening, or US$566 to $2833 through a targeted screening approach. Our model showed that screening programs resulted in a net savings for the health care system of approximately USD$21 to $32 per newborn for universal screening or USD$11-$27 per newborn for targeted screening by reducing lifetime costs for therapies and lost productivity due to CMV-related health problems. This finding addresses a major barrier to implementing CMV screening programs, as costs have often been viewed as an issue. (more…)
Author Interviews, JAMA, Supplements / 11.10.2016

MedicalResearch.com Interview with: Elizabeth D. Kantor, PhD MPH Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center NY, NY MedicalResearch.com: What is the background for this study? Response: Prior studies show that use of supplements increased between the 1980s and mid-2000s, and despite much research conducted on the health effects of supplements, we know little about recent trends in use. Given this gap, we decided to create an up-to-date, comprehensive resource on the prevalence and trends of supplement use among US adults using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Data were collected over seven continuous cycles (from 1999-2000 to 2011-2012). (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Outcomes & Safety / 10.10.2016

MedicalResearch.com Interview with: Jared Conley, MD, PhD, MPH Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston, MA 02114 MedicalResearch.com: What is the background for this study? What are the main findings? Response: As the U.S. healthcare system seeks to improve the health of populations and individual patients, there is increasing interest to better align healthcare needs of patients with the most appropriate setting of care—particularly as it relates to hospital-based care (accounting for 1/3 of total U.S. healthcare costs). Avoiding hospitalization—as long as safety and quality are not compromised—is often preferred by patients and the added benefit of potentially making care more affordable further promotes such care redesign efforts. There is a growing body of research studying alternative management strategies to hospitalization; we sought to comprehensively review and analyze this work. Alternative management strategies reviewed include outpatient management, quick diagnostic units, observation units, and hospital-at-home. (more…)
Alzheimer's - Dementia, Author Interviews, Genetic Research, JAMA, Race/Ethnic Diversity / 10.10.2016

MedicalResearch.com Interview with: Dr Tamara Shiner MD PhD Specialist in Neurology Neurology Division Tel Aviv Sourasky Medical Centre MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although in the past believed to be sporadic, there is much emerging evidence for a significant genetic contribution to Dementia with Lewy bodies (DLB). Hetrozygosity for common mutations in the GBA gene have been shown to be more frequent among DLB patients and Parkinson's disease patients than in the general population. We found that GBA mutations are in fact exceptionally frequent among Ashkenazi Jewish (AJ) patients with Dementia with Lewy bodies. Our results indicate that one in three of all Ashkenazi DLB patients carry mutations in this specific gene (compared to approximately 6% in the general Ashkenazi Jewish population). We also found that those who carry these mutations have a more severe disease phenotype. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pediatrics / 07.10.2016

MedicalResearch.com Interview with: Dr. Lars W. Andersen MD MPH Department of Emergency Medicine, Beth Israel Deaconess Medical Center Boston, Massachusetts Department of Anesthesiology and Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pediatric in-hospital cardiac arrest continues to carry a very high mortality. Thanks to companies such as AEDLeader, professional healthcare staff are able to obtain relevant equipment to help people in need. The health of patients is the priority of any paramedic or doctor. Given the relative rarity of these events at most centers and the acuity and complexity of cardiac arrest, few randomized trials exist. Moreover, few observational studies have addressed the effectiveness of intra-cardiac arrest interventions, including the use of medications and advanced airway management. This is further highlighted in the current American and international guidelines, which provide limited guidance to providers in regards to advanced airway management during pediatric in-hospital cardiac arrest. The primary objective of our study was to establish whether there is an association between tracheal intubation during in-hospital pediatric cardiac arrest and outcomes. As respiratory failure and hypoxia are common prior to cardiac arrest in children, there is a good rational for early advanced airway management in this population. (more…)
Author Interviews, Electronic Records, JAMA, NYU, Technology / 07.10.2016

MedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health New York University Langone School of Medicine, New York, NY 10016 [email protected] MedicalResearch.com: What is the background for this study? What are the main findings? Response: The identification of conditions or diseases in the electronic health record (EHR) is critical in clinical practice, for quality improvement, and for clinical interventions. Today, a disease such as heart failure is typically identified in real-time using a “problem list”, i.e., a list of conditions for each patient that is maintained by his or her providers, or using simple rules drawn from structured data. In this study, we examined the comparative benefit of using more sophisticated approaches for identifying hospitalized patients with heart failure. (more…)
Author Interviews, Education, JAMA, Mental Health Research, Pediatrics / 06.10.2016

MedicalResearch.com Interview with: Laurie Miller Brotman, PhD Bezos Family Foundation Professor of Early Childhood Development Director, Center for Early Childhood Health and Development Department of Population Health NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Children attending high-poverty schools are often exposed to an accumulation of stressors and adverse childhood experiences that can interfere with optimal mental health and learning. This study examines mental health and academic outcomes through second grade in nearly 800 Black and Latino children who participated in a randomized controlled trial of ParentCorps--a family-centered, school-based intervention in pre-kindergarten. In the original trial, elementary schools with pre-k programs serving primarily Black and Latino children from low-income families were randomized to receive ParentCorps or standard pre-k programming. ParentCorps includes professional development for pre-k and kindergarten teachers on family engagement, social-emotional learning, and behavioral regulation, and a program for families and pre-k students provided over four months at the school by specially trained pre-k teachers and mental health professionals. ParentCorps creates a space for families to come together, reflect on their cultural values and beliefs, and set goals for their children. Parents learn a set of evidence-based strategies and choose which ones fit for their families—such as helping children solve problems and manage strong feelings, reinforcing positive behavior, setting clear rules and expectations, and providing effective consequences for misbehavior. Teachers and parents help children learn social, emotional and behavioral regulation skills such as identifying feeling sad, mad, or scared, calming bodies during stressful situations, paying attention, and solving problems together. This three year follow-up study finds that ParentCorps as an enhancement to pre-k programming in high-poverty schools results in fewer mental health problems (behavioral and emotional problems) and better academic performance through second grade. (more…)
Author Interviews, Bone Density, JAMA, Mental Health Research, Mineral Metabolism, Pediatrics / 06.10.2016

MedicalResearch.com Interview with: Alexis Jamie Feuer MD Assistant Professor of Clinical Pediatrics Weill Cornell Medical College MedicalResearch.com: What is the background for this study? Response: Osteoporosis is a debilitating disorder characterized by low bone density and increased risk of fractures. Adolescence and young adulthood are critically important times for accruing peak bone density and failure to obtain adequate bone mass by early adulthood may result in future osteoporosis. In children, the use of certain medications can lead to a decrement in the acquisition of bone mass. Past studies have shown that stimulant medications, such as those used to treat Attention Deficit Hyperactivity Disorder (ADHD), may slow the rate of linear growth in children. To date, little research has been done to see what effects stimulant use may have on bone density and bone accrual in children. Stimulants exert their effects via activation of the sympathetic nervous system, and as there is mounting evidence that indicates the sympathetic nervous system plays a critical role in the acquisition of bone density, we sought to determine if there is any association between stimulant medication use and bone mass in the pediatric population. (more…)
Author Interviews, JAMA, Karolinski Institute, Mental Health Research / 05.10.2016

MedicalResearch.com Interview with: Gustaf Brander Department of Clinical Neuroscience Karolinska Institutet MedicalResearch.com: What is the background for this study? Response: Obsessive-compulsive disorder (OCD) is believed to be caused by a complex interaction between genetic and environmental factors. Whereas genetic studies are well underway, the research on environmental factors has been lagging behind. As they explain a significant portion of the variance, are potentially malleable, and are essential for understanding how the genetic component works, this area of research is of great importance. (more…)
Accidents & Violence, Author Interviews, Clots - Coagulation, JAMA, Surgical Research, Thromboembolism / 03.10.2016

