Author Interviews, Cancer Research, ENT, JAMA, Radiation Therapy, Stanford / 15.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29579" align="alignleft" width="188"]Michelle M. Chen, MD/MHS Department of Otolaryngology- Head and Neck Surgery Stanford University Dr. Michelle Chen[/caption] Michelle M. Chen, MD/MHS Department of Otolaryngology- Head and Neck Surgery Stanford University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The benefit of post-operative radiotherapy (PORT) for patients with T1-T2 N1 oral cavity and oropharyngeal cancer without adverse pathologic features is unclear. Starting in 2014, the national guidelines no longer recommended consideration of post-operative radiotherapy for N1 oropharyngeal cancer patients, but left it as a consideration for N1 oral cavity cancer patients. We found that post-operative radiotherapy was associated with improved survival in both oral cavity and oropharyngeal cancers, particularly in patients younger than 70 years of age and those with T2 disease.
Author Interviews, JAMA, Ophthalmology, Zika / 15.11.2016

MedicalResearch.com Interview with: Camila Ventura MD Pediatric Retina Research Fellow at Bascom Palmer Eye Institute (BPEI), USA PhD student at Federal University of São Paulo (Unifesp) Medical Retina, Ocular Oncology, and Uveitis Department at Altino Ventura Foundation Brazil MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Brazilian outbreak of Zika virus (ZIKV) began in April 2015 and since then, we have not been able to stop its rapid spread throughout the Americas. Not only has ZIKV been disseminating very rapidly, patients affected by the ZIKV have also been presenting with some findings never before reported in the literature. Until recently, ZIKV infection was only associated with mild symptoms such as headache, rash, arthralgia, and conjunctivitis. However, in October 2015, a twenty-fold increase in the prevalence of newborns with microcephaly was reported that was later confirmed to be associated to ZIKV infection during pregnancy. Although microcephaly and other central nervous system findings were the first abnormalities reported, recent publications have described other malformations associated with ZIKV congenital infection including hearing loss, limb anomalies and ocular findings. Due to all of these systemic findings, this new clinical condition has been named Congenital Zika Syndrome (CZS). In January 2016, our group published the first report on the ocular findings of infants with microcephaly and presumed congenital ZIKV infection, followed by another manuscript describing 10 additional cases. We have also contributed with an article published in JAMA Ophthalmology reporting the risk factors associated to the ocular findings in babies with CZS. Other authors such as De Paula Freitas et al and Miranda 2nd et al, have also contributed to the literature by describing similar ocular findings in these infants with CZS. In the present case series, we describe the Ocular Coherence Tomography (OCT) findings in ten eyes of eight infants with CZS.
Annals Internal Medicine, Author Interviews, Dermatology, Immunotherapy / 15.11.2016

