Author Interviews, Hospital Acquired, JAMA, Outcomes & Safety, Surgical Research / 12.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23379" align="alignleft" width="128"]Christina A. Minami, MD Surgical Outcomes and Quality Improvement Center Department of Surgery, Feinberg School of Medicine, Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Illinoi Dr. Christina Minami[/caption] Christina A. Minami, MD Surgical Outcomes and Quality Improvement Center Department of Surgery, Feinberg School of Medicine, Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Illinois MedicalResearch.com: What is the background for this study? Dr. Minami: An earlier study by our group demonstrated a seemingly paradoxical relationship between hospital quality and hospital penalization in the Hospital-Acquired Condition, or HAC, Reduction Program. Basically, of those hospitals that were penalized more frequently were those that were major teaching hospitals, had more quality accreditations, and had better performance on process and outcome measures. When CMS released that surgical-site infections were going to be added to the HAC scoring, we decided to see if these additional measures might exhibit the same paradoxical association between quality and penalization. MedicalResearch.com: What are the main findings? Dr. Minami: The SSI measures follow the same trend as was previously illustrated. Basically, the hospitals who were in the bottom 25% (that is, those who were the worst performers) were more often those that were major teaching hospitals, with more quality accreditations, and offered more advanced services. It’s possible that this is due in part to surveillance bias, or “the more you look, the more you find” phenomenon. Also, what do we really call an infection? The National Healthcare Safety Network has specific definitions and guidelines, but there are still different data collections used by different hospitals.
Author Interviews, End of Life Care, JAMA / 12.04.2016

MedicalResearch.com Interview with: Nancy L. Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Nancy L. Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Schoenborn: A growing body of research recommend that clinicians should consider patients’ life expectancy in a number of clinical decisions, but it is not clear how primary care clinicians approach these recommendations. We interviewed primary care clinicians to understand their perspectives on this topic. We found that clinicians describe a number of barriers and ambiguities in using long-term life expectancy to inform medical decisions; they also varied widely in their approaches to assess and to discuss life expectancy.
Author Interviews, Multiple Sclerosis, PNAS / 12.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23383" align="alignleft" width="141"]Dr-Christian-Gruber.jpg Dr. Christian Gruber[/caption] Dr. Christian W. Gruber PhD Assistant Professor tenure-track and ARC Future Fellow The University of Queensland, School of Biomedical Sciences, Australia Medical University of Vienna, Center for Physiology and Pharmacology, Vienna, Austria  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Gruber: We initially discovered that particular circular peptides (called cyclotides) isolated from an African traditional herbal medicine have promising immunosuppressive properties (Gründemann et al., 2012, J Nat Prod, 75(2):167-74). Cyclotides are considered a pharmacological ‘treasure trove’ (Koehbach et al., 2013, PNAS, 110(52):21183-8). Hence we aimed at testing the efficacy of these peptides to treat and ameliorate multiple sclerosis, and found that the new plant-derived drug (‘T20K’), in an animal model, can block the progression of the disease. We demonstrated in an animal model that T20K stopped progression of the normal clinical symptoms of multiple sclerosis (Thell et al., PNAS, doi: 10.1073/pnas.1519960113).
Author Interviews, Autism, Brigham & Women's - Harvard, PLoS / 09.04.2016

MedicalResearch.com Interview with: Ya Wen PhD TRANSCEND Research, Neurology Department Massachusetts General Hospital, Charlestown, Massachusetts, Harvard Medical School, Harvard University, Boston, Massachusetts Higher Synthesis Foundation, Cambridge, Massachusetts MedicalResearch.com: What is the background for this study? Dr. Ya Wen: At the time of this study (December 2014), the SFARI (Simons Foundation Autism Research Initiative) Gene-Human Gene Module recorded 667 human genes implicated as relevant to Autism spectrum disorders (ASDs). Now the number is close to 800. We sought to address the challenge of making sense of this large list of genes by identifying coherent underlying biological mechanisms that link groups of these genes together. To do this, we used information from several existing and well established databases and created a “demographics” of autism genes and pathways. MedicalResearch.com: What are the main findings? Dr. Ya Wen: From these hundreds of autism genes, we first found the relatively most important pathways, and then we generated a pathway network by mapping the pathway-pathway interactions into an Autism Pathway Network. Our systems analyses of this network converged upon an important role in autism pathophysiology for two pathways: MAPK signaling and calcium signaling, and specifically the process where they overlap, “calcium-protein kinase C-Ras-Raf-MAPK/ERK”. Our study also illuminated genetic relationships between autism and several other kinds of illness, including cancer, metabolic and heart diseases. Many of the significant genes and pathways were associated with vulnerability in the processing of challenging environmental influences.