MedicalResearch.com Interview with: Charles A. Karcutskie IV, MD, MA Postdoctoral Research Fellow University of Miami Miller School of Medicine Department of Surgery Divisions of Trauma, Surgical Critical Care, and Burns MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research group at the Ryder Trauma Center have recently done several studies showing various differences in outcomes and risk based on mechanism of injury. Additionally, venous thromboembolism (VTE) is another topic that our group has focused on in the past several years. Because trauma patients are inherently at a higher risk for VTE due to the nature of their injury, we questioned whether the most important risk factors for VTE were different after blunt or penetrating trauma. At our institution, we assess VTE risk with the Greenfield Risk Assessment Profile, which is a list of several risk factors that each have weight toward an overall risk score. We took these risk factors and analyzed them individually based on mechanism of injury. We found that the factors that contribute to the VTE risk are different based on injury mechanism: After blunt trauma, transfusion status, neurologic status, and pelvic fracture contributed most. After penetrating trauma, vascular injury, severe abdominal injury, and age 40-59 years contributed most. This tells us that mechanism of injury may need to be incorporated into the risk assessment in order to discover the highest risk patients. (more…)
Author Interviews, Diabetes, JAMA / 03.10.2016

MedicalResearch.com Interview with: Dr. Saeid Shahraz Assistant Professor of Medicine Tufts Medical Center MedicalResearch.com: What is the background for this study? Response: American Diabetes Association (ADA) has set up a lower cut point for diagnosing prediabetes ( those with Impaired Fasting  Glucose   100 mg/dL) compared to the World Health Organization's cut point, which is 110 mg/dL. This arbitrariness in cut point definition triples the number of cases labeled as prediabetes. Along with lowering the diagnostic threshold by the ADA, the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), and the ADA endorsed and advertised a web-based risk model to define high-risk population for prediabetes. The risk engine asks a few questions ( age, sex, family history of diabetes, history of gestational diabetes and high blood pressure, physical activity and weight) and outputs a score that defines if the person is at risk for prediabetes. We suspected that the risk engine might overestimate the risk. (more…)
Author Interviews, End of Life Care, JAMA / 03.10.2016

MedicalResearch.com Interview with: Joshua R. Lakin, MD Assistant Professor of Medicine Harvard Medical School Dana Farber Cancer Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: Research has increasingly shown the benefits of early palliative care interventions, especially in those around communication about patient goals and preferences in serious illness. These benefits include improved quality of life and psychological outcomes for patients as well as eased bereavement and decision making for loved ones. We have a large gap to fill in initiating early goals and values conversations with our patients and there are a myriad of systems failures and clinician barriers that do not allow us to do this work in a timely and effective way. Doing so with limited resources, both in specialty palliative care and in the many frontline clinicians doing this work, requires targeting our resources carefully. Doing these conversations earlier means identifying patients upstream, before they are in the last days of life. The Surprise Question – “Would you be surprised if this patient died in the next year?” – has emerged as an attractive option for screening for early palliative care interventions. It has been studied primarily in dialysis and cancer patients and has been demonstrated to have a strong association with risk of death. We set out to test it in a more diverse primary care population. (more…)
Author Interviews, JAMA / 28.09.2016

MedicalResearch.com Interview with: Kanu Okike MD MPH Department of Orthopaedic Surgery, Kaiser Moanalua Medical Center Honolulu, Hawaii MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many journals in the social sciences practice double-blind review, in which reviewers and authors are both blinded to each others' identities. In medicine, on the other hand, most journals practice single-blind review, in which authors' identities are known to reviewers. Concerns have been raised that this could lead to biased reviews, however, especially in the case of well-known authors. In our study, we composed a fabricated test manuscript and randomized reviewers for an orthopaedic journal to receive single-blind (prestigious authors listed) or double-blind (no authors listed) versions. In our study, the reviewers who were under the impression that the manuscript was written by prestigious authors (single-blind review) awarded higher marks and also recommended acceptance more often, in spite of the fact that the manuscripts were otherwise identical. (more…)
Author Interviews, JAMA, Stroke / 27.09.2016