MedicalResearch.com Interview with: Dr. Morton Scheinberg, MD, PhD From Hospital Israelita Albert Einstein and Hospital AACD, São Paulo, and Clinica Dermatosineida, Maringa, Parana, Brazil. MedicalResearch.com: What is the background for this study? What are the main findings? Response: That universal hair loss associated with a localized autoimmune reaction on the cells involved with the hair follicles can be halted with tofacitinib.
Accidents & Violence, Author Interviews, JAMA / 15.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29665" align="alignleft" width="200"]Ted Alcorn, MHS, MA Everytown for Gun Safety Brooklyn, New York Ted Alcorn[/caption] Ted Alcorn, MHS, MA Everytown for Gun Safety Brooklyn, New York MedicalResearch.com: What is the background for this study? Response: Two decades ago, opponents of gun violence prevention recognized that they could curb the development and enactment of effective laws if they halted scientific research on which good policy would be grounded or justified. So they adopted a strategy of intimidation towards the leading federal agencies funding research on this topic and generating data on which analysis relied. Journalists that observed the pattern and scientists that lived through it often described the “chilling effect” this had on the field of gun violence prevention research.
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 15.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29661" align="alignleft" width="175"]Katherine P. Theall, PhD Associate Professor Global Community Health and Behavioral Services Tulane University School of Public Health and Tropical Medicine New Orleans, Louisiana Dr. Katherine P. Theall[/caption] Katherine P. Theall, PhD Associate Professor Global Community Health and Behavioral Services Tulane University School of Public Health and Tropical Medicine New Orleans, Louisiana MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are stark health disparities in the U.S. by socioeconomic position as well as between racial and ethnic groups. Many of these health disparities may have a root cause in childhood and be driven by social risk factors. The authors report each neighborhood stressor was associated with biological stress as measured by shortened telomere length and cortisol functioning. Many children are exposed to violence and a greater understanding of the effect on children’s health is critical because social environmental conditions likely contribute to health disparities. Socioeconomically disadvantaged communities have a higher exposure to violence. Limitations of the study include its lack of applicability to other demographic groups. The study also cannot establish causality.
Author Interviews, Heart Disease, Lipids, NEJM, Pharmacology / 14.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29622" align="alignleft" width="133"]Kevin Fitzgerald, Ph.D. Alnylam Pharmaceuticals Cambridge, MA 02142 Dr. Kevin Fitzgerald[/caption] Kevin Fitzgerald, Ph.D. Alnylam Pharmaceuticals Cambridge, MA 02142 MedicalResearch.com: What is the background for this study? Response: Inclisiran (ALN-PCSsc) is a subcutaneously administered RNAi therapeutic targeting PCSK9 in development for the treatment of hypercholesterolemia. The Phase 1 trial of inclisiran was conducted in the U.K. as a randomized, single-blind, placebo controlled, single ascending-and multi-dose, subcutaneous dose-escalation study in 69 volunteer subjects with elevated baseline LDL-C (≥ 100 mg/dL). The primary objective of the study was to evaluate the safety, side effect profile, and pharmacodynamics effects of inclisiran.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Race/Ethnic Diversity, UT Southwestern / 13.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29589" align="alignleft" width="140"]Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 Dr. Wanpen Vongpatanasin[/caption] Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors.
Author Interviews, BMJ, Cancer Research, Cost of Health Care, Imperial College / 11.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29575" align="alignleft" width="200"]Peter Wise MD Charing Cross Hospital and Imperial College School of Medicine London, UK Dr. Peter Wise[/caption] Peter Wise MD Charing Cross Hospital and Imperial College School of Medicine London, UK MedicalResearch.com: What is the background for this analysis? Response: As a medical ethicist, I wished to know how much patients with advanced – metastatic – cancer knew about the drugs that were being used to treat it. What were their perceptions of likely treatment success and how did that tally with our knowledge of what drugs could actually achieve – and at what cost to the body and to the pocket. Did patients actually have a choice – and how did the drugs get approved for use in the first place?
Author Interviews, JAMA, Ophthalmology, Pediatrics, Technology / 11.11.2016

MedicalResearch.com Interview with: Krista Kelly, PhD Postdoctoral Fellow Crystal Charity Ball Pediatric Vision Evaluation Center Retina Foundation of the Southwest Dallas, TX 75231 MedicalResearch.com: What is the background for this study? Response: Amblyopia is one of the most common causes of monocular impairment in children, affecting 1 or 2 children in every US classroom. Patching of the fellow eye has been used for decades to improve visual acuity in the amblyopic eye. But patching does not always restore normal vision and does not teach the two eyes to work together. A novel technique originally designed by Drs Robert Hess and Ben Thompson at McGill University that works to reduce interocular suppression by rebalancing the contrast between the eyes has shown promising results in amblyopic adults. Dr Eileen Birch at the Retina Foundation of the Southwest worked with Dr Hess to adapt this contrast re-balancing approach to an iPad game platform suitable for children. Her research showed that the games were successful in improving visual acuity in amblyopic children as well. However, these initial games were rudimentary and resulted in low compliance.
Author Interviews, OBGYNE, Pediatrics / 10.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29559" align="alignleft" width="184"]Jason Bentley, MBiostat Doctoral Fellow Menzies Centre for Health Policy University of Sydney Jason Bentley[/caption] Jason Bentley, MBiostat Doctoral Fellow Menzies Centre for Health Policy University of Sydney MedicalResearch.com: What is the background for this study? Response: Planned birth (labor induction or pre-labor caesarean section) is a decision to intervene and so determines a gestational age at birth that would have otherwise been later if pregnancy had progressed through to spontaneous labor. Significant changes in clinical practice have seen an increase in planned births before 39-40 completed week’s gestation from an increased use of primary and repeat cesarean section and a greater use of labor induction. At a population level this has resulted in a decrease in modal gestational age with planned birth accounting for almost half of births before 39-40 weeks. Clinical research has indicated that the threshold for planned birth and the gestational age for intervening has reduced. Numerous reasons have been given as justification for this including litigation, patient and provider perception of safety versus risk, reduced perinatal mortality, increased fetal monitoring, maternal age, obesity and convenience. There has also been the clinical perception that birth just before the optimal date carries little significant morbidity, with a focus on short-term risks to mother or baby only rather than longer-term outcomes. It is of paramount importance to ensure there are no unintended harms from such a significant shift in clinical practice. This study investigated whether the timing of planned birth was associated with poorer developmental outcomes at school age.
Author Interviews, Dermatology, JAMA, Melanoma / 10.11.2016

