Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity / 20.01.2017

MedicalResearch.com Interview with: Fatima Rodriguez, MD, MPH Chief Cardiovascular Medicine Fellow Stanford University MedicalResearch.com: What is the background for this study? Response: Hispanics are the largest minority group in the U.S. Although cardiovascular disease (CVD) is the leading cause of death for Hispanics, most studies exploring disparities focus on Black and White differences. Additionally, Hispanics are often aggregated into one homogenous group, which masks important differences. There is also an interesting epidemiological phenomenon known as the “Hispanic paradox” that states that although Hispanics have greater risk factors for CVD, they experience lower mortality.
Anesthesiology, Author Interviews, JAMA, OBGYNE, Surgical Research / 20.01.2017

MedicalResearch.com Interview with: Adam Sachs MD Assistant Professor of Anesthesiology University of Connecticut School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: When women undergo appendectomy or cholecystectomy during pregnancy they are obviously concerned about the well being of their fetus. Unfortunately, the majority of the data available to council pregnant women is outdated and medical practice has significantly changed since their publication.
Author Interviews, Cancer Research, Immunotherapy, NEJM, Transplantation / 19.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31344" align="alignleft" width="160"]Kenar D. Jhaveri, MD Professor of Medicine Division of Kidney Diseases and Hypertension Hofstra Northwell School of Medicine, 100 Community Drive, Great Neck, NY 11021 Dr. Kenar Jhaveri,[/caption] Kenar D. Jhaveri, MD Professor of Medicine Division of Kidney Diseases and Hypertension Hofstra Northwell School of Medicine, 100 Community Drive, Great Neck, NY 11021 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The immune check point inhibitors are novel anti cancer agents being used rapidly in various cancers. Many cancers don’t allow our natural immune system to attack the cancer. These immunotherapy agents “activate” the immune system to attack the cancer. These agents have been reported to cause multiple end organ side effects as noted by this recent NYT article. We also recently reported the known renal effects of immunotherapy. In the kidney transplant patient who is on immunosuppressive agents, the physicians need to keep the immune system suppressed to preserve the kidney. When one of these agents are used for a cancer in a kidney transplant patient, prior reports have suggested severe rejection episodes and loss of the transplanted kidney. Our case in the NEJM is the first report of a preventive strategy used to allow for simultaneous treatment of cancer and preventive rejection of the kidney. We used a regimen of steroids and sirolimus( an anti-proliferative agent that is used to treat cancer and also is an immunosuppresant) along with the immunotherapy. The cancer started regressing and the kidney did not reject.
Author Interviews, BMJ / 19.01.2017

MedicalResearch.com Interview with: Salomeh Keyhani MD Associate professor of general internal medicine San Francisco VA Medical Center and University of California San Francisco, CA 94121, USA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Randomized controlled trials are the foundation of the evidence base. We examined the prevalence of financial ties in randomized controlled trials and also examined the relationship of financial ties of principal investigators (PI) with trial outcome. We defined a financial tie as the direct compensation (e.g., consulting fees) of a PI by the drug manufacturer of interest. Although there have been past studies that have examined this relationship, many did not separate financial ties from funding source for the trial and many were focused on one specialty, journal, or type of drug. This study identified a random sample of RCTs published in 2013 that were focused on assessing drug efficacy. Both the disclosure section of the paper and several online databases (Medline, Google, Propublica’s Dollars for Doctors, and the US Patent Office) were searched for evidence of financial ties. Principal investigators financial ties with industry were independently associated with positive study outcomes.
Author Interviews, Cost of Health Care, JAMA, Johns Hopkins, Medicare / 17.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31255" align="alignleft" width="150"]Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036 Dr. Ge Bai[/caption] Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated. The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).
Anemia, Author Interviews, Global Health, JAMA, OBGYNE / 17.01.2017