AHA Journals, Author Interviews, Heart Disease / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23317" align="alignleft" width="120"]Luigi Di Biase, MD, PhD, FACC, FHRS Section Head Electrophysiology Director of Arrhythmia Services Associate Professor of Medicine, Department of Medicine (Cardiology) Albert Einstein College of Medicine at Montefiore Hospital Moses and Weiler Campuses Montefiore-Einstein Center for Heart & Vascular Care Bronx, NY 10467 Dr. Luigi Di Biase[/caption] Luigi Di Biase, MD, PhD, FACC, FHRS Section Head Electrophysiology Director of Arrhythmia Services Associate Professor of Medicine, Department of Medicine (Cardiology) Albert Einstein College of Medicine at Montefiore Hospital Moses and Weiler Campuses Montefiore-Einstein Center for Heart & Vascular Care Bronx, NY 10467 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Di Biase: The superiority of catheter ablation of atrial fibrillation (AF) over antiarrhythmic drugs (AADS) has been tested and demonstrated in several randomized clinical trial in patients with normal ejection fraction and paroxysmal AF. Only a few studies are available for patients with heart failure and persistent AF. In this multicenter randomized trial we compared the most utilized AAD for heart failure patients to achieve a rhythm control strategy (Amiodarone) vs ablation of atrial fibrillation in patients with heart failure, persistent AF and ICD. Catheter ablation was superior to Amiodarone to achieve long term freedom from AF. In addition patients undergoing ablation had a lower re-hospitalization rate and importantly a lower mortality.
Aging, Author Interviews, Melanoma, Nature, Wistar / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23313" align="alignleft" width="200"]Ashani T. Weeraratna, Ph.D. Associate Professor Melanoma Research Center The Wistar Institute Philadelphia, PA 19104 Dr. Ashani Weeraratna[/caption] Ashani T. Weeraratna, Ph.D. Associate Professor Melanoma Research Center The Wistar Institute Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Weeraratna: The background for this study is the fact that advancing age remains the greatest risk factor for the development of many cancers, and melanoma is no exception. We found that age-related changes in normal skin, specifically dermal fibroblasts, increase both the metastatic potential and therapeutic resistance of melanoma cells. The most fascinating thing is that even targeted therapy, which should depend solely on the interaction between the drug and the target within the tumor cell is affected by the age of the microenvironment.
Author Interviews, BMJ, Cancer Research, Education / 08.04.2016

MedicalResearch.com Interview with: Dr Alex Ghanouni Research Associate UCL Research Department of Epidemiology and Public Health Health Behaviour Research Centre London MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ghanouni: This study comes out of growing concern among academics, doctors, and policymakers about the unintended harms of healthcare interventions. One prominent issue in the ongoing debate is ‘overdiagnosis’, that is detection of disease that would not have caused symptoms or death if it had remained undetected. There are many contexts in which overdiagnosis can occur but one of the most prominent is cancer screening, in which asymptomatic individuals undergoing testing may have slow-growing cancers detected that would never have otherwise come to light. However, because it is impossible to be sure which cancers are slow-growing and which are aggressive, most are treated. This means that overdiagnosis can lead to harm through the anxiety caused by a disease label and the negative effects of treatment (e.g. surgery) that is actually unnecessary. Despite professional concern about overdiagnosis, previous research has found that the public is mostly unaware that it exists. One study that was particularly relevant to our research was an Australian survey in which members of the public were asked whether they had encountered the term before and what they thought it meant. Although around half the sample stated that they had heard or seen the term before, only 41% were able to provide a definition that was approximately correct. We tested the extent to which this was true as part of an online survey of adults aged 50-70 years in the UK. We found that recognition of the term was very low (only 30%) and almost no-one (3%) gave an answer that was strictly accurate. Responses often indicated misconceptions (e.g. “misdiagnosis”, “false positive diagnosis”, or being “overly health conscious”).
Allergies, Author Interviews, JAMA, Pediatrics / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23309" align="alignleft" width="200"]Moshe Ben-Shoshan, MD, M.Sc. Assistant Professor Division of Pediatric Allergy and Clinical Immunology Department of Pediatrics McGill University Health Center Montreal, Quebec, Canada Dr. Moshe Ben-Shoshan[/caption] Moshe Ben-Shoshan, MD, M.Sc. Assistant Professor Division of Pediatric Allergy and Clinical Immunology Department of Pediatrics McGill University Health Center Montreal, Quebec, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ben-Shoshan: Given that up to 10% of children treated with amoxicillin are tagged as allergic usually with no confirmatory tests (given high waiting times to see an allergist and controversy regarding confirmatory tests) we aimed to assess the accuracy of the graded provocation challenge (PC) . Unlike previous studies we challenged ALL 818 children presenting with rashes on amoxicillin treatment . We were able to show that almost 95% tolerated the challenge while 17 had immediate reactions (within 1 hour ) and 31 had non immediate reactions . We found that although it is suggested to do skin tests ( with PrePen and pen G ) to diagnose immediate amoxicillin allergy only 1 of 17 had a positive skin test indicating poor sensitivity of this test. In addition among all those with negative challenge that we followed over 3 years 10% had mild skin reactions when they received subsequent full treatment .