MedicalResearch.com Interview with: [caption id="attachment_28969" align="alignleft" width="133"]Caroline Watts| Research Fellow Dr. Caroline Watts[/caption] Caroline Watts | Research Fellow Cancer Epidemiology and Prevention Research Sydney School of Public Health Melanoma Institute Australia (MIA) investigator The University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Melanoma Patterns of Care study was a population-based observational study of physicians’ reported clinical management of 2727 patients diagnosed with an in situ or invasive primary melanoma over a 12-month period from October 2006 to 2007 in New South Wales, Australia. This paper investigated the differences between 1052 (39%) patients who were defined as higher risk owing to a family history of melanoma, multiple primary melanomas, or many nevi (moles) compared to patients who did not have any risk factors. We found that the higher-risk group had a younger mean age at diagnosis compared to those without risk factors, (62 vs 65 years, P < .001) which varied by type of risk factor (56 years for patients with a family history, 59 years for those with many nevi, and 69 years for those with a previous melanoma). These age differences were consistent across all body sites. Among higher-risk patients, those with many nevi were more likely to have melanoma on the trunk (41% vs 29%, P < .001), those with a family history of melanoma were more likely to have melanomas on the limbs (57%vs 42%, P < .001), and those with a personal history were more likely to have melanoma on the head and neck (21% vs 15%, P < .001).
Author Interviews, Breast Cancer, Chemotherapy, JAMA, Karolinski Institute / 09.11.2016

MedicalResearch.com Interview with: Jonas Bergh M.D, Ph.D. F.R.C.P. (London, UK) Professor of Oncology (Mimi Althainz´donation) Director Strategic Research Program in Cancer Karolinska Institutet Radiumhemmet, Karolinska University Hospital Stockholm, Swede MedicalResearch.com: What is the background for this study? Response: Present standard dosing of chemotherapy is aiming at a similar dose for each individual (similar effects and side-effects) , by calculating the dose per mg/m2 based on a formula originally established by du Bois (1916), based on body surface calculations by measuring height and weight. As I recall it, this was done on nine individuals… However, the body surface has very little to do with how you cytotoxic drugs are metabolized and excreted… in practice this means that chemotherapy dosing based on body surface area will result in under- or overdosing of quite a proposition of the patients… Please Google/run a PubMed research on H. Gurney in Australia, he and other have really expressed their concerns with our present chemotherapy dosing strategies. In our prospective adjuvant chemotherapy study of high risk breast cancer patients we tested a very well established standard chemotherapy regimen given every third week (FEC100 mg/m2 x 3+ docetaxel 100 mg/m2 x3) vs. our experimental arm given very second week in a dose dense fashion. We also tried to optimize the dosing, aiming at avoiding overdosing some patients at the first course and increase the dose for those without predefined toxicities. Therapy duration was similar in both groups, 15 weeks. Please see the end of the discussion in JAMA for the shortcomings with our study.
Author Interviews, Gastrointestinal Disease, JAMA, Lipids / 09.11.2016

