Author Interviews, JAMA, OBGYNE, Toxin Research / 26.03.2015

Dr. Bradley S. Peterson, M.D Director of the Institute for the Developing Mind The Saban Research Institute of Children’s Hospital Los Angeles Children’s Hospital Los AngelesMedicalResearch.com Interview with: Dr. Bradley S. Peterson, M.D Director of the Institute for the Developing Mind The Saban Research Institute of Children’s Hospital Los Angeles Children’s Hospital Los Angeles Medical Research: What is the background for this study? Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7. Medical Research: What are the main findings? Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy.  We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression.  Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability. (more…)
Aging, Author Interviews, Exercise - Fitness, Frailty, JAMA, Vitamin D / 23.03.2015

MedicalResearch.com Interview with: Kirsti Uusi-Rasi, PhD, Adjunct Professor Senior Researcher UKK Institute for Health Promotion Research Tampere Finland Medical Research: What is the background for this study? What are the main findings? Dr. Kirsti Uusi-Rasi: Falls are the leading cause of unintentional injuries and fractures in older adults, head injuries and fractures being the most severe consequences. Therefore, falls prevention is important when trying to prevent injuries. There is strong high-quality evidence from previous studies that exercise that includes strength and balance training can reduce the risk of falling in older adults. However, there are also studies that have reported no benefit in reducing the actual incidence of falls. Effects of vitamin D have also been studied widely, and vitamin D is known to be vital for bone metabolism and health. However, results regarding effects on falls and fractures are inconsistent. Furthermore, persons with low vitamin D levels (serum 25OHD) have been associated with lower physical performance and greater decline in physical functioning, but clinical trials exploring the role of vitamin D in reducing falls and fractures and in improving physical functioning are inconclusive. Because there is hardly any evidence about exercise and vitamin D together, we investigated the separate and combined effects of multimodal exercise training and vitamin D supplementation in reducing falls and injurious falls among older women at risk for falling. We assigned 409 participants randomly to one of four groups with: 1)vitamin D 800 IU/day and exercise 2) placebo and exercise 3) vitamin D 800 IU/day without exercise 4) placebo without exercise. Exercise consisted of strength, balance, mobility and agility group training. At the end of two years, exercise seemed to be more effective in reducing injurious falls in this age group, with or without vitamin D. Exercise also improved physical functioning (strength, balance and mobility). In general, the training program was well tolerated with no severe adverse effects or injuries. Vitamin D helped maintain femoral neck BMD and increased trabecular bone density at the tibia. Our study also suggests that the current vitamin D recommendation (800 IU/d for older people) is adequate. (more…)
Author Interviews, Brigham & Women's - Harvard, Dermatology, JAMA / 22.03.2015

Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MAMedicalResearch.com Interview with: Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MA     Medical Research: What is the background for this study? What are the main findings? Dr. Mostaghimi: Spironolactone, a generic drug that’s been used in the clinic since 1959, is commonly prescribed for treating hormonal acne – acne that tends to affect the jaw line most commonly around the time of the month when a woman gets her period. The US Food and Drug Administration recommends frequent potassium monitoring in patients with heart failure who are taking spironolactone as a diuretic and antihypertensive treatment, but it’s been unclear if these guidelines should apply to healthy patients taking spironolactone for the treatment of acne, and, if so, how frequently such patients should have their potassium levels tested. My colleagues and I have found that for young, healthy women taking spironolactone to treat hormonal acne, potassium monitoring is an unnecessary health care expense. For the approximately 1,000 patients we studied, blood tests to monitor potassium levels did not change the course of treatment, but the tests cumulatively totaled up to $80,000. We suggest that routine potassium monitoring should no longer be recommended for this patient population in order to improve the patient care experience, decrease unnecessary office visits and reduce health care spending. (more…)
Author Interviews, Cognitive Issues, JAMA, University of Michigan / 18.03.2015

Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare SystemMedicalResearch.com Interview with: Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare System Medical Research: What is the background for this study? What are the main findings? Dr. Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Race/Ethnic Diversity, Surgical Research / 18.03.2015

Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s HospitalMedicalResearch.com Interview with: Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital Medical Research: What is the background for this study? Response: Disparities in the quality of care received by minority and low-income patients have been reported for years across multiple medical conditions, types of care, and institutions.  To determine whether clinicians’ unconscious race and/or social class biases correlated with a lower quality of care for minority patients and those of lower socioeconomic status, my colleagues and I conducted a web-based survey among 215 physicians at an academic, level one trauma center. Participants were asked to review eight clinical vignettes, and then respond to three questions about management of care after each. Following their response, a test known as an Implicit Association Test (IAT Test) was used to assess any unconscious preferences. Medical Research: What are the main findings? Response: We found that race and class biases, as measured by response time to a standardized Implicit Association Test, had no relationship to the way that patients were clinically treated. Whether the lack of association found between implicit bias and decision making in this study represents a true lack of association or the failure of clinical vignettes to capture the nuances of how implicit biases translate into management decisions remains unclear. Existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters. (more…)
Author Interviews, Breast Cancer, JAMA / 18.03.2015

Joann G. Elmore M.D., M.P.H. Professor of Medicine, Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499MedicalResearch.com Interview with: Joann G. Elmore M.D., M.P.H. Professor of Medicine, Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499 MedicalResearch: What is the background for this study? What are the main findings? Dr. Elmore: It is estimated that 1.6 million women in the United States each year undergo a breast biopsy. By interpreting these biopsies under the microscope, pathologists provide diagnoses on a spectrum from benign, to atypia, to ductal carcinoma in situ (DCIS), to invasive cancer. Using these diagnostic classifications, clinical doctors work with their patients to decide if they are at increased risk of developing breast cancer in the future, which can lead to additional surveillance, or how to treat them when the diagnosis is invasive breast cancer. As misclassification of breast lesions by pathologists may contribute to overtreatment and undertreatment of breast disease, we decided to study the accuracy of breast pathology diagnoses in the U.S. In the Breast Pathology (B-Path) Study, we used a set of 240 breast biopsy cases to evaluate the interpretive accuracy of 115 U.S. pathologists who were actively interpreting breast biopsies in their clinical practices. Their diagnoses were compared with reference diagnoses established by a consensus panel of experienced breast pathologists. When the panel members each independently diagnosed the slides pre-consensus, they agreed unanimously on 75 percent of their diagnoses; ninety percent of the panel members’ initial independent diagnoses agreed with the final consensus-derived reference diagnoses. When comparing participating pathologists’ diagnoses to the reference diagnoses, we found overall agreement for 75 percent of interpretations. The concordance rate for invasive breast cancer was reassuringly high at 96 percent, and fairly high for benign findings without atypia at 87 percent. However, concordance was lower for atypia at 48 percent and for DCIS at 84 percent. This means that nearly one out of five pathologists disagreed on the diagnosis of DCIS. We found disagreement with the reference diagnosis to be statistically more frequent when pathologists had lower weekly case volumes or worked in smaller labs. Disagreement was also statistically significantly more likely when the patient had dense breast tissue on mammogram; however, the absolute difference was small. Our accuracy findings were not altered when we used different methods of defining the reference diagnosis. (more…)
Author Interviews, Infections, JAMA, University of Michigan / 17.03.2015

Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MIMedicalResearch.com Interview with: Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections. The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
  1. Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
  2. Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
  3. Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates. A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively. The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program. (more…)
AHRQ, Author Interviews, Cost of Health Care, JAMA, Medical Imaging, Pain Research / 17.03.2015

Jeffrey (Jerry) G. Jarvik MD MPH Professor, Radiology, Neurological Surgery and Health Services Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine Director, Comparative Effectiveness, Cost and Outcomes Research Center University of Washington Seattle, WA  98104-2499MedicalResearch.com Interview with: Jeffrey (Jerry) G. Jarvik MD MPH Professor, Radiology, Neurological Surgery and Health Services Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine Director, Comparative Effectiveness, Cost and Outcomes Research Center University of Washington Seattle, WA Medical Research: What is the background for this study? Dr. Jarvik:  When I arrived at the Univ of WA over 20 years ago, my mentor, Rick Deyo, had just finished leading a project that was responsible for developing one of the first set of guidelines for the diagnosis and treatment of acute low back pain. These guidelines, published in a booklet by AHRQ (then called AHCPR), recommended that patients with acute low back pain not undergo imaging for 4-6 weeks unless a red flag was present. One of the exceptions was that patients older than 50 could get imaged immediately, the rationale being that older adults had a higher prevalence of potentially serious conditions such as cancer, infections, etc, that would justify the early imaging. As a practicing neuroradiologist, it was clear that a potential problem with this strategy is that the prevalence of age-related changes, which may or may not be related to back pain, also increases with age. So earlier imaging of older adults would almost certainly reveal findings, and these could easily start a series of unfortunate events leading to potentially poor outcomes and more healthcare resource use. Thus this policy of early imaging of older adults didn’t entirely make sense. About 5 years ago, these guidelines hit home when I developed acute low back pain and since I was over 50 (barely) my doctor recommended that I get an imaging study. Being a knowledgeable patient and having a reasonable doctor, we mutually agreed not to get the study. I improved but that wasn’t the end of it. When we had the chance to apply for one of the CHOICE ARRA awards funded by AHRQ, we made answering this question of early imaging in older adults one of our primary goals. (more…)
Author Interviews, Dermatology, Infections, JAMA / 15.03.2015