Author Interviews, Biomarkers, Columbia, JAMA, Lung Cancer / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23298" align="alignleft" width="191"]Adrian G. Sacher, M.D. Assistant Professor of Medicine Thoracic Oncology & Phase I Drug Development Columbia University/New York-Presbyterian Hospital Dr. Adrian Sacher[/caption] Adrian G. Sacher, M.D. Assistant Professor of Medicine Thoracic Oncology & Phase I Drug Development Columbia University/New York-Presbyterian Hospital  MedicalResearch.com: What is the background for this study? Dr. Sacher: The aim of this prospective study was to determine the accuracy, turnaround time and robustness of ddPCR-based liquid biopsy for the detection of EGFR and KRAS mutations in patients with advanced non-small cell lung cancer (NSCLC). The detection of these mutations is key to selecting optimal therapy for patients with this disease. Currently, the standard of care is to perform tissue biopsies on patients in order to obtain material to detect these mutations and make decisions about treatment. Frequently, patients undergo multiple tissue biopsies during the course of their treatment. We sought to determine if liquid biopsy could quickly and accurately detect these mutations with the ultimate goal of understanding how to use these tests to select treatment for patients.
Author Interviews, Breast Cancer, Endocrinology, Journal Clinical Oncology, Menopause / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23339" align="alignleft" width="200"]Karin Ribi, PhD, MPH Head of Quality of Life Office IBCSG International Breast Cancer Study Group Bern Switzerland Dr. Karin Ribi[/caption] Karin Ribi, PhD, MPH Head of Quality of Life Office IBCSG International Breast Cancer Study Group Bern Switzerland  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ribi: This study investigated the quality of life (QoL) outcomes for women in the Suppression of Ovarian Function (SOFT) trial. SOFT investigated the value of adding ovarian suppression (OFS) to tamoxifen and to determine the role of the aromatase inhibitor exemestane+OFS as adjuvant (post-surgery) therapies for hormone-sensitive early breast cancer. SOFT was conducted by the International Breast Cancer Study Group (IBCSG) in over 3000 premenopausal women from more than 500 centers worldwide. The primary analysis of SOFT compared tamoxifen alone with tamoxifen+OFS in over 2000 women, and showed that adding OFS to tamoxifen did not provide a significant benefit in the overall population of premenopausal women. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of OFS improved disease outcomes.[1] With regard to the QoL main findings, patients on tamoxifen+OFS were more affected than patients on tamoxifen alone by hot flushes at 6 and 24 months, by loss of sexual interest and sleep disturbance at 6 months, and by vaginal dryness up to 60 months. Without prior chemotherapy, patients on tamoxifen alone reported more vaginal discharge over the 5 years than patients on tamoxifen+OFS. Symptom-specific treatment differences at 6 months were less pronounced in patients with prior chemotherapy. Changes in global QoL indicators from baseline were small and similar between treatments over the whole treatment period.
Author Interviews, CDC, HPV, Pediatrics, Vaccine Studies / 07.04.2016

MedicalResearch.com Interview with: Natalie L. McCarthy, MPH Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recently, deaths immediately following 4vHPV vaccination have garnered intense media attention.  Often, these media stories do not take into account the background rates of death in older children and young adults or disclose the potential for non-vaccine related causes of death.  The publicity surrounding deaths temporally associated with HPV and the paucity of studies examining deaths in adolescents following vaccination, was the basis for our evaluation of deaths following vaccines administered to individuals 9 through 26 years of age in the Vaccine Safety Datalink (VSD). The VSD is a collaborative project between the Centers for Disease Control and Prevention and several integrated healthcare systems, which monitors the safety of vaccines in the U.S. This study assessed the risk of death in the first 30 days following vaccination, described the causes of death, and included an evaluation of the potential association of vaccination and death among older children and young adults. The risk of death was not increased during the 30 days following vaccination, and no deaths were found to be causally associated with vaccination. The causes of death were consistent with what would be expected for this age group.
