MedicalResearch.com Interview with:
Dr. Song Hee Hong PhD
Associate Professor,
Health Outcomes and Policy Research
Dept. Clinical Pharmacy
University of Tennessee Health Science Center
Memphis, TN 38163
Medical Research: What are the main findings of the study?
Dr. Hong: Use of GDDP (generic drug discount programs) increased to 23.1% in 2010 from 3.6% of patients receiving any prescription drugs in 2007.
Generic drug discount programs were more valued among the elderly, sicker and uninsured populations.
The lower use of Generic drug discount programs among racial/ethnic minorities observed when the program was deployed no longer existed when the program matured.
MedicalResearch.com Interview with:
Dr. Frank B. Hu
Department of Nutrition
Harvard School of Public Health
Boston, MA
Medical Research: What are the main findings of the study?
Dr. Hu: in this study among approximately 5000 patients with type 2 diabetes followed for up to 10 years, longer duration of sulfonylurea therapy was associated with a higher risk of coronary heart disease. The continuous sulfonylurea therapy for 10 years was associated with almost two times greater risk of coronary heart disease compared with nonusers. However, given the observational nature of the study, we cannot make causal inference from these findings.
MedicalResearch.com Interview with:
Lisa A. McDonnell
Program Manager, Prevention & Wellness Centre,
Division of Prevention and Rehabilitation,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Medical Research: What are the main findings of the study?
Answer: The analysis focuses on a comparison of women’s perceptions of their heart disease knowledge and heart health risk with their self‐reported knowledge and heart health risk status. In summary, it gives insight into the Perceptions vs Reality when it comes to women and their heart health.
Heart disease knowledge:
For the purposes of measuring knowledge related to heart health, a scoring index was created on which women responding to the survey could score as low as 0 or as high as 40. The overall mean score among women in the survey was 15.0, which is fairly modest given the maximum of 40. In a comparison of actual and perceived heart disease knowledge, 80% of respondents with a low knowledge score perceived that they were moderately or well informed.
The risk factors that Canadian women most commonly associate with heart disease are being overweight/having abdominal obesity (ov/ob), physical inactivity, smoking, and lacking fruits/vegetables. Smoking, diabetes and high blood pressure account for up to 53% of MI’s, followed by Ov/Ob, psychosocial factors, a lack of physical activity, and a lack of fruits/vegetables. The limited awareness of high blood pressure, high cholesterol and diabetes as key risk factors is particularly surprising, given that these are key determinants of heart disease.
Low awareness of symptomology among women in our survey were noted when comparing the occurrence of symptoms versus their recognition of these symptoms as possibly being related to their heart. Only 4 in 10 women could name chest pain as a symptom of heart disease, and a smaller proportion could identify symptoms including dyspnea, radiating pain, or typical prodromal symptoms. Such shortcomings might contribute to the greater number of unrecognized myocardial infarctions in women than in men, not to mention inappropriate treatment of acute events and premature discharge from emergency care.
MedicalResearch.com Interview with:
Tara Gomes
St Michael's Hospital
Toronto, ON, Canada
Medical Research: What are the main findings of the study?
Tara Gomes: We found that rates of opioid overdose in Ontario have increased more than 3-fold over the past 2 decades. Furthermore, these deaths are clustered among younger Ontarians; in 2010, 1 in 8 deaths among those aged 25 to 34 years were related to opioids. This has led to considerable burden due to loss of life.
MedicalResearch.com Interview with:
Tamara Haegerich, PhD
Deputy Associate Director for Science
Division of Unintentional Injury Prevention
CDC - National Center for Injury Prevention and Control
MedicalResearch: What are the main findings of the study?
Dr. Haegerich: In the first three decades of life, more people in the US die from injuries and violence than from any other cause. Approximately 60% of fatal injuries are unintentional (for example, from motor vehicle crashes, drug overdose, and falls), 20% are due to suicide, and 20% are due to homicide. Injuries and violence have been linked to a wide range of physical, mental health, and reproductive health problems, and chronic diseases. They take an enormous economic toll, including the cost of medical care and lost productivity. Importantly, injuries and violence are preventable through education, behavior change, policy, engineering, and environmental supports. For example, laws that promote the use of seat belts and child safety seats, and prevent drunk driving, can reduce motor-vehicle-related injuries. Early childhood home visitation, school-based programs, and therapeutic foster care are examples of evidence-based approaches to preventing violence. Improving proper prescribing of painkillers and access to treatment for substance misuse could prevent prescription drug overdoses. Improvements are possible by framing injuries and violence as preventable, identifying interventions that are cost-effective and based on research, providing information to decision makers, and strengthening the capacity of the health care system.