MedicalResearch.com Interview with: Dr. Ana Ramírez-Boscá, MD Department of Dermatology and Clinical Research UnitDr. Ana Ramírez-Boscá, MD Department of Dermatology and Clinical Research Unit and Vicente Navarro-López, MD Clinical Research Unit and Infectious Diseases Unit Centro Dermatológico Estético, Alicante, SpainVicente Navarro-López, MD Clinical Research Unit and Infectious Diseases Unit Centro Dermatológico Estético, Alicante, Spain   MedicalResearch: What is the background for this study? What are the main findings? Response: Infections have been related with the pathogenesis of guttate psoriasis, however antibiotic treatment does not improve prognosis nor does it affect the evolution of the disease. The association between psoriasis and other infectious diseases has been reported as well, although in these cases there is scarce information on the causative microbial likely involved and the role of these bacteria in the pathogenesis of this skin disease. MedicalResearch: What are the main findings?  Response: Bacterial DNA may be detected in bloodstream of a significant proportion of patients with active plaque psoriasis. Increased levels of pro-inflammatory cytokines in patients with presence of bacterial DNA but not in patients without presence of bacterial genomic fragments suggest a role of bacterial DNA translocation in inducing an inflammatory response. (more…)
Author Interviews, JAMA, Opiods, Pharmacology / 13.03.2015

Theodore J. Cicero, PhD Professor, Vice Chairman for Research Department of Psychiatry, Washington University St Louis, MissouriMedicalResearch.com Interview with: Theodore J. Cicero, PhD Professor, Vice Chairman for Research Department of Psychiatry, Washington University St Louis, Missouri MedicalResearch: What is the background for this study? What are the main findings? Dr. Cicero: Prescription opiate abuse (eg Vicodin, Percocet, OxyContin) has reached epidemic proportions in this country over the past decade. Although most people swallow the drugs whole, a relatively large number either chew the drugs to produce an immediate delivery of large quantities of drugs or they crush them and/or dissolve them in some solvent which makes them useful for intranasal (eg snorting) or intravenous administration. Non-oral routes, particularly injection, represent the most serious public health risk due to a high incidence of infection, including Hepatitis C and HIV, and the much greater severity of abuse. In an effort to reduce these practices, drug companies are introducing so-called abuse deterrent formulations (ADF) which are resistant to crushing or dissolving in an aqueous solution. In one such important effort, the company responsible for distributing one of the most widely abused prescription opiates, OxyContin, introduced an ADF in 2010. Although the abuse deterrent formulations was highly successful in reducing abuse of OxyContin by either chewing, crushing, or dissolving in water, there was none-the-less a clear limit to how effective it was. For example, some people simply switched to the oral route of administration or never did snort or inject the drug, whereas a small number found ways to defeat the abuse deterrent formulations and persisted in harmful patterns of abuse. Unfortunately, there was also an unintended result. ADF-OxyContin caused many individuals to abandon the use of OxyContin - a good thing - in favor of other opiates (a bad thing). Most serious, however, was that 70% of those who switched drugs moved from OxyContin to heroin abuse. Although by no means the only factor, the abuse deterrent formulations has contributed to the wide-spread reports of heroin abuse in suburban and rural Caucasian male and females, a group here-to-fore not the typical heroin users (i.e. poor minorities, living in large urban centers). (more…)
Aging, Author Interviews, Hearing Loss, JAMA / 13.03.2015

MedicalResearch.com Interview with: Isabelle Mosnier, MD, Praticien Hospitalier ORL Otologie, Implants Auditifs et Chirurgie de la Base du Crâne Centre Référent Implant Cochléaire Adulte d'Ile de France Centre Maladies Rares Surdité Génétique de l'adulte et Neurofibromatose de type 2 Groupe Hospitalier de la PITIE-SALPETRIERE Paris MedicalResearch: What is the background for this study? What are the main findings? Dr. Mosnier: Association between hearing impairment and cognitive decline has been established; however, the impact on cognition through cochlear implantation in profoundly deaf elderly patients is not known. The focus was to determine the impact of hearing rehabilitation including cochlear implant on cognitive functions, in addition to the influence of cognitive factors on cochlear implant outcomes over time. (more…)
Author Interviews, Colon Cancer, Genetic Research, JAMA / 12.03.2015