Author Interviews, Hearing Loss, JAMA / 07.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23274" align="alignleft" width="200"]Prof. dr. Wilko Grolman MD, PhD Department of Otolaryngology Head and Neck Surgery Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands. Linkedin: https://www.linkedin.com/in/wilko-grolman-73a4927 Prof. Grolman[/caption] Prof. dr. Wilko Grolman MD, PhD Department of Otolaryngology Head and Neck Surgery Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands. Linkedin: https://www.linkedin.com/in/wilko-grolman-73a4927   MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Grolman: The importance of healthy hearing is extremely important for us humans. Decline in hearing will potentially affect not only our functional status but also our emotional and social health but also our economic status. It is impossible to imagine what the impact of losing one’s hearing ability is while still having a healthy hearing. Although many of us will eventually suffer from reduced hearing as part of the physiological effect of getting older, scientists are alarmed by the fact that hearing loss is on the rise and especially the number of youngsters that are affected is increasing. The WHO in their report of March 2015 reveal some alarming statistics; 360 million people have disabling hearing loss. In the acquired hearing loss group, excessive noise from personal audio devices and concert and festival visits has gained importance. Occupational noise has long been recognized as a source of acquired hearing loss. The WHO recognizes that half of the hearing loss cases can be prevented by primary prevention. For the noise induced hearing loss category, it is important to reduce exposure to loud sounds by raising awareness about the risks, implement relevant legislation and to encourage the use of personal protective devices such as earplugs, noise-canceling earphones and headphones. Our previous systematic review of the effectiveness of wearing earplugs to music venues showed that there were only two studies on this subject of which only one was a randomized clinical trial but had a major different set-up.
Author Interviews, Baylor College of Medicine Houston, Heart Disease, JACC / 07.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23268" align="alignleft" width="125"]Dr. William Frank Peacock MD, FACEP Baylor College of Medicine, Houston Dr. Frank Peacock[/caption] Dr. William Frank Peacock MD, FACEP Baylor College of Medicine, Houston MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Peacock: ​Patients with atrial fibrillation get strokes but can take anticoagulation which is very effective at preventing strokes. Patients on anticoagulation bleed, to the point that a very few die. The higher the CHADSVASC score, the more likely you are to have a stroke.​ ​Also the more likely ​you are to bleed. But the risk of stroke ALWAYS exceeds the risk of bleeding. We studied diabetics with atrial fibrillation as a subset, because diabetes is significant predictor for both stroke and bleeding and we wanted to determine if our understanding of the risks and benefits were maintained in real world trial. What we found was the risk of a fatal major bleed for a diabetic with atrial fibrillation who was taking rivaroxaban was 0.09/100 patient years of treatment. We know that the risk of having a stroke in a patient with a CHADS score of 2 is about 3% per year (that is 3/100 patients will stroke). Put in a similar denominator as our study, failing to treat an Afib diabetic will results 300 strokes for every 100 patient years, which compares to the effect of treatment, which will significantly prevent stroke, at the cost of 0.1 major bleed fatality per 100 patient years. Even if the effect of treatment was as low as 50% (which it is not), that is still preventing 150 strokes. 0.1 dead, to prevent 150 strokes seems like easy math to me.  ​
Author Interviews, Heart Disease, JACC / 07.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23262" align="alignleft" width="120"]Laura Mauri, MD,MSc Professor, Harvard Medical School Brigham and Women Hospital Dr. Laura Mauri[/caption] Laura Mauri, MD,MSc Professor, Harvard Medical School Brigham and Women Hospital MedicalResearch.com: What is the background for this study? Dr. Mauri: The Dual Antiplatelet Therapy (DAPT) Study, the largest randomized controlled trial to date comparing different durations of dual antiplatelet therapy (thienopyridine plus aspirin) after coronary stenting, found that patients who were free from major ischemic or bleeding events at 1 year after coronary stenting with either drug-eluting or bare metal stents, and who were compliant with their antiplatelet therapy, experienced significant reductions in stent thrombosis and myocardial infarction (MI) but increases in moderate or severe bleeding when treated with 30 months of thienopyridine plus aspirin, as compared with 12 months.  In this analysis of the DAPT Study, we wanted to determine whether the subset of patients who had a MI before the study or at the time of the index stenting procedure had different risks or benefits with long-term dual antiplatelet therapy compared to patients with no history of MI prior to or at the time of the index stenting procedure.  We also wanted to evaluate whether the use of a clinical decision tool to identify patients expected to derive benefit vs. harm from continuing thienopyridine beyond one year after coronary stenting (the DAPT Score), would aid in the individualized prescription of dual antiplatelet therapy duration among these populations.
