Author Interviews, JAMA, Sleep Disorders / 16.02.2015

David S. Black, Ph.D., M.P.H. Associate Professor of Preventive Medicine Keck School of Medicine of USC.MedicalResearch.com Interview with: David S. Black, Ph.D., M.P.H. Associate Professor of Preventive Medicine Keck School of Medicine of USC. Medical Research: What is the background for this study? What are the main findings? Dr. Black: Sleep disturbances pose a significant medical and public health concern for our nation’s aging population. An estimated 50% of people aged 55 years and older suffer from some form of sleep problem, including initiating and maintaining sleep. Sleep can be affected by a number of things. There are obvious factors like disturbances, dealing with insomnia or any form of aches and pains. But there is also one that many people have probably not considered. Traffic noise. Just like the factors listed previously, there is always a solution to a problem. There isn't anything that cannot be fixed. If you are someone that is having trouble sleeping due to the high level of traffic noises around your area, it may be best to look into a site like soundproofpanda.com to find a solution that can help reduce this issue and eventually provide you with a good's night sleep. Older adults report the highest prevalence of sleep problems compared to younger age groups when quantified by both self-report and biological assessment. Moderate sleep complaints in older adults are often associated with deficits in daytime functioning, including elevated levels of fatigue, disturbed mood such as depressive symptoms and reduced quality of life, and lead to the onset of clinical insomnia. Addressing moderate sleep complaints and sleep-related daytime dysfunction using community-accessible programs is a promising public health approach. Our main findings indicate that the mindfulness training program, which is available to the general community, resulted in improvement in sleep quality at post-intervention relative to a highly active and standardized sleep hygiene education program. Effect size for improvement in sleep quality was large (0.89) and of clinical relevance considering that effect sizes obtained from all types of behavioral interventions on self-reported sleep quality outcomes averages 0.76 in older adults. Meta-analyses comparing treatment modalities indicate that the mean effect size for self-reported sleep improvements resulting from pharmacotherapy (0.87) (i.e., benzodiazepines, benzodiazepine receptor agonists) and behavioral therapy (0.96) are of medium-to-large magnitude in mixed-age adult samples with primary insomnia. Thus, our observed changes are consistent with previous studies and are at the level of a minimally important difference for insomnia severity. The mindfulness program also yielded relative improvements on sleep-related daytime impairments of depression and fatigue symptoms that were of medium-to-large effect size. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania / 13.02.2015

Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PAMedicalResearch.com Interview with: Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PA Editor’s note: Dr. Emanuel is a medical oncologist as well as director of the department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel was kind enough to answer several questions regarding his most recent study, published in the new JAMA Oncology journal, Patient Demands and Requests for Cancer Tests and Treatments. Medical Research: What is the background for this study? What are the main findings? Dr. Emanuel: The genesis for this study is twofold. One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers...all were more to blame than doctors themselves for the high cost of US health care. Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience. In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters). We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means. (more…)
Author Interviews, JAMA, Mental Health Research, UCSF / 12.02.2015

Carol Mathews UCSF Professor, Psychiatry UCSF School of MedicineMedicalResearch.com Interview with: Carol Mathews Professor, Psychiatry UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Mathews: The background for this study is that, as a part of ongoing genetic studies of Tourette Syndrome, the Tourette Syndrome Association International Genetics Collaborative (TSAICG) has collected a wealth of information about commonly co-occurring psychiatric disorders in individuals with Tourette Syndrome and their families, providing us with an opportunity to explore questions about Tourette Syndrome that are relevant to individuals with Tourette Syndrome, their families, and their treating clinicians. (more…)
Author Interviews, Cancer Research, JAMA, MD Anderson, Outcomes & Safety / 12.02.2015

Kenneth L. Kehl, MD Division of Cancer Medicine, MD Anderson Cancer Center Houston, TexasMedicalResearch.com Interview with: Kenneth L. Kehl, MD Division of Cancer Medicine, MD Anderson Cancer Center Houston, Texas Medical Research: What is the background for this study? What are the main findings? Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions.  We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication.  We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication.  This effect was independent of patients' stated preferences regarding involvement in decision-making. (more…)
Author Interviews, JAMA, Mental Health Research / 12.02.2015