MedicalResearch.com Interview with: Borge G. Nordestgaard, MD, DMSc Professor, University of Copenhagen Chief Physician, Dept. Clinical Biochemistry, Herlev and Gentofte Hospital Copenhagen University Hospital Herlev, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Acute pancreatitis is an inflammatory disorder of the pancreas with gallstones and high-alcohol consumption as leading risk factors, while mild-to-moderately increased plasma triglycerides hitherto has been overlooked. We surprisingly found that the risk of developing acute pancreatitis was increased already from triglycerides of 175 mg/dL (2 mmol/L) and above. When triglycerides were above 443mg/dL (5mmol/L) the risk was increased a massive 9-fold. Interestingly, this risk was higher than the corresponding 3.4-fold higher risk for myocardial infarction.
Author Interviews, JAMA, OBGYNE, Pediatrics / 09.11.2016

MedicalResearch.com Interview with: Dr. Sharon Unger BSc, MD, FRCP Staff Neonatologist at Mount Sinai Hospital Associate Staff Neonatologist at The Hospital for Sick Children (SickKids) Associate Professor in the Department of Paediatrics at the University of Toronto. Medical Director of the Rogers Hixon Ontario Human Milk Bank and Dr. Deborah L. O’Connor PhD, RD Senior Associate Scientist in Physiology & Experimental Medicine SickKids and Professor Department of Nutritional Sciences at the University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: Babies who are born very early (before 32 weeks’ gestation) and/or at very low weights (less than 1,500 grams) are among the most fragile of all paediatric patients, typically facing serious medical issues and requiring care in a Neonatal Intensive Care Unit (NICU). In addition to underdeveloped organs and risk of neurodevelopmental issues, preterm and very low birth weight babies are at risk of a severe bowel emergency called necrotizing enterocolitis, which involves the damage and potential destruction of the intestinal tissue. This disease affects approximately six per cent of very low birth weight infants each year, making it one of the most common causes of death and long-term complications in this population. As a neonatologist and a PhD-trained dietitian, we have spent our careers working to improve outcomes for babies and supporting breastfeeding. While there is already strong evidence to suggest that breastfeeding is associated with a variety of benefits including reduced risk of childhood infections and may play a role in the prevention of overweight and diabetes, in healthy, full-term infants, we launched a research program a decade ago to figure out how to ensure the same advantage could be provided to vulnerable hospitalized infants, specifically very low birth weight infants. Breastfeeding initiation rates in Canada are now at all-time high for healthy newborns, but for many reasons related to preterm birth, up to two thirds of mothers of very low birth weight infants are unable to provide a sufficient volume of breast milk to their infant. A variety of factors may limit breast milk production in these cases, including immaturity of the breast cells that make milk, maternal illness, breast pump dependency, and stress. In addition to the health benefits attributed to mother’s milk for full-term, healthy infants, previous studies have shown that use of mother’s milk in very low birth weight infants is associated with a reduction in necrotizing enterocolitis. It is also associated with a reduction in severe infection, improved feeding tolerance and more rapid hospital discharge. Ten years ago, along with our inter-professional colleagues at 21 NICUs in the Greater Toronto and Hamilton areas, we began to examine whether using donor breast milk as a supplement to mother’s milk would improve health outcomes of very low birth weight infants when mother’s milk was not available.
Author Interviews, Cost of Health Care, Diabetes, JAMA / 08.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29503" align="alignleft" width="200"]Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada Tara Gomes[/caption] Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: In August 2013, the Ontario government introduced reimbursement limits for blood glucose test strips. Subsequent research has suggested that the provincial government saved $24 million in the first year after implementing this quantity limit policy. This study investigated whether these quantity limits led to any change in diabetes-related patient outcomes. We found that limiting the number of blood glucose test strips reimbursed by the government to levels recommended by the Canadian Diabetes Association had to no change in diabetes control (measured as rates of emergency department visits for hypoglycemia or hyperglycemia, and mean HbA1c) in the 1.5 years after implementation. Similarly, there was no worsening of patient outcomes in a subgroup of individuals who had been frequent users of test strips prior to the policy being announced.
Author Interviews, Cost of Health Care, JAMA / 08.11.2016