Author Interviews, JAMA, Pulmonary Disease, Smoking / 07.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23256" align="alignleft" width="117"]Dr. William Phillips MD MPH USPSTF Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine Dr. William Phillips[/caption] Dr. William Phillips MD MPH USPSTF  Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Phillips: Chronic obstructive respiratory disease, or COPD, is a serious, chronic condition that affects a person’s ability to breathe. It is the third leading cause of death in the United States. When the Task Force reviewed the research on screening adults for COPD in a primary care setting, we concluded with moderate certainty that screening has no net benefit, which is why we do not recommend screening for COPD in people who do not have symptoms.
Author Interviews, BMJ, Heart Disease, Social Issues / 07.04.2016

MedicalResearch.com Interview with: Dr. Simon Graff Department of Public Health Aarhus University MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Graff: We knew that a substantial amount of evidence have accumulated, linking our mental wellbeing to our body. With that in mind we wanted to examine one of the (if not the most) most stressful life event; the loss of a partner! Former studies have ranked bereavement of a life partner as the most stressful life event we humans can experience. Our study reports that spousal bereavement is followed by a transiently increased risk of new onset of atrial fibrillation (AF). The risk was highest 8-14 days after the loss and remains elevated for one year.
Author Interviews, Nature, Transplantation / 07.04.2016

MedicalResearch.com Interview with: Muhammad M. Mohiuddin, MD Cardiothoracic Surgery Research Program National Heart, Lung, and Blood Institute MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Mohiuddin: There are around 150,000 patients waiting for organ transplants. Unfortunately, the supply of human donor organs will never be able to meet this demand. We are trying to explore if animal (pig) organs can be used for these patients. Pig organs are rejected within a few minutes by humans or baboons. Therefore, we along with our industrial partner Revivicor Inc. have modified the pig genetics to knock out molecules harmful to humans and have also expressed some human genes in these pigs. Through these modifications, along with the use of novel target-specific immunosuppressive drugs, we have extended pig heart survival in the abdomen for almost 3 years. In this experimental model, the heart is transplanted in the abdomen while the original heart stays in the chest cavity. The major advantage of this model is that the baboon is kept alive, despite the rejection of the transplanted organ in the abdomen.
Author Interviews, Cancer, Cancer Research, End of Life Care / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_16091" align="alignleft" width="200"]Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Director, Center for Research on End of Life Care Weill Cornell Medical College New York Presbyterian Hospital New York City, New York Dr. Holly Prigerson[/caption] Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Director, Center for Research on End of Life Care Weill Cornell Medicine New York Presbyterian Hospital New York City, New York 10065  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Prigerson: Patients need to know their prognosis to be informed consumers of end-stage cancer care. We found that most patients have an overly optimistic view of their life-expectancy and that few patients base their life expectancy estimate on communications with their healthcare providers. It was striking that 0% of black patients said their prognostic estimate was based on a medical professional.
Addiction, Author Interviews, JAMA, Opiods / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23240" align="alignleft" width="133"]Dr. Eugenia Oviedo-Joekes PhD Assistant Professor, School of Population and Public Health University British Columbia Centre for Health Evaluation and Outcome Sciences Providence Health Care, St Paul’s Hospital, Vancouver British Columbia, Canada Dr. Oviedo-Joekes[/caption] Dr. Eugenia Oviedo-Joekes PhD Assistant Professor, School of Population and Public Health University British Columbia Centre for Health Evaluation and Outcome Sciences Providence Health Care, St Paul’s Hospital, Vancouver British Columbia, Canada  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Oviedo-Joekes: Diacetylmorphine is the active ingredient in heroin. Medically prescribed diacetylmorphine has shown greater effectiveness than methadone alone for the treatment of patients with long term opioid dependence who are not benefitting from available treatments (i.e., they continue injecting in the street daily for many years).  Medically prescribed diacetylmorphine is being used in a small number of countries in Europe but is unlikely to be accepted in many countries around the world, including Canada and the US.  SALOME is the world’s first study to examine the effectiveness of hydromorphone, a licensed, legal pain medication, as an alternative treatment to diacetylmorphine for chronic heroin addiction. Participants were randomly assigned to receive injectable diacetylmorphine or hydromorphone, double-blinded (up to three times daily) for six months under supervision. Injectable hydromorphone was as effective as injectable diacetylmorphine for long-term street opioid users not currently benefitting from available treatments (about 10 per cent of the heroin-dependent population).Study participants on both medications reported far fewer days of street-heroin and other opioid use at six months compared to almost daily illicit opioid use before taking part in the study. They also reported a reduction in days of illegal activities, from an average of 14.1 days per month to fewer than four.