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden MedicalResearch.com Interview with: Dr. Ola Andersson MD, PhD Uppsala University, Uppsala, Sweden MedicalResearch.com: What is the background for this study? Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants. At birth, approximately 1/3 of the child's blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood. Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant. The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.
Author Interviews, BMJ, HIV, STD / 17.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31241" align="alignleft" width="200"]Michael Rekart, MD, DTM&H Clinical Professor, Medicine and Global Health The University of British Columbia .... On behalf of my co-authors Dr. Michael Rekart[/caption] Michael Rekart, MD, DTM&H Clinical Professor, Medicine and Global Health The University of British Columbia .... On behalf of my co-authors MedicalResearch.com: What is the background for this study? Response: The background for this study is the observation that new syphilis cases over the last decade in British Columbia, Canada, have been escalating more rapidly than anyone could have predicted and that syphilis incidence has outpaced the incidence of other sexually transmitted diseases (STDs), including gonorrhea and chlamydia. This unexpected increase in syphilis has been almost wholly concentrated in men who have sex with men (MSM). Most of these MSM are HIV-1 infected and many are taking highly active antiretroviral therapy (HAART). In fact, the expansion in HAART coverage in MSM parallels the growth in syphilis in the same population. In addition, my co-authors and I had serious doubts as to whether 'treatment optimism', the generally accepted explanation for this phenomenon, was robust enough to account for such a dramatic increase in new syphilis cases. Treatment optimism posits that HAART availability and effectiveness have led to the perception in both HIV-1-infected and HIV-1-uninfected individuals that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhea, chlamydia and syphilis.
Author Interviews, Genetic Research, Nature / 17.01.2017

MedicalResearch.com Interview with: Natalie Shaw, MD, MMSc National Institute of Environmental Health Sciences Research Triangle Park, North Carolina and Harrison Brand, PhD Molecular Neurogenetics Unit and Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research Massachusetts General Hospital, Boston Massachusetts, USA. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Congenital arhinia, or absence of the nose and olfactory system, is an extremely rare malformation, often accompanied by defects in the eyes and reproductive system. Arhinia has been reported in only 80 patients in the past century and though a genetic cause had been suspected, no previous study had identified a plausible genetic candidate. Through an international collaboration among clinicians and investigators spanning 10 different countries, we were able to assemble a cohort of 40 arhinia patients. Using whole-exome sequencing, we found that 84% of the patients had rare mutations in the same gene – SMCHD1. Further, modeling studies based on patient cells and SMCHD1 knockdown in zebrafish strongly support a role for the gene in arhinia. We were surprised by this discovery because mutations that impair SMCHD1 function are known to interact with other regions of the genome to cause a type of muscular dystrophy (FSHD2) that does not affect the bones or cartilage of the face. Deep phenotyping of our cohort revealed that individuals with arhinia can in fact develop FSHD2, but it is still unclear why individuals with FSHD2 do not have arhinia.
Author Interviews, Diabetes, JAMA, Schizophrenia / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31233" align="alignleft" width="150"]Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London Dr. Toby Pillinger[/caption] Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our meta-analysis has provided strong evidence that compared with healthy controls, individuals with early schizophrenia are at increased risk of developing type 2 diabetes mellitus, even when the effects of antipsychotic drugs, diet and exercise are taken out of the equation. Schizophrenia is associated with a dramatically reduced life expectancy, with individuals dying up to 30 years earlier than the general population. Approximately 60% of this excess mortality is due to physical health disorders such as heart attack or stroke, for which diabetes is a major risk factor. People with long-term schizophrenia are 3 times more likely than the general population to have diabetes, something that has previously been blamed on poor diet and exercise habits, as well as the use of antipsychotic medication. However, the link between schizophrenia and diabetes was first made back in the 19th century, long before the use of antipsychotics, and in an era where diets were less likely to cause diabetes. This could suggest that there is a causative link between schizophrenia and diabetes. Our meta-analysis examined whether diabetes risk is already raised in people at the onset of schizophrenia, before antipsychotics have been prescribed and before a prolonged period of illness that may be associated with poor diet and sedentary behaviour. We pooled data from 16 studies comprising 731 patients and 614 individuals from the general population. We collated blood data examining fasting blood glucose levels, blood glucose levels following the oral glucose tolerance test, fasting insulin levels and degree of insulin resistance. We demonstrated that compared with healthy controls, individuals with early schizophrenia had raised fasting glucose, raised levels of glucose following the oral glucose tolerance test, raised fasting insulin and elevated insulin resistance. Furthermore, these results remained statistically significant even when we restricted our analyses to studies where individuals with schizophrenia were matched to healthy controls with regards their diet, the amount of exercise they engaged in and their ethnic background. This suggests that our results were not wholly driven by differences in lifestyle factors or ethnicity between the two groups, and may therefore point towards a direct role for schizophrenia in increasing risk of diabetes.
Author Interviews, BMJ, Brigham & Women's - Harvard, Pain Research, Stroke / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31109" align="alignleft" width="135"]Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Clinical Director, Critical Care Division Dr. Matthias Eikermann[/caption] Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia Harvard Medical School Clinical Director, Critical Care Division  MedicalResearch.com: What is the background for this study? Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura. Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year. We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.
Author Interviews, Endocrinology, Gender Differences, JCEM / 13.01.2017