Matthew B. Yurgelun, MD Instructor in Medicine Harvard Medical SchoolMedicalResearch.com Interview with: Matthew B. Yurgelun, MD Instructor in Medicine Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Yurgelun: Germline mutations in the TP53 gene are linked to Li-Fraumeni syndrome, which is an inherited syndrome associated with a 73-100% lifetime risk of cancer. Classically, cancers linked to Li-Fraumeni syndrome include early-onset breast cancer, leukemias, soft tissue sarcomas, brain cancer, and adrenocortical cancer, although recent data have shown an increased risk of colorectal cancer as well.  Our study’s primary aim was to determine the frequency of germline TP53 mutations in patients with early-onset colorectal cancer. We studied 457 patients from the multinational Colon Cancer Family Registry who were diagnosed with colorectal cancer at age 40 or younger, and found that 1.3% carried a germline alteration in the TP53 gene.  None of these individuals had personal or family histories of cancer that fulfilled clinical criteria for Li-Fraumeni syndrome. (more…)
Author Interviews, Cost of Health Care, JAMA, Medical Imaging, NYU / 12.03.2015

Danil Makarov, MD Lead Investigator Assistant Professor, Departments of Urology, Population Health and Health Policy Member, Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center, New York, NYMedicalResearch.com Interview with: Danil Makarov, MD Lead Investigator Assistant Professor, Departments of Urology, Population Health and Health Policy Member, Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center, New York, NY Medical Research: What is the background for this study? Dr. Makarov: The background for this study is that regional variation in patterns of care and healthcare spending is widely known.  The drivers of this regional variation, though, are poorly understood.  Certain policy groups like the IOM have suggested that policy efforts be focused on individual providers and patients. Programs such as Choosing Wisely, which encourage a dialogue between physicians and patients, are a great example of such efforts.  However, some of our prior research suggests that regional variation is not random and that there might be are regional-level factors which drive variation. To test out our hypothesis, we wanted to see whether inappropriate imaging for two unrelated cancers was associated at a regional level (it should not be). Medical Research: What are the main findings? Dr. Makarov: We found that, at a regional level, inappropriate breast cancer imaging was associated with inappropriate prostate cancer imaging. (more…)
Author Interviews, JAMA, Pain Research / 11.03.2015

Matthew J. Bair, MD, MS Research Service, Veterans Affairs Health Services Research and Development, Center for Health Information and Communication Richard L. Roudebush Veterans Affairs Medical Center, Department of Medicine, Indiana University School of Medicine, Health Services Research, Regenstrief Institute, Inc, Indianapolis, IndianaMedicalResearch.com Interview with: Matthew J. Bair, MD, MS Research Service, Veterans Affairs Health Services Research and Development, Center for Health Information and Communication Richard L. Roudebush Veterans Affairs Medical Center, Department of Medicine, Indiana University School of Medicine, Health Services Research, Regenstrief Institute, Inc, Indianapolis, Indiana MedicalResearch.com: What is the background for this study? Dr. Bair: Despite the prevalence and functional, psychological, and economic impact of chronic pain, there have been few intervention studies to treat chronic pain in Veterans. MedicalResearch.com: What are the main findings? Dr. Bair: A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in Veterans with chronic musculoskeletal pain. (more…)
Author Interviews, JAMA, Orthopedics, Surgical Research / 11.03.2015

Prof. Amar Rangan Clinical Professor, Trauma & Orthopaedic Surgery School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon The James Cook University Hospital MiddlesbroughMedicalResearch.com Interview with: Prof. Amar Rangan Clinical Professor, Trauma & Orthopaedic Surgery School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon The James Cook University Hospital Middlesbrough Medical Research: What is the background for this study? What are the main findings? Prof. Rangan: The majority of fractures of the proximal humerus (broken shoulders) occur in people older than 65 years. Although surgical treatment is being increasingly used for the more serious (displaced) fractures, it has been unclear whether surgical intervention (fracture fixation or humeral head replacement) produces consistently better outcomes than non-surgical treatment (arm-sling); both followed by physiotherapy. Our multicentre randomized controlled trial (ProFHER), funded by the UK National Institute for Health Research’s Health Technology Assessment Programme, recruited 250 patients aged 16 years or older (mean age, 66 years) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 after sustaining the most common types of acute displaced fracture of the proximal humerus. Data for 231 patients (92.4% of 250) included in the primary analysis showed that there was no significant difference between the two treatment groups over two years or at 6, 12 and 24 months follow-up in self-reported pain and function scores. Nor were there significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, later surgery or treatment for these complications, and death. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Lipids, Statins / 11.03.2015