MedicalResearch.com Interview with: Robert Humble, MS, MD Candidate, 2019 President, EQUAL Med Governmental Relations Chair, CCOM Student Government University Iowa Matthew D. Krasowski, MD, PhD Department of Pathology University of Iowa Hospitals and Clinics, Iowa City MedicalResearch.com: What is the background for this study? What are the main findings? Response: Laboratory testing is a critical tool in clinical decision-making. Clinical laboratories frequently receive “extra” tubes of blood. On collection, they have no testing associated with them. They are stored in the laboratory for a period of time for add-on testing. We sought to analyze patterns of extra tube collection at an academic medical center over an extended period of time, and determine patterns of add-on testing before and after implementation of new laboratory information system (LIS) software (Epic Beaker). Until this study, extra tube collection and utilization had not been quantified at our institution to this extent. We found that most extra tubes weren’t used for laboratory testing. After collection, the vast majority of these tubes were stored until disposal. Over the period of study our institution moved from a paper ordering protocol to a ‘paperless ordering’ system that printed labels only for tubes needed for testing ordered by providers. After implementation of Epic Beaker, we saw utilization practices improve, though there is still room for improvement. Overall, we’ve seen significant decreases in extra tube collection across the institution.
Author Interviews, Hepatitis - Liver Disease, JAMA, Neurological Disorders / 08.11.2016

MedicalResearch.com Interview with: Philip Van Damme, MD, PhD Department of Neurology and Department of Neurosciences, Experimental Neurology KU Leuven University of Leuven VIB, Vesalius Research Center, Leuven, Belgium Philip Van Damme, MD, PhD Department of Neurology and Department of Neurosciences, Experimental Neurology KU Leuven University of Leuven VIB, Vesalius Research Center, Leuven, Belgium MedicalResearch.com: What is the background for this study? Response: The hepatitis E virus (HEV) has been discovered more that 60 years ago. Its clinical manifestations are usually self-limiting and mild. More recently, several immune-mediated neurological complications of this virus have been described, such as the Guillain-Barre syndrome (GBS) and neuralgic amyotrophy. In this study, we investigated the frequency of a preceding HEV infection in patients presenting with a GBS syndrome or one of its less common disease variants. At the same time, we tested for other known pathogens known to be associated with GBS.
Author Interviews, Nature, Stem Cells / 07.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29434" align="alignleft" width="151"]Dr. Fred Levine MD PhD Professor & Director Sanford Children's Health Research Center Sanford Burnham Prebys Medical Discovery Institute La Jolla, CA Dr. Fred Levine[/caption] Dr. Fred Levine MD PhD Professor & Director Sanford Children's Health Research Center Sanford Burnham Prebys Medical Discovery Institute La Jolla, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is the latest in a series that began in 2010 when we published that the combination of severe pancreatitis and ablation of preexisting pancreatic beta-cells led to the formation of new beta-cells by direct conversion of alpha-cells, which are the neighboring cells in the islets of Langerhans producing glucagon, which like insulin is also involved in glucose homeostasis. The phenomenon of generating new beta-cells by islet cell transdifferentiation went against the conventional wisdom in the field, which is that most beta-cell neogenesis in adults occurs by differentiation from cells in the pancreatic ducts, similar to what happens during embryogenesis. Since then, we have shown that beta-cell neogenesis by islet cell transdifferentiation appears to occur in murine and human type I diabetes, making it highly translationally relevant. Understanding the mechanism by which new beta-cells are formed from alpha-cells is required for eventual clinical translation. The current study describes that mechanism, which involves the activation of an atypical G protein coupled receptor called Protease Activated Receptor 2 (PAR2). Unlike most other GPCRs, it is activated by extracellular proteases such as are found in the exocrine pancreas or following tissue damage. PAR2 activation by an injectable peptide agonist was both necessary and sufficient to induce beta-cell neogenesis when preexisting beta-cells are absent, as occurs in type I diabetes.
Author Interviews, Diabetes, Nutrition, PLoS, University of Michigan / 06.11.2016