MedicalResearch.com Interview with: Caroline J. Davidge-Pitts, M.B., Ch.B Mayo Clinic Rochester, Minn. MedicalResearch.com: What is the background for this study? Response: The awareness of transgender healthcare issues has increased, leading to improved coverage of both hormonal and non-hormonal therapies. In endocrinology practices, there is an increased demand for providers who are competent in these areas. We wanted to assess the current status of knowledge and practice in transgender health amongst our current and future endocrinologists.
Author Interviews, Biomarkers, JAMA, Prostate Cancer, Radiation Therapy / 13.01.2017

MedicalResearch.com Interview with: Trevor Royce MD MS Resident, Harvard Radiation Oncology Program MedicalResearch.com: What is the background for this study? What are the main findings? Response: Clinical trials in early prostate cancer take more than a decade to report on. Multiple early reporting endpoints have been proposed, but which one is best, remains unknown, until now. Of all the possible early endpoints examined, to date, how low a PSA blood test falls to, after treatment with radiation and hormonal therapy, appears to be the best, specifically, if the PSA doesn’t get below half a point, that patient is very likely to die of prostate cancer if given standard treatment for recurrence. Those men deserve prompt enrollment on clinical trials in order to properly save their life.
Annals Internal Medicine, Author Interviews, Breast Cancer, Cancer Research, Prostate Cancer / 13.01.2017

MedicalResearch.com Interview with: Karsten Juhl Jørgensen, MD, Dr. MedSci The Nordic Cochrane Centre Rigshospitalet, Copenhagen  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our systematic Cochrane review of the original randomised breast screening trials showed substantial conflict between their estimates of the benefit. Some trials showed a large benefit, others none or a small benefit. This difference was related to the design of the trials. The most optimistic trials were those with suboptimal randomisation. The main findings of our current study support those of the most rigorously performed randomised trials: breast screening does not fulfill its fundamental premise, which is to reduce the occurrence of late stage disease. This means a mortality reduction is unlikely and that use of less invasive surgery due to breast screening is also unlikely. However, we did find very substantial increases in early stage breast cancer, which persisted over our 17 year observation period. This means that breast screening likely leads to substantial overdiagnosis of breast cancers that would otherwise not have caused health problems during a woman’s lifetime. We estimate that 1 in 3 breast cancers detected in a screened population is likely overdiagnosed.
Author Interviews, JAMA, OBGYNE, Pediatrics / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31204" align="alignleft" width="141"]Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine Dr. Alex Kemper[/caption] Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine MedicalResearch.com: What is the background for this study? Response: Neural tube defects, where the brain or spinal cord do not develop properly in a baby, can occur early in pregnancy, even before a woman knows she is pregnant. Taking folic acid before and during pregnancy can help protect against neural tube defects. Most women do not get enough folic acid in their diets, so most clinicians recommend that any woman who could become pregnant take a daily folic acid supplement.
Author Interviews, Emergency Care, JAMA, Stroke, Surgical Research / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31220" align="alignleft" width="181"]Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto Dr. Vitor Mendes Pereira[/caption] Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Lancet, Medical Imaging, MRI, Social Issues / 12.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31180" align="alignleft" width="135"]Dr Ahmed Tawakol MD Massachusetts General Hospital and Harvard Medical Schoo Dr Ahmed Tawakol[/caption] Dr Ahmed Tawakol MD Co-Director, Cardiac MR PET CT Program Massachusetts General Hospital and Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: While the link between stress and heart disease has long been established, the mechanism mediating that risk hasn’t been clearly understood. Animal studies showed that stress activates bone marrow to produce white blood cells, leading to arterial inflammation.  This study suggests an analogous path exists in humans. Moreover, this study identifies, for the first time in animal models or humans, the region of the brain (the amygdala) that links stress to the risk of heart attack and stroke. The paper reports on two complementary studies. The first analyzed imaging and medical records data from almost 300 individuals who had PET/CT brain imaging, primarily for cancer screening, using a radiopharmaceutical called FDG that both measures the activity of areas within the brain and reflects inflammation within arteries.  All participants in that study had no active cancer or cardiovascular disease at the time of imaging and each had information in their medical records on at least three additional clinical visits after imaging. The second study enrolled 13 individuals with a history of post-traumatic stress disorder, who were evaluated for their current levels of perceived stress and received FDG-PET scanning to measure both amygdala activity and arterial inflammation.
Author Interviews, Education, Nature / 12.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31169" align="alignleft" width="133"]Prof. Shulamit (Shu) Kahn Department of Markets, Public Policy and Law Questrom School of Business Boston University Prof. Shulamit Kahn[/caption] Prof. Shulamit (Shu) Kahn Department of Markets, Public Policy and Law Questrom School of Business Boston University MedicalResearch.com: What is the background for this study? What are the main findings? Response: We started this research because Donna Ginther (Kansas) and I had an NIH R01 to study gender differences in biomedical careers. We quickly discovered that a major problem for women was the fact that between many years of graduate study and long postdocs, their biological clocks had almost expired before they would have a decent amount of time in their lives to think about having children.
Author Interviews, Biomarkers, Critical Care - Intensive Care - ICUs, Infections, JAMA, Pediatrics / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31122" align="alignleft" width="140"]Halden F. Scott MD, Assistant Professor Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine Dr. Halden F. Scott[/caption] Halden F. Scott MD, Assistant Professor Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine MedicalResearch.com: What is the background for this study? Response: Sepsis, a dysregulated immune response to infection, is a leading cause of death for children. Survival depends on rapid diagnosis and timely delivery of life-saving resuscitative care, including fluids and antibiotics. However, it can be challenging to make an early diagnosis of sepsis in children. Millions of children present for emergency care of infection and fever every year, most of whom will not develop sepsis. Tools that assist providers in distinguishing the sickest children with infection at an early stage could enable the early delivery of life-saving treatments. Lactate is a clinically-available laboratory test that has played a critical role in improving the diagnosis and treatment of sepsis in adults. Sepsis may cause lactate levels to rise in the blood during sepsis, through reduced delivery of oxygen to the tissues, as well as through changes in how energy is produced and in how lactate is cleared by the kidney and liver. Data about lactate in pediatric sepsis, particularly early levels and whether it is associated with mortality, have been limited.
Author Interviews, Diabetes, Diabetologia, Infections, Pediatrics / 11.01.2017