Elizabeth Walker, PhD, MPH, MAT FIRST Postdoctoral Fellow Center for Behavioral Health Policy Studies Rollins School of Public Health, Emory UniversityMedicalResearch.com Interview with: Elizabeth Walker, PhD, MPH, MAT FIRST Postdoctoral Fellow Center for Behavioral Health Policy Studies Rollins School of Public Health, Emory University   Medical Research: What is the background for this study? Response: Mental disorders are a major cause of disability globally and are associated with premature mortality.  Quantifying and understanding excess mortality among people with mental disorders can inform approaches for reducing this burden.  The purpose of this study was to systematically review the literature in order to estimate individual- and population-level mortality rates associated with mental disorders.  We conducted a comprehensive systematic review and meta-analysis, which included 203 studies from 29 countries. Medical Research: What are the main findings? Response: We estimated that 8 million deaths worldwide per year are attributable to mental disorders.  People with mental disorders have over 2 times the risk of mortality compared to the general population or people without mental disorders.  This translates to a median of 10 years of life lost.  In total, 67.3% of people with mental disorders died from natural causes, 17.5% from unnatural causes, and the remainder from unknown causes. (more…)
Author Interviews, Dermatology, JAMA / 11.02.2015

Omar A. Ibrahimi, M.D., Ph.D Connecticut Skin Institute Founding Medical Director Stamford, CT 06905MedicalResearch.com Interview with: Omar A. Ibrahimi, M.D., Ph.D Connecticut Skin Institute Founding Medical Director Stamford, CT 06905 www.ctskindoc.com Medical Research: What is the background for this study? What are the main findings? Dr. Ibrahimi: The delivery of healthcare in a efficient and cost effective fashion is one of the largest themes in medicine today. Malpractice lawsuits have steadily increased with the cost of healthcare delivery. Mohs surgery involves the surgical removal, the tissue analysis and the reconstruction of a skin cancer all in a single visit that bundles multiple procedures in a cost effective manner that is proposed to be the gold standard for treating certain skin cancers. Information regarding malpractice involving Mohs surgery is lacking. The only previous study that has been done was a survey of Mohs surgeons looking at how many had been involved in lawsuits and the reasons for being involved. Our study examined a legal database to identify all the lawsuits involving Mohs surgery and skin cancer. We were surprised to find that the majority of lawsuits involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis, cosmetic outcome issues, lack of informed consent, and a delay of or failure in referral to a Mohs surgeon. (more…)
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA / 10.02.2015

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School | University of Oxford Oxford United KingdomMedicalResearch.com Interview with: Prof. Kazem Rahimi  DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease. We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes. (more…)
Author Interviews, Genetic Research, JAMA, Personalized Medicine / 09.02.2015

Andres Moreno De Luca, MD Investigator and Resident Physician Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822MedicalResearch.com Interview with: Andres Moreno De Luca, MD Investigator and Resident Physician Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822   Medical Research: What is the background for this study? What are the main findings? Response: The main finding of our study is that family background contributes to the variability in cognitive, behavioral, and motor performance seen in children with 16p11.2 deletions, and perhaps other genetic syndromes, and this may be attributed in part to genetic background effects. In the general population the best predictor of a child’s outcomes in traits such as cognitive ability, height, BMI, etc. is the biparental mean performance in such domains and this is due in part to genetic background. For example, if a child’s parents have IQ scores of 130 and 110, it is expected that the child will have an IQ within 2 standard deviations of 120 (bi-parental mean). However, when studying individuals with genetic conditions, most researchers tend to overlook the influence of familial/genetic background on the affected child’s outcomes and commonly attribute the manifestations (or lack thereof) to the genetic mutation alone. This creates confusion when studying children with neurodevelopmental disorders, such as autism, which show significant clinical variability, as some children with a specific genetic mutation (e.g. deletion 16p11.2) may have intellectual disability without autism, while other children with the same mutation may have autism without intellectual disability. Based on these observations, some researchers have argued that deletion 16p11.2 is incompletely penetrant. However, our study showed that the 16p11.2 deletion has a detrimental effect on cognitive and behavioral performance for all children, but the clinical status (affected vs. unaffected) and ultimate performance level is influenced by the parental performance. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 09.02.2015