Joost Besseling PhD-student Academic Medical Center Dept. of Vascular Medicine AmsterdamMedicalResearch.com Interview with: Joost Besseling PhD-student Academic Medical Center Dept. of Vascular Medicine Amsterdam Medical Research: What is the background for this study? What are the main findings? Response: Statins are associated with an increased risk for type 2 diabetes mellitus (DM). The exact mechanism for this adverse event is largely unknown, although the upregulation of the low-density lipoprotein receptor (LDLR) has been suggested to play a role. In familial hypercholesterolemia (FH) the uptake of LDL-cholesterol via the LDLR is decreased due to a genetic defect. We found that the prevalence of type 2 DM is 50% lower in relative terms in patients with familial hypercholesterolemia. Moreover, there was a dose-response relationship: the more severe the genetic defect that causes familial hypercholesterolemia, the lower the prevalence of type 2 DM. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, JAMA, University of Michigan / 11.03.2015

Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800MedicalResearch.com Interview with: Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800   Medical Research: What is the background for this study? What are the main findings? Dr. Prescott: The post-hospital period has been widely recognized as a vulnerable time for patients. In particular, patients who survive sepsis are frequently readmitted to the hospital in the following three months. In this study, we examined data from 2,600 survivors of sepsis, a severe infection that leads to organ failure. About 42% of the sepsis patients were readmitted in the next 90 days, similar to the rate seen for patients hospitalized for other acute conditions. However, the reasons for hospital readmission after sepsis are different. A greater number of patients are re-hospitalized for “ambulatory-care sensitive conditions”, which are conditions that could potentially be prevented or treated early in the outpatient setting to avoid a hospital stay. (more…)
Author Interviews, Electronic Records, JAMA / 11.03.2015

MedicalResearch.com Interview with: Jonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado DenverJonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado Denver Medical Research: What is the background for this study? Dr. Pell: Back in 2001, the Institute of Medicine's charter document Crossing the Quality Chasm proposed that the health care system needs to do a better job of patient centered care. In order to provide true patient centered care, we must provide patients and their families with the knowledge and tools they need to make autonomous and informed decisions about their healthcare. A patient cannot make informed decisions about their healthcare without having easy access to their own health information. Almost 15 years later, we are still discussing whether or not patients should have immediate electronic access to information in their electronic health record. Studies have shown that giving outpatients direct electronic access to their test results and even doctors notes does not cause patients worry or confusion, and there is no undue burden on care providers explaining this newly accessible information to their patients - if they can deliver thinking of you flowers from Flowercard, there's no reason they can't deliver a simple print-out of relevant information. Despite this, many institutions still have a moratorium on release of patients' test results, and the duration of this moratorium is variable from institution to institution. The technology to deliver this type of information real-time to patients is readily available. We decided to explore the effect of giving hospitalized patients real-time access to their test results and hospital medication list/schedule. (more…)
Author Interviews, Colon Cancer, JAMA, Vegetarians / 09.03.2015

Michael J. Orlich, MD, PhD Program Director, Preventive Medicine Residency Loma Linda University Co-Investigator, Adventist Health StudiesMedicalResearch.com Interview with: Michael J. Orlich, MD, PhD Program Director, Preventive Medicine Residency Loma Linda University Co-Investigator, Adventist Health Studies Medical Research: What is the background for this study? What are the main findings? Dr. Orlich: Colorectal cancer is the second leading cause of death from cancer in the United States.  Screening efforts such as colonoscopies have helped save many lives by detecting pre-cancerous polyps and removing them.  However, it is even better to prevent cancers from forming in the first place.  We call this primary prevention.  Diet is a potentially important approach to reduce the risk of developing colorectal cancer.  In this analysis, we compared those eating different categories of vegetarian dietary patterns to those eating a non-vegetarian diet.  About half of our study population was classified as non-vegetarian, which we defined as eating meat at least weekly.  The other half of our population we called vegetarian and further divided them into four different vegetarian groups:  semi-vegetarians ate meat but less than once per week; pesco-vegetarians ate fish but avoided other meats; lacto-ovo-vegetarians avoided meat but ate eggs and/or dairy products; and vegans avoided all meats, eggs, and dairy.  All vegetarians together had on average a 22% relative reduction in the risk of developing colorectal cancer, compared to non-vegetarians, after carefully adjusting for many other factors.  Pesco-vegetarians in particular had a much lower risk compared to non-vegetarians. (more…)
Author Interviews, Cancer Research, JAMA / 09.03.2015