MedicalResearch.com Interview with: Dr. Hanna Honkanen PhD University of Tampere. MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association between enteroviruses and type 1 diabetes has been suggested for long and analyzed in several studies. However, only few studies have been able to study this association at the time when the disease process starts, which happens several months or years before type 1 diabetes is diagnosed. Our study made this possible since it was based on a large cohort of children who were followed from birth and samples were collected already before the disease process had started (prospective DIPP-study in Finland). Enterovirus infections were detected by analyzing the presence of viral nucleic acids in longitudinal stool sample series. Infections were found more frequently in case children who developed islet autoantibodies compared to control children. This excess was detected several months before islet autoimmunity appeared. This study is the largest such study carried out so far. The results suggest that enterovirus infections may contribute to the initiation of the disease process that eventually leads to type 1 diabetes.
Author Interviews, Blood Pressure - Hypertension, Global Health, JAMA / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31158" align="alignleft" width="147"]Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington Dr. Gregory Roth[/caption] Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time. In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased. Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).
Author Interviews, Cost of Health Care, JAMA / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31052" align="alignleft" width="131"]Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 Dr. Joel Segel[/caption] Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 MedicalResearch.com: What is the background for this study? Response: Americans’ health insurance plans increasingly include deductibles, which require patients to pay a certain amount out-of-pocket before the health plan will cover most services. In addition, the levels of these deductibles have been increasing with more and more Americans enrolling in high-deductible health plans (HDHP’s), which in 2013 were plans with a deductible of $1,250 or more for an individual or $2,500 or more for a family. Furthermore, nearly 40% of those with private insurance have a HDHP including most of the bronze and silver plans on the federal Marketplace. This trend has many worried that patients are facing greater financial risk and may delay or forego necessary care because of costs. A population that may be most vulnerable to these problems are Americans with common chronic conditions.
Annals Internal Medicine, Author Interviews, Cost of Health Care / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31055" align="alignleft" width="200"]Devan Kansagara MD, MCR Associate Professor of Medicine, Oregon Health and Science University Director, Evidence-based Synthesis Program, Portland VA Medical Center Staff Physician, Portland VA Medical Center Dr. Devan Kansagara[/caption] Devan Kansagara MD, MCR Associate Professor of Medicine Oregon Health and Science University Director, Evidence-based Synthesis Program, Portland VA Medical Center Staff Physician, Portland VA Medical Center MedicalResearch.com: What is the background for this study? Response: Historically, the US health care system has been dominated by a fee-for-service payment structure in which health care providers are paid for discrete procedures and visits regardless of care quality. Pay for performance programs are part of the move towards value-based care. They tie a portion of payments to individual health care providers, institutions, or health care systems to performance on a discrete set of measures of health care quality. In theory, these programs are meant to encourage the right care at the right time and thereby improve the health of the patient population. Over the last decade, many studies in and outside the US have examined whether or not, in fact, these programs do result in improved care, reduced cost, and improved patient health. Our study is a systematic review of this literature.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Surgical Research / 10.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31114" align="alignleft" width="120"]Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC Executive Director of Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart & Vascular Center Professor of Medicine, Harvard Medical School Boston, MA 02115 Dr. Deepak L. Bhatt[/caption] Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC Executive Director of Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart & Vascular Center Professor of Medicine, Harvard Medical School Boston, MA 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cangrelor is a potent, fast on, fast off, intravenous ADP receptor antagonist that is now available for use during PCI. Glycoprotein IIb/IIIa inhibitors are intravenous antiplatelet agents that work by a different mechanism. Doctors have asked whether there is any advantage to combining them or whether one class is preferable to the other during PCI. We analyzed close to 25,000 patients from the CHAMPION trials. Cangrelor’s efficacy in reducing peri-procedural ischemic complications in patients undergoing PCI was present irrespective of glycoprotein IIb/IIIa inhibitor administration. However, glycoprotein IIb/IIIa inhibitor use resulted in substantially higher bleeding rates, regardless of whether the patient was randomized to cangrelor or to clopidogrel. Thus, in general, cangrelor and glycoprotein IIb/IIIa inhibitors should not routinely be combined. If an operator wishes to use a potent intravenous antiplatelet during PCI, cangrelor is similarly efficacious as glycoprotein IIb/IIIa inhibitors, but with less bleeding risk.
Author Interviews, Lancet, Pediatrics, Surgical Research, Weight Research / 10.01.2017