MedicalResearch.com Interview with: Torsten Olbers MD, PhD Assistant Professor of Surgery Sahlgrenska University Hospital Gothenburg, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th. (more…)
Author Interviews, Dermatology, JAMA, OBGYNE, UC Davis / 05.02.2015

MedicalResearch.com Interview with: Dr. Eleanor B. Schwarz, M.D., M.S University of California, Davis Sacramento, CA MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Schwarz: The background for this study is that… Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects. Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard). (more…)
Author Interviews, JAMA / 04.02.2015

John Holcomb, M.D. Principal investigator, Retired U.S. Army Surgeon Director of the Division of Acute Care Surgery The University of Texas Health Science Center at Houston UTHealth Medical SchoolMedicalResearch.com Interview with John Holcomb, M.D. Principal investigator, Retired U.S. Army Surgeon Director of the Division of Acute Care Surgery The University of Texas Health Science Center at Houston UTHealth Medical School MedicalResearch: What is the background for this study? Dr. Holcomb: This study is the result of two decades of work by literally hundreds of investigators. It started as an observation in 1993 in Somalia that whole blood was a superior resuscitation product in casualties that were bleeding to death. Unfortunately, whole blood is not widely available, and 1:1:1 is the closest we can get at this time. After many studies from the battlefield, and even more in the civilian area, we have now published a randomized study documenting that 1:1:1 is a superior transfusion strategy, safe and helps prevent patients from bleeding to death. MedicalResearch: What are the main findings? Dr. Holcomb: The 1:1:1 resuscitation strategy significantly decreased the rate of bleeding to death, and there were no increased complications between groups. (more…)
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 03.02.2015

Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, IllinoisMedicalResearch.com Interview with: Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, Illinois     MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Merkow: The measurement of hospital readmissions has become an important quality and cost-containment metric. Hospitals, policy makers, and individual practitioners are closely tracking readmissions. For the past decade the focus has been primarily on three medical conditions (pneumonia, heart failure and myocardial infarction) and although controversial, many thought leaders and policy makers believed that readmissions were preventable, and stemmed from poor transition of care, outpatient follow up or simply a failure of the medical system to appropriately care for these patients. Recently, the Center for Medicare and Medicaid Services has become increasingly interested in using readmissions as a quality measure and is now mandated by the Hospital Readmission Reduction Program to track hospital-wide readmissions (including all surgical patients), and for the first time, after individual surgical procedures (i.e., total hip and knee replacement). Future inclusion of additional surgical procedures is anticipated. However, despite the growing focus on readmissions after surgery, there have been few studies comprehensively evaluating the underlying reasons and factors associated with readmissions after surgical hospitalizations. Furthermore, the relationship between readmissions and complications that occur during the initial hospitalization after surgery is not clearly established. Importantly, unlike medical conditions, surgical patients undergo a discrete invasive event with known risks of complications. By studying this topic, initiatives to decrease readmissions can be more precisely determined, and national policy decisions that are now targeting readmissions can be appropriately formulated. The primary findings of our study identified surgical site infections as the most frequent reason that patients are readmitted after surgery, Importantly, in >95% of patients this complication was new, occurring after they left the hospital. The other common reason for readmission was obstruction or ileus, which was the second most frequent reason for readmission, particularly after abdominal surgery. Overall, the vast majority of readmissions were the result of new postdischarge, postoperative complications. With respect to factors associated with readmissions, most of the variation was due to differences in patient factors, such as ASA class, renal failure, ascites and/or steroid use. (more…)
Author Interviews, JAMA, Outcomes & Safety, University of Michigan / 03.02.2015

Nicholas Osborne, M.D., M.S Vascular Surgery Fellow University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Dr. Osborne: The American College of Surgeons launched the National Surgical Quality Improvement Program (ACS-NSQIP) in the early 2000s. This program collects and reports surgical outcomes to participating hospitals. One retrospective study of participating hospitals in the ACS-NSQIP reported improvements in risk-adjusted outcomes with participation. This study, however, did not compare ACS-NSQIP hospitals to control hospitals. The purpose of our study was to compare ACS-NSQIP to similar non-participating hospitals over time and determine whether participation in the ACS-NSQIP was associated with improved outcomes. MedicalResearch.com: What are the main findings? Dr. Osborne: When comparing hospitals participating in a national quality reporting program (ACS-NSQIP) to similar hospitals, there is no appreciable improvement in outcomes (mortality, morbidity, readmissions or cost)  outside of pre-existing trends across all hospitals. In other words, Hospitals nationwide were improving over this same time period and ACS-NSQIP hospitals did not improve above and beyond these existing trends. (more…)
Author Interviews, Hepatitis - Liver Disease, JAMA, University of Pittsburgh / 03.02.2015