MedicalResearch.com Interview with> Katarina Borer, Ph.D. Professor Po-Ju Lin,PhD School of Kinesiology The University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: This study was part of the doctoral dissertation of Po-Ju Lin, who is now a post-doctoral fellow at the University of Rochester. With this study, we wanted to answer three questions: (1) Is daily carbohydrate load responsible for evening glucose intolerance and post-meal insulin resistance. (Evening glucose intolerance represents well-documented higher glucose and insulin responses in the evening than in the morning when the same quantity of glucose is eaten or infused intravenously) To answer this question we offered two daily meals containing about 800 Kcal and either 30% or 60% of carbohydrates. (2) Will exercise before the meals improve glucose tolerance (glucose clearance from the blood and insulin response) after eating? (Exercise is a well-known means of increasing glucose uptake by the muscle and of increasing muscle sensitivity to insulin action for a number of hours after exercise). To answer this question we had the subjects exercise for two hours walking on a treadmill at 45% of their maximal aerobic effort one hour before each meal. (3) Is the upper-intestinal hormone GIP involved in any effects associated with variation in dietary carbohydrate? (GIP or glucose-dependent insulinotropic peptide, stimulates insulin secretion in advance of absorbed glucose).
Author Interviews, Cancer Research, JAMA / 04.11.2016

MedicalResearch.com Interview with: Ayako Okuyama, RN, PHN, MW, PhD Center for Cancer Control and Information Services National Cancer Center, Japan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for chemotherapy patients. Despite widespread concern, not all chemotherapeutic drugs cause severe CINV. Our study illustrated that the potential for overuse of prophylactic antiemetics for chemotherapy with minimal and low emetic risks according to the antiemetic guidelines.
Author Interviews, End of Life Care, HIV, Pediatrics, Pediatrics / 03.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29351" align="alignleft" width="176"]Maureen E. Lyon PhD Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National The George Washington University School of Medicine and Health Sciences Washington, District of Columbia Dr. Maureen E. Lyon[/caption] Maureen E. Lyon PhD Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National The George Washington University School of Medicine and Health Sciences Washington, District of Columbia MedicalResearch.com: What is the background for this study? Response: Despite policy recommendations to include adolescents with chronic and life-limiting conditions in decision-making about their own end-of-life care, barriers continue in clinical practice, including fear of distressing vulnerable adolescents and providers’ beliefs that these conversations are potentially harmful.
Author Interviews, End of Life Care, JAMA, Race/Ethnic Diversity, UCSF / 02.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29236" align="alignleft" width="150"]Krista Lyn Harrison, PhD Division of Geriatrics School of Medicine University of California San Francisco VA Medical Center San Francisco, CA 94121 Dr. Krista Lyn Harrison[/caption] Krista Lyn Harrison, PhD Division of Geriatrics School of Medicine University of California San Francisco VA Medical Center San Francisco, CA 94121 MedicalResearch.com: What is the background for this study? Response: Advance care planning (ACP) is the process of discussing plans and preferences for end-of-life care. It may include completion of advanced directives or a living will and designation of a surrogate decision-maker in a durable power of attorney for health care. There is a growing awareness of the benefits of such discussions for both elders and their families. In absence of these discussions, loved ones are left to guess what the affected individual wanted or may even get mired in unexpected legal issues. But until recently, it was unknown if all races/ethnicities, education levels, and incomes have benefited from efforts to improve engagement in advance care planning, and if these discussions are greater among those in worse health and with a poorer prognosis.
Author Interviews, JAMA, OBGYNE, Pediatrics, Vaccine Studies / 02.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29371" align="alignleft" width="130"]Malini B. DeSilva, MD, MPH Clinician Investigator HealthPartners Institute Dr. Malini B. DeSilva[/caption] Malini B. DeSilva, MD, MPH Clinician Investigator HealthPartners Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: This is a retrospective study of more than 324,000 live births at seven Vaccine Safety Datalink sites between 2007 and 2013 which showed that the Tdap vaccine in pregnant mothers was not associated with increased risk for microcephaly or other major birth defects in their offspring.
Author Interviews, CHEST, Clots - Coagulation, Surgical Research / 02.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29338" align="alignleft" width="200"]William T. Kuo, MD, FSIR, FCCP, FSVM Director, Stanford IVC Filter Clinic Director, IR Fellowship Program Founding Director, IR-DR Residency Program Associate Professor, Interventional Radiology Stanford University Medical Center Stanford, CA Dr. William T. Kuo[/caption] William T. Kuo, MD, FSIR, FCCP, FSVM Director, Stanford IVC Filter Clinic Director, IR Fellowship Program Founding Director, IR-DR Residency Program Associate Professor, Interventional Radiology Stanford University Medical Center Stanford, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the USA, over 250,000 IVC filters are now implanted each year, and rising filter use has led to an increase in filter-related morbidity and recognition of the potential complications from indwelling IVC filters. Consequently, the FDA has issued two safety communications alerting all physicians caring for patients with IVC filters to consider removing the filter as soon as protection from pulmonary embolism is no longer needed: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm?so urce=govdelivery&utm_medium=email&utm_source=govdelivery Despite heightened awareness, up to 40-60% of IVC filters cannot be easily removed using standard methods alone, after the filter becomes firmly embedded. Additionally, many patients have undergone prior placement of a permanent-type filter not even designed for retrieval, leaving them with few options for safe device removal. Although all of these patients can develop filter-related morbidity especially after chronic implantation, there is currently no routine option for removing embedded IVC filters refractory to standard retrieval methods. Our 5-year first-in-human study of a novel procedure—laser-assisted filter removal— demonstrates the safety and efficacy of this technique to treat such patients. In a cohort refractory to standard retrieval methods and high force, endovascular laser-assisted retrieval was overall safe and successful in removing a variety of filter types including permanent filters, regardless of dwell time and without the need for open surgery.
Accidents & Violence, Author Interviews, JAMA, Karolinski Institute, Mental Health Research / 01.11.2016