MedicalResearch.com Interview with: Dr Thomas H. Inge MD University of Colorado Denver School of Medicine Aurora, CO 80045 MedicalResearch.com: What is the background for this study? Response: Gastric bypass surgery helps severely obese teenagers lose weight and keep it off, according to the first long term follow up studies of teenagers who had undergone the procedure 5-12 years earlier. However, the studies show some patients will need further surgery to deal with complications or may develop vitamin deficiencies later in life, according to two studies published in The Lancet Diabetes & Endocrinology. Severe obesity is classified as having a BMI of 40 or over (around 100 pounds overweight) and affects around 4.6 million children and teenagers in the USA. It causes ill health, poor quality of life and cuts life expectancy. The studies are the first to look at long-term effects of gastric bypass surgery in teenagers. Until now, it has been unclear how successful the surgery is in the long-term and whether it can lead to complications. Thousands of teenagers are offered surgical treatment each year.
Author Interviews, Global Health, JAMA, OBGYNE, Surgical Research / 09.01.2017

MedicalResearch.com Interview with: Jianmeng Liu, PhD, MD Professor in Epidemiology and Biostatistics Director, Institute of Reproductive and Child Health/key Laboratory of Reproductive Health Ministry of Health Director, Office for National Maternal and Child Health Statistics of China Peking University Health Science Center Beijing, China MedicalResearch.com: What is the background for this study? Response: Cesarean overuse can jeopardize maternal and child health. It has been widely concerned that cesarean rate in China is at an extremely high level. Concerns about “alarming” rates increased after a World Health Organization (WHO) report that 46.2% of births were delivered by cesarean in 2007-2008, based on analysis of deliveries in 21 hospitals of 3 provinces of China. Since 2002, reducing the cesarean rate has been a national priority, and a variety of policies, programs and activities have emerged at both the central and local governments. Previous national estimates of cesarean rates have been based on surveys with limited geographical coverage. Given the marked diversity of geography, economy, and life circumstances throughout China, survey estimates are likely to be sensitive to the area sampled. By analyzing county-level national data on cesarean rates that have been collected since 2008, this study aimed to determine the overall rate and change in rate of cesarean deliveries, examine geographic variation, and, in areas where declines occurred, assess changes in maternal and perinatal mortality.
Author Interviews, Exercise - Fitness, JAMA / 09.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31030" align="alignleft" width="125"]Gary O’Donovan, Ph.D. Research Associate: Exercise as Medicine School of Sport, Exercise and Health Sciences National Centre for Sport and Exercise Medicine Loughborough University Dr. Gary O’Donovan,[/caption] Gary O’Donovan, Ph.D. Research Associate: Exercise as Medicine School of Sport, Exercise and Health Sciences National Centre for Sport and Exercise Medicine Loughborough University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was inspired by the classic Harvard University study of weekend warriors. It was a privilege to work with Professor I-Min Lee, one of the authors of the classic study. Our study was much larger than the classic study. With greater statistical power, we found that, compared with inactive adults, all-cause mortality, cardiovascular disease mortality, and cancer mortality risks were significantly lower in weekend warriors who performed the recommended amount of 150 minutes of moderate or 75 minutes of vigorous activity in one or two sessions per week. Our study extends the classic study by showing that the benefits of the weekend warrior physical activity pattern are much the same in men and women.
Author Interviews, Baylor College of Medicine Houston, Genetic Research, NEJM / 09.01.2017