Adeel A. Butt, MD, MS, FACP, FIDSA Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of MedicineMedicalResearch.com Interview with: Adeel A. Butt, MD, MS, FACP, FIDSA Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of Medicine   MedicalResearch: What is the background for this study? What are the main findings? Dr. Butt: Studying clinical consequences of hepatitis C virus (HCV) infection is often limited by the lack of knowledge of actual time of infection. We used the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES), a well-established national cohort of HCV infected veterans and corresponding HCV-uninfected controls, to identify patients with a known time frame for HCV infection. Our primary aim was to determine the rate of liver fibrosis progression among HCV-infected persons over time, with and to determine factors associated with development of cirrhosis and hepatic decompensation among these persons. Among 1840 persons who were HCV+ and 1840 HCV− controls, we found that fibrosis progression started early after HCV infection tapered off after 5 years. After 10 years of follow-up, 18.4% of HCV+ and 6.1% of HCV- persons developed liver cirrhosis. Nine years after diagnosis of cirrhosis, only 1.8% of HCV+ and 0.3% of HCV- persons had developed hepatic decompensation. (more…)
Author Interviews, JAMA, Prostate Cancer, Radiology / 29.01.2015

MedicalResearch.com Interview with: Mohummad Minhaj Siddiqui, MD AssiMohummad Minhaj Siddiqui, MD Assistant Professor of Surgery - Urology Director of Urologic Robotic Surgery University of Maryland School of Medicine andstant Professor of Surgery - Urology Director of Urologic Robotic Surgery University of Maryland School of Medicine and Peter A. Pinto, M.D Head, Prostate Cancer Section Director, Fellowship Program Urologic Oncology Branch National Cancer Institute National Institutes of Health Bethesda, Maryland 20892-1210 Peter A. Pinto, M.D Head, Prostate Cancer Section  Director, Fellowship Program Urologic Oncology Branch National Cancer Institute  National Institutes of Health  Bethesda, Maryland Medical Research: What is the background for this study? What are the main findings? Response: For men suspected of having prostate cancer due to an elevated PSA or abnormal digital rectal exam, the next step in their diagnostic workup has traditionally been a standard 12-core biopsy to evenly sample the entire gland.  Unlike most other cancers, prostate cancer is one of the few solid tumors left which is diagnosed by randomly sampling the gland with the hope of biopsying the tumor, if it is present.  This paradigm has been largely due to the fact that imaging to date has been limited in its ability to identify prostate cancer.  Recent advancements in multiparametric MRI of the prostate however has significantly improved clinician's ability to identify regions in the prostate suspicious for cancer.  This has led to the emergence of MR/Ultrasound fusion technology which allows for targeted biopsy of the prostate into regions suspicious for cancer. Although conceptually, it makes sense that a targeted biopsy has the potential to perform better than the standard random sampling of the prostate in the diagnosis of prostate cancer, studies were needed to understand if this is true, and if so, if the improvement was substantial enough to justify the extra expense and effort needed to obtain a MRI guided biopsy.  This study performed at the National Cancer Institute's Clinical Center sought to address this clinical question of interest.  From 2007-2014, a total of 1003 men suspected to have prostate cancer underwent an MRI of the prostate.  If an area of suspicion was seen in the prostate, these men underwent both the targeted biopsy of the suspicious region in the prostate as well as the standard 12-core needle biopsy during the same session.  The results from the targeted biopsy were compared to the results of the standard biopsy. The key findings in this study was that targeted biopsy improved the rate at which high-risk clinically significant cancer was diagnosed by 30%.  Of interest, the study also found that low-risk, clinically insignificant disease (the type of prostate cancer that is unlikely to cause any harm to the patient over the course of his natural life) was decreased in diagnosis by 17%.  Decrease of diagnosis of such disease has the potential benefit that it could lead to less over-treatment of cancer that never needed to be treated.  In a subset of 170 men that ultimately underwent surgery to remove the prostate to treat their cancer, we were further able to examine how well the prostate biopsy reflected the actual cancer burden in the whole gland.   It is well known that standard biopsy can actually underestimate the total cancer grade in the whole prostate in upwards of 30-40% of cases.  We found that the targeted biopsy was significantly better at predicting whether the patient had intermediate to high-risk cancer compared to standard biopsy.  Through further analysis using a statistical method called decision curve analysis, we further found that for men who wish to undergo surgery for intermediate to high-risk cancer, but wish to go on active surveillance for low-risk cancer, targeted biopsy led to better decision making compared to standard biopsy, or even the two techniques combined. (more…)
Author Interviews, Geriatrics, Hearing Loss, JAMA / 28.01.2015