Author Interviews, BMJ, Cannabis, OBGYNE, Pediatrics / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23192" align="alignleft" width="192"]Cara Christ, M.D., M.S. Director of the Arizona Department of Health Services Dr. Cara Christ[/caption] Cara Christ, M.D., M.S. Director of the Arizona Department of Health Services MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Christ: This study was a systematic review. The purpose of a systematic review is to critically assess and summarize the best available research evidence on a specific issue. This usually involves a critical synthesis of the results of several high quality studies on the issue under review. Overall, this review found that infants exposed to cannabis during pregnancy had a 77% higher likelihood of being underweight (<2500grams) at birth, compared to infants whose mothers did not use cannabis. Also, if the mother used cannabis during pregnancy, the likelihood of her infant needing to be placed in a neonatal intensive care unit was two times higher compared to those infants whose mothers did not use cannabis during pregnancy.
Author Interviews, Diabetes, Diabetologia / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23245" align="alignleft" width="183"]Dr. Dennis James Petrie Melbourne School of Population and Global Health Dr. Dennis Petrie[/caption] Dr. Dennis James Petrie Melbourne School of Population and Global Health MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Petrie: Life expectancy estimates for those with type 1 diabetes allow gaps with the general population to be identified and improvements to be quantified. This research examined mortality for those with type 1 diabetes in Sweden from 2002 till 2011. The aim was to explore whether life expectancy of those with type 1 diabetes has improved in Sweden over the last decade and how any improvement compared with improvements seen in the general population. It found that for men with type 1 diabetes, the remaining life expectancy at age 20 increased significantly by about 2 years (from 47.7 in 2002–06 to 49.7 years in 2007–11) but for women with type 1 diabetes there was no significant change, with a life expectancy at age 20 of 51.7 years in 2002–06 and 51.9 years in 2007–11. There have been recent gains for both men and women from reductions in cardiovascular mortality however these gains were also seen in the general population which meant that the life expectancy gaps have stayed at about 11 years for men and 12 years for women over the last decade in Sweden.
Author Interviews, Mental Health Research, NYU/NYMC, PLoS, PTSD / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_22994" align="alignleft" width="149"]Glenn Saxe, MD Arnold Simon Professor of Child and Adolescent Psychiatry and Chair, Department of Child and Adolescent Psychiatry NYU Langone’s Child Study Center Dr. Glenn Saxe[/caption] Glenn Saxe, MD Arnold Simon Professor of Child and Adolescent Psychiatry and Chair, Department of Child and Adolescent Psychiatry NYU Langone’s Child Study Center Dr. Saxe’s bio page   MedicalResearch.com: What is the background for this approach? What are the main advantages and drawbacks to the CS-CN method in psychiatry research? Dr. Saxe: Psychiatric disorders are complex and, in all likelihood, emerge and are sustained over time because they form what is called a complex system, involving the interaction between a great many variables of different types (e.g. molecules, neurons, brain circuits, developmental, social variables). There is a strong literature on complex systems in other fields that show remarkably similar properties between vastly different types of systems. Unfortunately, data methods used in research in psychiatry are not designed to ‘see’ the possible complex systems nature of a psychiatric disorder. Our method is designed to identify networks of variables related to psychiatric disorders that, together, have properties of complex systems. If such a system is identified, it may reveal new ways to treat these disorders.
Author Interviews, Brain Cancer - Brain Tumors, Brigham & Women's - Harvard, PNAS / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23151" align="alignleft" width="144"]Rakesh K. Jain, Ph.D. A.W.Cook Professor of Radiation Oncology (Tumor Biology) Director, E.L. Steele Laboratory Department of Radiation Oncology Harvard Medical School and Massachusetts General Hospital Boston, MA 02114 Dr. Rakesh Jain[/caption] Rakesh K. Jain, Ph.D. A.W.Cook Professor of Radiation Oncology (Tumor Biology) Director, E.L. Steele Laboratory Department of Radiation Oncology Harvard Medical School and Massachusetts General Hospital Boston, MA    02114

MedicalResearch.com: What is glioblastoma and why is it difficult to treat?

Dr. Jain: Glioblastoma (GBM) is the most common malignant tumor of the brain, and remains highly lethal. The standard treatment consists of surgical removal followed by chemo-radiation and anti-angiogenic therapy with anti-vascular endothelial growth factor (VEGF) antibody. Unfortunately, glioblastoma cells invade the brain far from the original tumor mass. Hence, even with the best surgical techniques it is not possible to remove all tumor cells, as they are embedded in vital parts of the brain at the time of the surgery. As a result, even after multimodal therapies, most  glioblastoma patients succumb to their disease within 2 years. New approaches are desperately needed.

MedicalResearch.com: What is anti-angiogenic therapy and why is it used for glioblastoma?