MedicalResearch.com Interview with: Jennifer E Posey MD, PhD Assistant Professor Department of Molecular and Human Genetics Baylor College of Medicine Tamar Harel MD, PhD Clinical Genetics Academic Research Fellow Department of Molecular and Human Genetics Baylor College of Medicine Current affiliation: Department of Genetic and Metabolic Diseases Hadassah-Hebrew University Medical Center Jerusalem, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: As physician scientists and geneticists, our goal is to understand how genetic variation in each of us can impact health and disease. Physicians are often taught that the simplest explanation for a medical condition is the most correct explanation, and have historically searched for a single unifying diagnosis. However, in our own practice, we have met – and learned from – individuals who have more than one genetic condition affecting their health. In the past, it was difficult for physicians to diagnose such individuals. Genetic testing required a physician to recognize the potential for more than one genetic diagnosis in an individual. Single-gene and gene panel testing provided an additional barrier to accurate diagnoses, as they are more narrow in scope, and more than one molecular test was often needed to identify all conditions. Targeted testing also required a physician to accurately pre-suppose which combination of genetic conditions was most likely, and choose the correct targeted tests. The clinical availability of whole exome sequencing (WES) has removed these barriers: WES is a broad-based, unbiased analysis of an individual’s genetic variation that does not pre-suppose a specific genetic cause. If analysis is pursued systematically, WES can identify more than one genetic diagnosis in an individual, even when not suspected. In our study, we have been able to assess the frequency with which individuals can have more than one genetic diagnosis, and have begun to understand how genetic variation at more than one place in the genome can affect how a condition may present. We found that among 7,374 individuals referred for WES, 2,076 (28%) had a molecular diagnosis. Of these 2,076, 5% had two, three, or four molecular diagnoses. In our analyses of the clinical features that may be observed in an individual with two genetic conditions, we found that pairs of diagnoses with overlapping clinical features may be incompletely diagnosed as having one or the other condition, and pairs of diagnoses with very distinct clinical features may be erroneously diagnosed in the clinic as having an entirely new condition.
Author Interviews, Nature, Pain Research, Vitamin D / 09.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31087" align="alignleft" width="146"]Dr-Jyrki-Virtanen.jpg Dr. Jyrki Virtanen[/caption] MedicalResearch.com: What is the background for this study? What are the main findings? Response: Formation of vitamin D in the skin with UVB light from the sun is a main source of vitamin D during summer months, but in the winter months the UVB light is too weak for vitamin D production. Headache prevalence has been suggested to be related to increasing latitude (less UVB light throughout the year) and possibly to be less prevalent during summer (more UVB light), which suggests a possible role for vitamin D exposure. Some previous small studies have suggested that low serum vitamin D levels might be associated with more frequent headache or migraine. Our study included 2601 men from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) from eastern Finland, aged 42-60 years in 1984-1989, which makes it one of the largest studies so far regarding vitamin D and headache. In our study chronic headache (occurring weakly or daily) was reported by 250 men, and men reporting chronic headache had lower serum vitamin D levels than others. When we divided the study population into four groups based on their serum vitamin D levels, the group with the lowest levels had over a twofold risk of chronic headache in comparison to the group with the highest levels. Chronic headache was also more frequently reported by men who were examined outside the summer months of June through September.