Margaret T. Dillon, AuD University of North Carolina School of MedicineMedicalResearch.com Interview with: Margaret T. Dillon, AuD University of North Carolina School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Dillon: The goal of this study was to evaluate whether age at revision cochlear implantation influences post-revision speech perception performance. A cochlear implant is an implantable auditory prosthesis that aims to provide sound to patients with certain degrees of hearing loss, by converting and transmitting the acoustic sound into electric stimulation. Research has shown cochlear implant recipients experience improved speech perception in quiet and noise as compared to preoperative performance with conventional amplification (ie, hearing aids). There is variability in postoperative performance. Understanding the cause or causes of this variability is the primary goal of a number of research studies. One suspected indicator for this variability is advanced age at the time of surgery. Though the incidence of revision cochlear implantation is low, it may be warranted when the internal device is no longer functional or not functioning optimally. We reviewed the pre-revision and post-revision speech perception performance of younger (< 65 years of age) and older (> 65 years of age) adult cochlear implant recipients. There was no difference between the post-revision speech perception performance between the two groups. (more…)
Author Interviews, Cognitive Issues, JAMA / 26.01.2015

Shelly L. Gray, PharmD, MS Professor of Pharmacy School of Pharmacy, University of Washington, SeattleMedicalResearch.com Interview with: Shelly L. Gray, PharmD, MS Professor of Pharmacy School of Pharmacy, University of Washington, Seattle Medical Research: What is the background for this study? What are the main findings? Dr. Gray: Many medications have anticholinergic effects such as those used to treat overactive bladder, seasonal allergies, and depression.  The general view is that anticholinergic-induced cognitive impairment is reversible, however, emerging evidence suggests that these medications may be associated with increased dementia risk.  We conducted a prospective population-based cohort study in 3434 older adults to examine whether cumulative anticholinergic medication use is associated with increased risk of incident dementia.  Using automated pharmacy data, we found that higher 10-year cumulative dose was associated with increased risk for dementia and Alzheimer disease over an average of 7.3 years of follow-up.  In particular, people with the highest use (e.g. taking the equivalent of oxybutynin 5 mg/day or chlorpheniramine 4 mg/day for longer than 3 years) were at greatest risk. (more…)
Author Interviews, JAMA, Ophthalmology / 26.01.2015

MedicalResearch.com Interview with: Simone L. Li, PhD Retina Foundation of the Southwest Dallas, Texas Medical Research: What is the background for this study? What are the main findings? Dr. Li: In a previous study, we found that binocular iPad game play significantly improved visual acuity in the amblyopic eye. The purpose of the current study was to determine the longevity of these effects and we found that the visual acuity improvements obtained with binocular iPad game play had been retained for at least 12 months after the treatment ended. (more…)
Author Interviews, JAMA, Mental Health Research / 23.01.2015