MedicalResearch.com Interview with: Dr. Michael Hill, MSc, MD, FRCPC Professor for the Departments of Clinical Neurosciences, Community Health Sciences, Medicine and Radiology University of Calgary Director of the Stroke Unit Calgary Stroke Program Alberta Health Services MedicalResearch.com: What is the background for this study? What are the main findings? Response: The HERMES collaboration is a pooled individual patient meta-analysis of recent endovascular ischemic stroke trials. The current analysis assesses the role of time to treatment and outcome. We show that there is a clear relationship between time from onset-to-treatment and outcome, with treatment gradually becoming less effective as time elapses from stroke onset. Treatment was still effect, on average, out to just beyond 7 hours from stroke onset. (more…)
Author Interviews, JAMA, Pediatrics / 27.09.2016

MedicalResearch.com Interview with: Erik Berg, MD Department of Global Public Health and Primary Care University of Bergen Bergen, Norway MedicalResearch.com: What is the background for this study? What are the main findings? Response: Parents regularly express concern about long term health outcomes for children born with oral cleft. In this study we used population-based long-term follow-up data from multiple national registries to focus on the future health outcomes of cleft cases without additional chronic medical conditions or congenital anomalies. The study cohort consisted of all individuals born in Norway between 1967 and 1992. All patients treated for clefts in Norway during the study period were invited to participate. 2 337 cases with isolated clefts and 1 413 819 unaffected individuals were followed until 2010. The main outcome variables were conditions diagnosed in childhood or early adulthood, need for social security benefits, and risk of death. (more…)
Author Interviews, Baylor College of Medicine Houston, Brain Injury, Depression, JAMA / 26.09.2016

MedicalResearch.com Interview with: Ricardo E. Jorge  MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist  Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury. Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course. Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment. (more…)
Author Interviews, JAMA, NIH, OBGYNE / 26.09.2016

MedicalResearch.com Interview with: Stefanie N. Hinkle, Ph.D. Staff Scientist | Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thank you for the interest in our research. Nausea and vomiting are very common early in pregnancy and these symptoms can be difficult for women. Before we began this study there was very limited high-quality data on the implications of these difficult symptoms in pregnancy. Our study is unique because we asked women to report their symptoms continuously throughout their pregnancy before they may or may not have gone on to have a loss. We found that among women with 1 or 2 prior pregnancy losses, women who have nausea, and particularly nausea with vomiting, were less likely to have a pregnancy loss. (more…)
Author Interviews, Biomarkers, JAMA, NIH, Parkinson's / 26.09.2016

MedicalResearch.com Interview with: Yong Cheng, PhD, post-doc fellow Section on Cellular Neurobiology Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: Parkinson’s disease is the second most neurodegenerative disease after Alzheimer’s disease. The symptoms of the disease are typically movement related. However, the nonmotor features in PD are increasingly recognized. Evidence suggests that inflammation may play a role in the development of AD, and a substantial number of studies have demonstrated altered levels of peripheral blood inflammatory cytokines in patients with  Parkinson’s disease, but findings have been inconsistent for individual cytokines and between studies. Therefore, we undertook a systematic review of the scientific literature, using a meta-analysis to quantitatively summarize clinical data on blood cytokine levels in patients with PD, compared with healthy controls. (more…)
Author Interviews, Epilepsy, JAMA, Mayo Clinic, Neurological Disorders / 23.09.2016