MedicalResearch.com Interview with: Zheng Chang PhD Dept. of Medical Epidemiology and Biostatistics Karolinska Institutet and Seena Fazel MD Department of Psychiatry Warneford Hospital University of Oxford, Oxford, England MedicalResearch.com: What is the background for this study? What are the main findings? Response: There were more than 10 million prisoners worldwide in 2015, with approximately 2.2 million in the United States alone. Despite reported decreases in violence in many countries, reoffending rates remain high. From 2005 through 2010, more than one-third of released prisoners in the United States and the United Kingdom were reconvicted of a new crime within 2 years. Most programs to reduce reoffending focus on psychosocial interventions, but their effect sizes are weak to moderate. As psychiatric and substance use disorders, which increase reoffending rates, are overrepresented among jail and prison populations. This study investigated the main psychotropic medication classes prescribed to prisoners using longitudinal Swedish population registers and examined the association between prescription of psychotropic medication and risk of violent reoffending. We found that three classes of psychotropic medications were associated with substantial reductions in violent reoffending: antipsychotics, a 42% reduction; psychostimulants, 38%; and drugs used in addictive disorders, a 52% reduction. The magnitudes of these associations were as strong as and possibly stronger than those for widely disseminated psychological programs in prison.
Author Interviews, JAMA, Pediatrics, Sleep Disorders, Technology / 01.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29335" align="alignleft" width="200"]Senior Lecturer in Medical Statistics Statistics Editor for the Cochrane Skin Group (Honorary Associate Professor, Nottingham University) Institute of Primary Care and Public Health Cardiff University Dr. Ben Carter[/caption] Dr Ben Carter PhD Senior Lecturer in Medical Statistics Statistics Editor for the Cochrane Skin Group (Honorary Associate Professor, Nottingham University) Institute of Primary Care and Public Health Cardiff University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study leads from the growing use of mobile and media device use in children. We report the impact of devices leads to poorer sleep outcomes. MedicalResearch.com: What should readers take away from your report? Response: Using or even merely access to your mobile and media device should be restricted 90 minutes prior to bedtime.
Addiction, Author Interviews, CHEST, Toxin Research / 01.11.2016