MedicalResearch.com Interview with: David P.G. van den Berg PhD student Clinical Psychologist Cognitive behavioural therapist Parnassia Psychiatric Institute Early Detection and Intervention Team (EDIT) Zoutkeetsingel, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The last decade it has become clear that many people with psychotic disorders suffered severe childhood trauma. These experiences enhance chances of developing psychosis, but also result in comorbid posttraumatic stress disorder (PTSD). PTSD is highly prevalent in patients with psychotic disorders and negatively influences prognosis and wellbeing. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective treatments and recommended as first choice treatments in PTSD guidelines worldwide. Although there is no evidence to support this, patients with psychosis are excluded from PTSD treatment due to fear of destabilization or psychotic decompensation. Moreover, psychosis is the most used exclusion criterion in PTSD trials. This is the first randomized clinical trial (RCT) of the efficacy of PTSD treatment in psychosis. In this RCT 155 patients with a psychotic disorder and comorbid PTSD were randomly assigned to PE, EMDR or Waiting List (WL). In the treatment conditions participants received 8 sessions of 90-minutes therapy. Standard protocols were used. Treatment was not preceded by stabilizing psychotherapeutic interventions or skills training. The first session comprised psycho-education about PTSD and target selection. In sessions 2 to 8 traumas were treated, starting with the most distressing experience. Baseline, post-treatment and 6-month follow-up assessments were made. Participants in both PE and EMDR showed greater reduction of PTSD symptoms than those in WL. Between group effect sizes were large. About sixty percent of the participants in the treatment groups achieved loss of diagnosis. Treatment effects were maintained at six-month follow-up for both PE and EMDR. Treatments did not result in serious adversities. (more…)
Author Interviews, Genetic Research, JAMA, Ophthalmology / 21.01.2015

Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne UniversityMedicalResearch.com Interview with: Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne University MedicalResearch: What is the background for this study? What are the main findings? Prof. Mackey: Too much or too little sun? Excessive sun exposure is associated with the eye disease pterygium, while lack of outdoor activity in childhood increases the risk of myopia (short sightedness). Measuring the amount of early sun damage to a person’s eyes would be of great use to researchers and potential use in clinical practice. Over the last few years we have developed a biomarker for sun exposure to the eye by photographing Conjunctival UV Auto-Fluorescence (CUVAF). The study published in JAMA Ophthalmology looked at the genetic and environmental factors that contribute to CUVAF levels in three Australian studies from Tasmania, Perth and Brisbane. People who live in sunnier environments closer to the equator have more evidence of sun damage using CUVAF.  However, genetic factors also play a role. (more…)
Author Interviews, Brigham & Women's - Harvard, Geriatrics, Hospital Readmissions, JAMA, Surgical Research / 21.01.2015

Thomas C. Tsai, MD, MPH Departments of Surgery and Health Policy and Management Harvard School of Public Health, Boston, Massachusetts MedicalResearch.com Interview with: Thomas C. Tsai, MD, MPH Departments of Surgery and Health Policy and Management Harvard School of Public Health, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Dr. Tsai: Emerging evidence is suggesting that fragmented care is associated with higher costs and lower quality. For elderly patients undergoing major surgical procedures, fragmentation of care in the post-discharge period may be especially problematic. We therefore hypothesized that elderly patients receiving fragmented post-discharge care would have worse outcomes. We found that among Medicare patients who are readmitted after a major surgical operation, one in four are readmitted to a different hospital than the one where the original operation was performed. Even taking distance traveled into account, we find that this type of postsurgical care fragmentation is associated with a substantially higher risk of death. (more…)
Author Interviews, Baylor College of Medicine Houston, JAMA, Mental Health Research / 21.01.2015

M. Justin Coffey MD Associate Professor Menninger Department of Psychiatry & Behavioral Sciences Baylor College of MedicineMedicalResearch.com Interview with: M. Justin Coffey MD Associate Professor Menninger Department of Psychiatry & Behavioral Sciences Baylor College of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Coffey: Although both the US Surgeon General and the Institute of Medicine have called on health care systems to reduce suicide, the few assessments of suicide in such systems have examined only specific patient groups and not the entire population of health plan members. Our study reports the first information on suicide for the entire membership of a large health maintenance organization (HMO). The findings provide a previously unavailable baseline data for health care systems who are engaged in important efforts to measure and prevent suicide. We identified all suicides among the entire membership of our HMO network between 1999 and 2010, determining the date and cause of death using official state mortality records. In our sample, the annual suicide rate among all HMO members (including non-patient members) did not change over time, whereas the annual suicide rate in the general population of the state of Michigan increased significantly. Importantly, suicides actually decreased among HMO members who received specialty mental health services, whereas suicides increased among HMO members who accessed general medical services but not specialty mental health services.   (more…)
Author Interviews, Education, JAMA / 21.01.2015

Dr. Juliane Kämmer Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality Berlin GermanyMedicalResearch.com Interview with: Dr. Juliane Kämmer  Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality  Berlin Germany Medical Research: What is the background for this study? What are the main findings? Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy). In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error. (more…)
Author Interviews, CDC, JAMA, OBGYNE / 20.01.2015

Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention, Atlanta, GeorgiaMedicalResearch.com Interview with: Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Boulet:  Intracytoplasmic Sperm Injection is generally considered a safe and effective treatment for male factor infertility; however, some studies have shown that ICSI is increasingly used in patients without male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). In addition to increasing the cost of an IVF cycle, use of  Intracytoplasmic Sperm Injection has been found to increase the risk for adverse infant outcomes such as birth defects, chromosomal abnormalities and autism. Using data from CDC’s National Assisted Reproductive Technology Surveillance System, we found that use of ICSI increased by fourfold from 1996 through 2012 (from 15.4% to 66.9%). Furthermore, we found that use of  Intracytoplasmic Sperm Injection did not improve reproductive outcomes such as rates of pregnancy, miscarriage and live birth, when compared with conventional IVF, regardless of whether male factor infertility was present. (more…)
Aging, Author Interviews, Heart Disease, JAMA, Salt-Sodium / 19.01.2015

Andreas Kalogeropoulos, MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Emory Clinical Cardiovascular Research Institute Atlanta GA 30322MedicalResearch.com Interview with: Andreas Kalogeropoulos, MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Emory Clinical Cardiovascular Research Institute Atlanta GA 30322 Medical Research: What is the background for this study? What are the main findings? Dr. Kalogeropoulos: There is ongoing debate on how low should we go when it comes to dietary sodium (salt) restriction recommendations. In this study, we examined the association between self-reported dietary sodium intake and 10-year risk for death, cardiovascular disease, and heart failure in approximately 2,600 adults 71-80 years old. The subjects (women: 51.2%; white: 61.7%; black: 38.3%) were participants of the community-based Health, Aging, and Body Composition Study, which is sponsored by NIH and focuses on aging processes, i.e. was not specifically designed to address the issue of dietary salt intake. Also, it is important to note that salt intake was self-reported (not objectively measured) using a food frequency questionnaire, which underestimates salt intake. Keeping these limitations in mind, we did not observe a significant association between self-reported sodium intake and 10-year mortality, cardiovascular disease, and heart failure. Ten-year mortality was lower in the group reporting 1500–2300 mg daily sodium intake (30.7%) compared to those reporting daily intake less than 1500 mg (33.8%) or over 2300 mg (35.2%); however, this difference was not statistically significant. The 10-year event rates for cardiovascular disease (28.5%, 28.2%, and 29.7%) and heart failure (15.7%, 14.3%, and 15.5%) were also comparable across the <1500-mg, 1500-2300-mg, and >2300-mg dietary sodium intake groups. (more…)
Author Interviews, Columbia, JAMA, Neurological Disorders / 19.01.2015

Jose Gutierrez MD, MPH Assistant Professor of Neurology Division of Stroke and Cerebrovascular Disease Columbia University Medical Center NY, NYMedicalResearch.com Interview with: Jose Gutierrez MD, MPH Assistant Professor of Neurology Division of Stroke and Cerebrovascular Disease Columbia University Medical Center NY, NY Medical Research: What is the background for this study? What are the main findings? Dr. Gutierrez: There is growing interest in the effects of vascular health in cognition. The prevailing thought is that vascular disease leads to worse cognition due to direct structural damage of the brain, as in the case of brain infarcts, microhemorrhages or white matter hyperintensities, which are themselves associated with traditional cardiovascular risk factors such as hypertension, diabetes, smoking etc. Arterial stiffness, particularly of the aorta, has gained interest among researchers as predictors of vascular disease and worse cognition, but it is not clear whether arterial stiffness in the absence of traditional definition of vascular disease may be associated with worse cognition. We investigated in a representative sample of the US among adults 60 years or older who underwent cognitive testing with the Digit Symbol Subtraction test and who also had other measures of vascular disease, including blood workup, blood pressure measurement and Pulse pressure. We hypothesized that indirect measures of arterial stiffness such as ABI > 1.3 or pulse pressure would be associated with worse cognition, even among those without any clinical vascular disease or traditional vascular risk factors. We Included 2573 US adults in the sample, segregated those with any self-reported vascular disease or vascular risk factors and we found that among those without vascular disease or risk factors, an ABI > 1.3 and increased intra-visit blood pressure variability were predictors of worse cognitive performance compared with those without these indicators. Among participants with both indirect markers of arterial stiffness, their cognitive performance was worse that having only one of them suggesting additive effects of these two variables. (more…)
Aging, Author Interviews, JAMA, Lifestyle & Health / 19.01.2015