Dr. Jain: One key feature ofglioblastomas is their highly abnormal, leaky and ineffective vasculature. This leads to brain swelling around the tumor and poor tumor blood perfusion, which in turn can render the tumors more aggressive. These vascular abnormalities are due to the uncontrolled overproduction in GBMs of angiogenic factors such as VEGF. Anti-angiogenic therapies using anti-VEGF agents can transiently “normalize” the GBM vasculature structure and function and reduce brain swelling, increase blood perfusion, and impact morbidity and survival. Unfortunately, even when this therapy is added to the standard therapy with surgery and chemo-radiation, GBM patients typically do not survive on average more than 1.5 years.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Stroke / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_22962" align="alignleft" width="200"]Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK Dr. Kazuomi Kario[/caption] Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Kario: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly. The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent. The present analysis shows that home BP measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home BP and CAD or stroke events.
Author Interviews, JAMA, Pain Research, Surgical Research, University of Pittsburgh, Weight Research / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23148" align="alignleft" width="150"]Wendy King, PhD Associate Professor of Epidemiology Epidemiology Data Center, Room 105 University of Pittsburgh Pittsburgh, PA 15213 Dr. Wendy King[/caption] Wendy King, PhD Associate Professor of Epidemiology Epidemiology Data Center, Room 105 University of Pittsburgh Pittsburgh, PA 15213 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. King: Severe obesity is associated with significant joint pain and impaired physical function, such as difficulty bending, lifting carrying and walking. Excess weight can lead to joint damage and accompanying pain, resulting in activity restriction and walking limitations. Obesity can also contribute to pain and physical limitations through factors such as impaired cardiorespiratory function, systematic inflammation, reduced flexibility, low strength per body mass, and depression.  Previous studies have reported significant improvements in mean values of bodily and joint specific pain, physical function, and walking capacity in the first 3-12 months following RYGB or LAGB. However, very few studies have examined the variability in response to surgery or reported on longer-term follow-up of these procedures. My colleagues and I followed 2,221 patients participating in the Longitudinal Assessment of Bariatric Surgery-2, a large NIH-funded prospective study of adults with severe obesity undergoing weight-loss surgery at one of 10 hospitals across the U.S. Through three years of follow-up, approximately 50 to 70 % of patients who underwent bariatric surgery reported clinically important improvements in bodily pain, physical function and usual walking speed. About three-quarters of the participants with symptoms indicative of osteoarthritis before surgery experienced improvements in knee and hip pain and function. In addition, over half of participants who had a mobility deficit prior to surgery did not post-surgery. Several baseline characteristics such as younger age, male sex, higher household income, lower body mass index, fewer depressive symptoms and no history of diabetes or venous edema with ulcerations, were associated with a higher chance of improvement in pain and physical function following surgery. In addition, pre- to post-surgery reductions in weight and depressive symptoms, and remission of diabetes and venous edema with ulcerations were associated with pre- to post-surgery improvements. Thus, our findings reinforce results from shorter-term studies by addressing the durability or response and expand our understanding of the variability in response, and what factors are related to chance of improvement.
Author Interviews, Dermatology, PLoS, Stem Cells / 06.04.2016

MedicalResearch.com Interview with: Takashi Tsuji, PhD Team Leader of  Laboratory for Organ Regeneration RIKEN Center fo r Developmental Biology Chuo-ku, Kobe, Hyogo Japan MedicalResearch.com: What was the impetus for this research? What made you think about creating a skin model? Answer. Previously, we successfully demonstrated the functional organ regeneration including tooth (PNAS 2009), hair follicles (Nature Communications 2012), salivary gland (Nature Communications 2013a) and lachrymal gland (Nature Communications 2013b). We focused onto a complex organogenesis through the epithelial and mesenchymal cell interaction. In the current study as a continuous work, we would like to regenerate organ system by using multipotent stem cells such as ES and iPS cells. In this study, we first demonstrated the generation of a functional bioengineered 3D integumentary organ system from murine iPS cells. MedicalResearch.com: Can you describe what you created in layperson terms? How big is it, what does it look like and what is it capable of doing? Answer. We succeeded to demonstrate the proof-of-concept to generate 3D integumentary organ system, complete skin, which has skin appendages such as hair follicle and sebaceous gland, by mimicking the organogenesis during embryogenesis. In this work, we performed in murine system, so, the transplantable skin size is small as 1 mm2 /1 site. We think that further studies for humanization and the development of in vitro culture system would lead to realize of clinical applications for severe burned patients and severe hair loss. Furthermore, this method will contribute to understand the onset of dermoid tumor, which has ectodermal organs such as tooth and hair follicle, in human.