MedicalResearch.com Interview with: Brian Nils Lundstrom, MD, PhD Department of Neurology Mayo Clinic Rochester, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: About as many people have drug-resistant focal epilepsy as have multiple sclerosis, and treatment options are limited. This study describes an alternative treatment option that has proven very helpful for the majority of participants. Electrical stimulation is delivered continuously via implanted electrodes to the region of brain where seizures start. The electrical stimulation decreases the seizure-related discharges from the brain, and for about 40% of patients their disabling seizures were completely stopped. (more…)
Author Interviews, JAMA, Pharmacology, Rheumatology / 23.09.2016

MedicalResearch.com Interview with: Jacques-Eric Gottenberg, MD, PhD Department of Rheumatology National Reference Center for Systemic Autoimmune Diseases Strasbourg University Hospital, Université de Strasbourg Strasbourg, FranceJacques-Eric Gottenberg, MD, PhD Department of Rheumatology National Reference Center for Systemic Autoimmune Diseases Strasbourg University Hospital, Université de Strasbourg Strasbourg, France MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is no recommendation for the choice of the second biologic in patients with rheumatoid arthritis and insufficient response to a first anti-TNF, which is a common situation in our daily practice (approximately one third of patients treated with anti-TNF). We therefore conducted the first randomized trial to date to investigate the best strategy in such a setting. (more…)
Author Interviews, JAMA, Opiods / 21.09.2016

MedicalResearch.com Interview with: Bradley D. Stein, MD, MPH, PhD RAND Corporation University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: The United States is in the midst of a serious opioid abuse epidemic and we know that medically assisted treatment is one of the best ways to help people with addiction to opioids. The drug buprenorphine has advantages over methadone, the historic medical treatment, because it can be prescribed by physicians in the community who receive a waiver allowing them to prescribe it after undergoing eight hours of training.. Methadone is dispensed at special clinics that many people with opioid addition may be unable to get to with the frequency required by effective treatment. To better understand patterns of the use of buprenorphine, we examined treatment patterns in the states with the most buprenorphine-waivered physicians (California, Florida, Massachusetts, Michigan, New York, Pennsylvania and Texas). Our data came from a prescription records that account for over 80 percent of the retail pharmacies in the nation. We examined use patterns among 3,200 physicians who treated 250,000 patients. We had two surprising findings:  First, the median length of treatment with buprenorphine was 53 days, which is much shorter than the duration that most individuals are likely to need for optimal results. Second, despite concerns that federal limits on the number of patients and waivered physician can treat being a significant barrier for many individuals obtaining treatment, we found that most physicians were treating far fewer patients than would be allowed by the patient limits. In fact, 22 percent of the physicians treated an average of 3 patients per month and just 9 percent treated 75 or more patients per month. (more…)
Author Interviews, Baylor College of Medicine Houston, Brain Injury, Depression, JAMA / 21.09.2016

MedicalResearch.com Interview with: Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury (TBI). Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course. Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment. (more…)
Author Interviews, Cost of Health Care, Depression, JAMA, Pediatrics / 21.09.2016

MedicalResearch.com Interview with: Laura P. Richardson, MD, MPH Interim Chief | Division of Adolescent Medicine Director | UW Leadership Education in Adolescent Health (LEAH) Program Professor | UW Department of Pediatrics Seattle Children's | University of Washington MedicalResearch.com: What is the background for this study? Response: Adolescent depression is one of the most common mental health conditions during adolescence. Up to one in five adolescents experience an episode of major depression by age 18. Depressed youth are at greater risk of suicide, dropping out of school and poor long-term health. Treatments, including medications and psychotherapy, have been proven to be effective but most depressed teens don’t receive any treatment. Two years ago, we showed that the Reaching Out to Adolescents in Distress (ROAD) collaborative care model (a.k.a. Reach Out 4 Teens) designed to increase support and the delivery of evidence-based treatments in primary care was effective in treating depression in teens, significantly improving outcomes. We ran a randomized clinical trial at nine of Group Health’s primary care clinics and reported effectiveness results in JAMA. The current paper represents the next step in this work, examining the cost-effectiveness of collaborative care for adolescent depression in our intervention sample of 101 adolescents with depression, ages 13-17 years. (more…)