Jane Wardle University College London MedicalResearch.com Interview with: Jane Wardle University College London Medical Research: What is the background for this study? What are the main findings? Dr. Wardle: Previous studies have shown that couples tend to have similar health behaviours to one another, but no studies had compared having a partner who takes up a healthy behaviour (e.g. quits smoking) with having one whose behaviour is consistently healthy (e.g. never smoked). Nor have there been other studies in the older age group – our participants were over 60 on average.  We used data from 3722 couples participating in the English Longitudinal Study of Ageing (ELSA) to explore this issue for three behaviours: smoking, physical activity, and weight loss. For each behaviour, we found that when one partner changed their behaviour, the other partner was more likely to make a positive change, and the effect was stronger than having a partner whose behaviour was consistently healthy (i.e. never smoked/always exercised). (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Surgical Research / 18.01.2015

Soko Setoguchi, MD DrPH Assistant Professor of Medicine Harvard Medical School and Harvard School of Public Health Director of Safety and Outcome Research in Cardiology Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s HospitalMedicalResearch.com Interview with: Soko Setoguchi, MD DrPH Assistant Professor of Medicine Harvard Medical School and Harvard School of Public Health Director of Safety and Outcome Research in Cardiology Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Setoguchi: Medicare made a decision to cover Carotid Artery Stenting (CAS) in 2005 after publication of SAPPHIRE, which demonstrated the efficacy of Carotid Artery Stenting (CAS) vs Carotid endarterectomy (CEA) in high risk patients for CEA. Despite the data showing increased carotid artery stenting dissemination following the 2005 National Coverage Determination, peri-procedural and long-term outcomes have not been described among Medicare beneficiaries, who are quite different from trial patients, older and with more comorbidities in general population. Understanding the outcomes in these population is particularly important in the light of more recent study, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which established CAS as a safe and efficacious alternative to CEA among non-high-surgical risk patients that also expanded the clinical indication of carotid artery stenting. Another motivation to study ‘real world outcomes in the general population is expected differences in the proficiency of physicians peforming stenting in trial setting vs. real world practice setting. SAPPHIRE and CREST physicians were enrolled only after having demonstrated CAS proficiency with low complication rates whereas hands-on experience and patient outcomes among real-world physicians and hospitals is likely to be more diverse. We found that unadjusted mortality risks over study period of 5 years with a mean of 2 years of follow-up in our population was 32%.  Much higher mortality risks observed among certain subgroups with older age, symptomatic patients and non-elective hospitalizations. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medicare, Mental Health Research, Pharmacology / 16.01.2015

Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical SchoolMedicalResearch.com Interview with: Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical School   Medical Research: What is the background for this study? What are the main findings? Dr. Madden: When Medicare Prescription Drug Coverage started in 2006, many experts voiced concerns about disabled patients with serious mental illness making the transition from state Medicaid coverage to Medicare.  Our study is one of the first to examine the impact of the transition in mentally ill populations.  People living with schizophrenia and bipolar disorder are at high risk of relapse and hospitalization and are especially vulnerable to disruptions in access to their treatments. We found that the effects of transitioning from Medicaid to Medicare Part D depended on where patients lived.  Transition to Part D in states that put limits on Medicaid drug coverage resulted in fewer patients going without treatment. By contrast, in states with more generous drug coverage, we saw reductions in use, of antipsychotics in particular, after patients shifted to Medicare Part D.  This may have been due to new cost controls used within many private Medicare drug plans.  Given that most states in the US are in this latter category, with the relatively generous Medicaid drug coverage, we also found reductions in antipsychotic use nation-wide. Although a very large group of people made that transition from Medicaid to Medicare in 2006, thousands more still transition every year because when disabled people qualify for Medicare, they must wait 2 years for their benefits kick in.  Also, many other disabled patients are on Medicaid only and don’t qualify for Medicare.  They are of course affected by restrictions on Medicaid coverage, which vary from state to state. (more…)