MedicalResearch.com Interview with: Guy Soo Hoo, MD West Los Angeles VA Medical Center Los Angeles, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wound botulism occurs as a result of infection by material contaminated with C. botulinum. While typically associated with trauma and crush injury, it is also an infection associated with injection drug users especially with “skin popping”. Black tar heroin is an especially common vehicle for the development of wound botulism. Black tar heroin is the predominant form of heroin used in the western United States and there has been an epidemic of wound botulism cases associated with black tar heroin users especially in California. In fact, the vast majority of wound botulism cases in California occurs in injection drug users, specifically those who inject the drug subcutaneously or intramuscularly. The typical presentation in wound botulism in an acute neurologic illness with cranial nerve palsies, flaccid descending paralysis. Respiratory failure requiring mechanical ventilation may occur and may require an extended period of ventilator support for recovery. A high index of suspicion as well as general supportive care is needed for optimal treatment and recovery. Optimal treatment includes wound debridement, early administration of botulinum antitoxin and penicillin therapy. This case is unique in that the initial presentation was bilateral vocal cord paralysis and cranial nerve function was initially intact. The patient subsequently developed a flaccid paralysis that included cranial nerve palsies, functional quadriplegia and respiratory failure. He recovered to be discharged to a rehabilitation facility about six weeks after his initial presentation.
Author Interviews, Colon Cancer, JAMA / 30.10.2016

MedicalResearch.com Interview with: Fausto Petrelli, MD Oncology Unit, Oncology Department Treviglio ,Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: This meta-analysis evaluated if side (excluding rectum site) represents an independent prognostic factor for survival in patients with stages 1-4 colon cancer. This variable is in fact associated with an adverse outcome with a reduced risk of death by 20% if patients are affected by a left colon cancer compared to those with right colon cancers. Implications are enormous: for prognosis first but also for follow-up, stratification into clinical trials and treatment (for both medical and surgical therapies). The power of the study is relevant: it enclosed 66 studies with more than 1 million of patients retrospectively or prospectively analyzed for survival according to common variables known to be prognostic in colorectal cancer (age, sex, stage, race, adjuvant CT..etc) in multivariate analysis. Side is significantly associated with survival independent of other covariates analyzed. The question of the side is old and partially known, but no study systematically explored the published literature to confirm this suggestion. Recent large randomized trials in metastatic disease showed different results according to the site of disease with right colon cancers usually less responsive to anti-EGFR treatment due to a different molecular behavior and conversely left colon cancers which attained the greater benefit from cetuximab and panitumumab due to less BRAF mutations in their tissue. Also, a less extensive and radical lymphadenectomy in right-sided cancers, without a complete mesocolon excision during surgery, could hamper their cure rate, as our colorectal surgeon's team lead by Prof. Giovanni Sgroi and Luca Turati MD, suggested in the discussion. It is also well known the leads term bias with a later diagnosis of right cancers due to clinical and anatomic reasons.
Author Interviews, Heart Disease, JACC, Medical Imaging / 29.10.2016

MedicalResearch.com Interview with: Kristina H. Haugaa, MD, PhD, FESC Ida Skrinde Leren MD, PhD Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet Oslo, Norway MedicalResearch.com: What is the background for this study? Response: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inheritable cardiomyopathy, predisposing to life-threatening arrhythmias. Ventricular arrhythmias are frequent in ARVC patients and importantly, arrhythmias may occur also before evident structural changes are seen, making risk stratification challenging. Additional tools are needed to detect early disease and to optimize medication and timing of implantation of a cardioverter defibrillator (ICD). We aimed to explore early markers of ARVC disease and their association with previous ventricular arrhythmias.
Author Interviews, Endocrinology, Hormone Therapy, JCEM / 29.10.2016

MedicalResearch.com Interview with: Mario Philip Reyes Festin, MD World Health Organization Geneva, Switzerland.  MedicalResearch.com: What is the background for this study? Response: Researchers are trying to identify a hormonal male contraceptive that is effective, reversible, safe, acceptable, affordable, and available. Most of the research has been done either by groups of university researchers. However, in the 1990s, WHO undertook two multi-center, multinational studies. The studies were unable to provide evidence to support the development of a commercially viable, and user-acceptable product.