Prof. Sigurdur Y Kristinsson Professor of Hematology University of IcelandMedicalResearch.com Interview with: Prof. Sigurdur Y Kristinsson Professor of Hematology University of Iceland MedicalResearch: What is the background for this study? What are the main findings? Prof. Kristinsson: Multiple myeloma is always preceded by a precursor condition called monoclonal gammopathy of undetermined significance (MGUS). MGUS is characterized by a detectable monoclonal protein in persons without evidence for end-organ damage or other related plasma cell or lymphoproliferative disorders. MGUS is very common and is detected in approximately 5 percent of persons 70 years or older. However, only a small proportion of MGUS progresses to a malignant disorder, in fact the annual risk of progression to multiple myeloma or other related disorders is on average 1 percent, with varying risks according to risk groups. Current guidelines suggest, depending on the individual patient’s clinical risk score, life-long monitoring of MGUS individuals to detect progression to multiple myeloma or related disorders. At this time, the impact of annual monitoring on the outcome of patients who eventually develop multiple myeloma is unclear. Using high-quality population-based data from Sweden, we estimated the impact of prior knowledge of MGUS diagnosis and comorbidities on multiple myeloma survival, by performing a large population-based study using data on more than 14,000 multiple myeloma patients diagnosed in Sweden 1976-2005, with follow-up through 2007. The hypothesis that detection and follow-up of MGUS may influence survival in multiple myeloma is unlikely to ever be tested in a prospective clinical study due to the large sample size required with long follow-up time, and consequent extreme costs. We found that multiple myeloma patients with prior knowledge of MGUS had significantly 15% better survival, despite having significantly more comorbidities. Interestingly, low-risk MGUS (with very low M-protein) had highest risk of death. The observation that low M-protein concentration at MGUS diagnosis was associated with poorer multiple myeloma survival may reflect less frequent clinical follow-up. Our observations stress the importance of clinical follow-up in MGUS, regardless of risk stratification. (more…)
Author Interviews, Breast Cancer, Duke, Genetic Research, JAMA, Personalized Medicine / 05.03.2015

Dr. Michaela A. Dinan Ph.D Department of Medicine Duke UniversityMedicalResearch.com Interview with: Dr. Michaela A. Dinan Ph.D Department of Medicine Duke University Medical Research: What is the background for this study? What are the main findings? Dr. Dinan: We wanted to examine how  Oncotype DX® Breast Cancer Test (ODX) was being used in real-world practice at the population level. ODX has been examined in clinical trials and limited academic settings but we know that these patients are often younger, have fewer medical comorbidities, and do not necessarily accurately reflect the majority patients with cancer.  In our study, we observed that Oncotype DX® Breast Cancer Test was being used predominately in accordance with guidelines which recommend the test for women with estrogen-receptor positive, disease. We also looked just at women under the age of 70 who met guideline criteria for testing, because this population would include those women who were more likely to be chemotherapy candidates, and we saw a rapid uptake of the test between 2005 and 2009, with use of the test increasing from 8% to 39%. (more…)
Author Interviews, Endocrinology, JAMA, Thyroid Disease / 05.03.2015

Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma RomaMedicalResearch.com Interview with; Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma Roma MedicalResearch: What is the background for this study? What are the main findings? Dr. Filetti: Thyroid nodule diagnosis is becoming more and more frequent in clinical practice. This trend stems largely from the incidental discovery of small nodules due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Ultrasound studies, for example, are widely used for evaluating other structures in the neck, such as the carotid arteries, parathyroid glands, lymph nodes, and salivary glands. Over 90% of detected thyroid nodules are clinically insignificant, in that they have been cytologically proven to be benign or they have no ultrasound features that raise the suspicion of malignancy. However, consensus is lacking regarding the best way to follow these nodules, mainly because little is known about the actual frequency and magnitude of their growth. The results of our study suggest that most benign nodules exhibit no significant size changes over time, and some actually decrease in size. Only a small subgroup of nodules can be expected to grow, about 15% in our series. However, the growth is slow and limited in magnitude. Most important, the occurrence of cancer is very rare in nodules like this, that appear to be benign. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 03.03.2015