Author Interviews, Heart Disease, JACC, Vitamin D / 05.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23091" align="alignleft" width="96"]Dr Klaus Witte MD, FRCP, FESC, FACC Associate Professor and Consultant Cardiologist Lead Clinician for Cardiology University of Leeds and Leeds Teaching Hospitals NHS Trust Dr. Klaus Witte[/caption] Dr Klaus Witte MD, FRCP, FESC, FACC Associate Professor and Consultant Cardiologist Lead Clinician for Cardiology University of Leeds and Leeds Teaching Hospitals NHS Trust  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Witte: Chronic heart failure (CHF) is a condition of heart muscle weakness that despite optimal treatment often leaves patients with ongoing symptoms of breathlessness and fatigue. Vitamin D has a large number of effects in the body beyond its known effects on the skeleton. Patients with  Chronic heart failure are frequently deficient in vitamin D, but until now there were no data demonstrating a benefit from supplements. We conducted a randomised, placebo-controlled study of a non-calcium-based vitamin D supplement providing 4000IU or 100mcg per day of vitamin D3 (VINDICATE). Endpoints included 6-minute walk distance and cardiac function. We saw no improvement in 6 minute walk distance but a large and significant improvement in heart function (left ventricular ejection fraction) and heart size (left ventricular dimensions and volumes) after on year. We saw no significant adverse effects and the tablets were well tolerated.
Author Interviews, Cost of Health Care, Heart Disease, JACC / 05.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23181" align="alignleft" width="133"]Dr. Jordan B. King Post Doctoral Fellow Pharmacotherapy Outcome Resctr, University of Utah Dr. Jordan B. King[/caption] Dr. Jordan B. King Post Doctoral Fellow Pharmacotherapy Outcome Resctr, University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cornerstone of treatment in heart failure with reduced ejection fraction (HFrEF) revolves around low-cost generic medications such as angiotensin converting enzyme inhibitors (ACEIs) and beta-blockers (BBs). However, recently the dual-acting angiotensin receptor neprilysin inhibitor (ARNI) sacubitril-valsartan, demonstrated improved survival and reduction in heart failure hospitalizations relative to enalapril, an ACEI, and optimal background therapy. This creates a situation in which we have a new medication which improves outcomes, but carries a high price tag ($4,560 per year) compared with ACEIs, the standard of care over the last 20 years, and are available as generic medications for <$50 per year. We set out to determine the incremental cost-effectiveness ratio (ICER) per quality adjusted life year gained (QALY) from the perspective of a health care payer in the U.S. The ICER is a measure of how much we have to pay for sacubitril-valsartan to gain 1 unit of health relative to enalapril. In this case the unit of health is a year of life adjusted for quality. We used a Markov model to estimate the costs and effectiveness of the two treatment options over a lifetime. In the base case, the ICER for sacubitril-valsartan was $50,959 per QALY gained. Health care interventions which cost <$50,000 per QALY are generally considered cost-effective, but some argue that <$100,000 per QALY is a more appropriate threshold in the U.S. In a probabilistic sensitivity analysis, 57% and 80% of all simulations fell below the $50,000 and $100,000 per QALY thresholds, respectively. Sacubitril-valsartan was the less costly treatment arm in 5% of simulations, and enalapril dominated (less costly and more effective) in 17% of simulations.
Author Interviews, Breast Cancer, JAMA, Nutrition, UCSD / 05.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23016" align="alignleft" width="130"]Ruth E. Patterson, PhD Professor, Department of Family Medicine and Public Health Associate Director, Population Sciences Program Leader, Cancer Prevention Moores Cancer Center UC San Diego La Jolla, CA Dr. Ruth Patterson[/caption] Ruth E. Patterson, PhD Professor, Department of Family Medicine and Public Health Associate Director, Population Sciences Program Leader, Cancer Prevention Moores Cancer Center UC San Diego La Jolla, CA MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Patterson: Our research team was intrigued with studies in mice showing that even when eating a high-fat diet, mice who were subjected to a 16-hour fasting regimen during the sleep phase were protected against abnormal glucose metabolism, inflammation and weight gain; all of which are associated with poor cancer outcomes. We had access to a study conducted in breast cancer survivors called the Women’s Healthy Eating and Living Study (WHEL).  Participants in this study completed food records, which give the time of eating meals and snacks.  We used the food records to estimate the average nightly fasting interval in 2413 breast cancer survivors.  Overall, we found that women who had a nightly fasting interval of less than 13 hours had a 36% increased risk of breast cancer recurrence and a nonsignificant increase in mortality.  We also found that women with a short nightly fast had poorer glucoregulation and worse sleep, both of which might explain the link to breast cancer.