MedicalResearch.com Interview with: Dr. Kevin Vagi, Ph.D Division of Violence Prevention, CDC’s Injury Center. MedicalResearch: What is the background for this study? What are the main findings? Dr. Vagi: Although there has been research on teen dating violence (TDV) for several decades, the subject has only received attention as a public health concern in recent years. Over time, prevalence estimates of physical teen dating violence victimization from CDC’s national Youth Risk Behavior Survey (YRBS) (first measured in 1999) have remained around 9% with similar rates among female and male students. Until recently, there have been no ongoing national studies of sexual TDV to our knowledge. This article describes new physical and sexual teen dating violence victimization questions first administered in the 2013 YRBS, shares the prevalence and frequency of TDV and national estimates using these new questions, and assesses associations of teen dating violence experience with health-risk behaviors. By including questions on both physical and sexual TDV, we are able to look at those youth who experienced physical TDV only, sexual TDV only, both physical and sexual TDV, any TDV, and none. These distinctions were important when investigating health outcomes associated with different types or combinations of TDV, as some health-risk behaviors have been shown to be associated with certain types of teen dating violence but not others. In 2013, among high school students who dated, 1 in 5 females and 1 in 10 males experienced physical and/or sexual TDV in the 12 months before the survey. The majority of students who experienced physical and sexual teen dating violence experience it more than once. Students who experienced both physical and sexual TDV are more likely to have other health-risks, such as suicidal ideation and behavior, fighting, carrying a weapon, being electronically bullied, alcohol and drug use, and risky sexual behaviors. This report also offers the first national estimate of sexual TDV. Findings suggest that comprehensive prevention efforts should focus on helping students develop healthy relationship skills to prevent teen dating violence and other risk behaviors. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease / 03.03.2015

Mallika L. Mendu, MD, MBA Division of Renal Medicine Brigham and Women’s Hospital, Harvard Medical School Boston, MAMedicalResearch.com Interview with: Mallika L. Mendu, MD, MBA Division of Renal Medicine Brigham and Women’s Hospital, Harvard Medical School Boston, MA MedicalResearch: What is the background for this study? What are the main findings? Dr. Mendu: Chronic kidney disease affects a significant number of adults in the United States, approximately 13%, and is associated with significant morbidity, mortality and cost. We conducted a review of 1487 patients referred for initial evaluation of chronic kidney disease to two academic medical centers in Boston over a 3-year period, and examined how often laboratory and imaging tests were ordered and how often these tests affected diagnosis and/or management. The main finding was that a number of tests (renal ultrasound, paraprotein testing, serologic testing) were commonly ordered despite low diagnostic and management yield. Urine quantification and hemoglobin A1c testing had the highest diagnostic and management yield. (more…)
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics, JAMA / 03.03.2015

MedicalResearch.com Interview with: Dr. Enrico Mossello Research Unit of Medicine of Ageing Department of Experimental and Clinical Medicine University of Florence MedicalResearch: What is the background for this study? What are the main findings? Dr. Mossello: In spite of the high prevalence of high blood pressure (HBP) and cognitive impairment in old age, their relationship is still controversial. While several (but not all) studies have identified high blood pressure as a risk factor for incident cognitive impairment, evidence regarding the prognostic role of blood pressure in cognitively impaired older subjects is scarce and inconsistent. To our knowledge, no longitudinal study has been published up to now regarding Ambulatory Blood Pressure Monitoring (ABPM) in subjects with cognitive impairment. Moreover recent European and American guidelines on HBP leave decisions on antihypertensive therapy of frail elderly patients to the treating physician and do not provide treatment targets for cognitively impaired patients. In the present cohort study of subjects with dementia and Mild Cognitive Impairment (MCI) low values of day-time systolic blood pressure measured with ABPM were associated with greater progression of cognitive decline after a median 9-month follow-up. This association was limited to subjects treated with anti-hypertensive drugs and was independent of age, vascular comorbidity and baseline cognitive level, holding significant both in dementia and in Mild Cognitive Impairment subgroups. A similar trend of association was observed for office systolic blood pressure, although this was weaker and did not reach statistical significance in all analyses. (more…)
Author Interviews, Heart Disease, JAMA, Nutrition / 03.03.2015

Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer EpidemiologistMedicalResearch.com Interview with: Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer Epidemiologist MedicalResearch: What is the background for this study? What are the main findings? Dr. Shu: Nuts are rich in nutrients, such as unsaturated fatty acids, fiber, vitamins, phenolic antioxidants, arginine, and other phytochemicals. These are all known to be beneficial to cardiovascular health, probably through their anti-oxidative, anti-inflammatory, and endothelial function maintenance properties.   Previous studies, primarily conducted in white and affluent populations, have shown that nut consumption may be related to cardiovascular health. Much of the nut consumption in those populations would be tree nuts. In our study, we found that peanut consumption was associated with reduced total mortality and CVD mortality in a predominantly low-income black and white population in the US, and among Chinese men and women living in Shanghai. Because peanuts are much less expensive than tree nuts, as well as more widely available to people of all races and all socioeconomic backgrounds, increasing peanut consumption may provide a potentially cost-efficient approach to improving cardiovascular health. (more…)
Author Interviews, JAMA, Pediatrics, Smoking / 03.03.2015

Rebecca S. Williams, MHS, PhD University of North Carolina at Chapel Hill Chapel Hill, NCMedicalResearch.com Interview with: Rebecca S. Williams, MHS, PhD University of North Carolina at Chapel Hill Chapel Hill, NC MedicalResearch: What is the background for this study?  Dr. Williams: In recent years, the e-cigarette industry has ballooned into a multi-billion dollar market, with at least 466 brands and 7764 unique flavors of e-cigarettes sold online. With both smokers and people who never smoked turning to e-cigarettes, there are concerns about their safety, lack of regulation and accessibility to teens. The CDC reported that 17% of high school seniors use e-cigarettes, more than twice as many as use traditional cigarettes; furthermore, that hundreds of thousands of youth annually are using e-cigarettes who never smoked cigarettes. Our previous studies of Internet cigarette sales indicated that Internet Tobacco Vendors did a poor job of preventing sales to minors, which helped inform development of state and federal regulations to regulate such sales.  In 2013, North Carolina passed a law requiring age verification for online e-cigarette sales. This study was the first study to examine age verification used by Internet e-cigarette vendors and the first to assess compliance with North Carolina’s e-cigarette age verification law. MedicalResearch: What are the main findings? Dr. Williams: It was very easy for minors to buy e-cigarettes online. It took little effort for them to bypass the age verification practices of the vendors because there was very little use of rigorous age verification.  With only 5 orders rejected by vendors due to age verification, there was a youth e-cigarette purchase success rate of 94.7%.  No vendors used age verification at delivery, and few used rigorous methods of age verification that could potentially block youth access. While 7 vendors claimed to use age verification techniques that could potentially comply with North Carolina’s law, only one actually did. (more…)
Author Interviews, JAMA, Outcomes & Safety, Surgical Research / 03.03.2015

MedicalResearch.com Interview with: Dr. Stephen Duquette MD Indiana University Department of Surgery, Division of Plastic Surgery R.L Roudebush VA  Indianapolis, IN Medical Research: What is the background for this study? What are the main findings? Dr. Duquette: Carpal tunnel syndrome is the most common compressive peripheral neuropathy, causing pain, numbness and weakness.  Conservative treatment options include splinting, NSAID pain medications, and steroid injections.  Most often the definitive therapy is carpal tunnel release (CTR).  Over 500,000 procedures are performed in the US yearly, making it one of the most commonly performed hand surgery procedures.  In the United States it is most common to perform this operation in the operating room, under sedation and locoregional anesthesia.  Because it is a very common disease that is treated surgically, process improvement can have a major impact in time to OR, patient recovery, patient satisfaction, and overall throughput.  This is especially valuable in the Veterans Administration (VA) system, where recent problems have arisen due to lack of adequate resources to care for all veterans. This study examined the impact of opening an office-based procedure room in a VA to perform awake hand surgery under local anesthesia only.   This was compared to the prior practice of operating room carpal tunnel release though a number of performance metrics, including time to OR and complications.  Although office carpal tunnel releases are performed routinely in Canada, some surgeons still believe that the complications would increase outside the very sterile environment of the operating room. The current study showed that wait times from initial consultation and initial visit to surgical intervention were significantly decreased in the procedure room group compared to the operating room.  The complication rate was the same for both groups, showing that the procedure room and the operating room were both equally safe and efficacious in providing an environment that was ideal for the performance of carpal tunnel releases. (more…)