MedicalResearch.com Interview with:
Jacques Baillargeon, PhD
Director, Epidemiology Division
Associate Professor
Department of Preventive Medicine and Community Health
University of Texas Medical Branch
MedicalResearch: What are the main findings of the study?
Dr. Baillargeon: The main findings of the study were that older men who were treated with testosterone did not appear to have an increased risk of Myocardial Infarction. For men with high MI risk, testosterone use appeared to be modestly protective against MI.
MedicalResearch.com Interview with:Dr. Robin L. Toblin LCDR Robin L. Toblin, PhD, MPH (USPHS) Clinical Research Psychologist Walter Reed Army Institute of Research MedicalResearch: What are the main findings of your study? Dr. Toblin: Our study focused on chronic pain and opioid use in an infantry brigade three months after returning from war. We surveyed...
MedicalResearch.com Interview with:
Nicholas B. King, PhD,
Biomedical Ethics Unit
McGill University
Montreal QC Canada
MedicalResearch: What are the main findings of the study?
Dr. King: Unintentional overdoses from prescription opioid painkillers have been rising sharply in the US and Canada during the past two decades, killing thousands of people every year. A lot has been written about the subject in both popular media and scholarly literature, but we still don't have a very good idea of why this has happened. So we tried to objectively and systematically assess evidence for what has contributed to increasing mortality. We found the following:
(1) The evidence base for why mortality has increased is very thin, and more research is urgently required.
(2) We found evidence for at least 17 different causes of increased mortality. We found the most evidence for the following factors: dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like oxycodone and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic characteristics. We found little evidence that internet sales of pharmaceuticals and errors by doctors and patients--factors commonly cited in the media--have played a significant role.
MedicalResearch.com Interview with:
Theodore J. Cicero, PhD
Professor, Vice Chairman for Research
Department of Psychiatry
Washington University in St Louis
St Louis, Missouri
MedicalResearch: What are the main findings of the study?
Dr. Cicero: Heroin users nowadays are predominantly white men and women in their late 20s living outside large urban areas who were first introduced to opioids through prescription drugs compared to the 1960s when heroin users tended to be young urban men whose opioid abuse started with heroin.
MedicalResearch.com Interview with:
Scott Stroup, MD, MPH
Professor of Psychiatry
Director, Program for Intervention Effectiveness Research,
Associate Director for Adult Services, Division of Mental Health Services and Policy Research, New York State Psychiatric Institute
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
MedicalResearch: What are the main findings of the study?
Dr. Stroup: We conducted a study sponsored by the National Institute of Mental Health that compared long-acting injectable antipsychotics for people with schizophrenia. Long-acting injectable antipsychotics, also known as depot antipsychotics, are used to promote treatment adherence. We compared a newer injectable antipsychotic, paliperidone palmitate, to an older one, haloperidol decanoate. We did not find an advantage for the newer drug in overall effectiveness. The drugs performed very similarly, and were tolerated about the same.
MedicalResearch.com Interview with:
Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?
Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery.
MedicalResearch.com Interview with:
Michael H. Hall, MD
North Shore-LIJ Health System
MedicalResearch: What are the key points of your research?
Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary.
MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc
The Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging,Professor of Medicine and Pharmacy
University of Montreal Centre de Recherche
Institut Universitaire de Gériatrie de Montréal
Montreal, QC
MedicalResearch.com: What are the main findings of the study?
Dr. Tannenbaum: The EMPOWER study showed that providing older patients with information about the harms of sleeping pill use led to discontinuation or dose reduction in 1-in-every 4 patients with longstanding use of benzodiazepines. Receipt of evidence-based information about drug harms resulted in a 8-fold higher likelihood of benzodiazepine cessation. Many physicians think that patients become too dependent on sedative-hypnotics to successfully discontinue. Regardless of age, sex, and duration of use, 27% of patients aged 65-95 in this study successfully completed the recommended 20-week tapering protocol during a 6-month time period and another 11% were in the process of tapering. EMPOWERing patients with evidence-based information therefore results in appropriate risk reduction.
MedicalResearch.com Interview with:
Robyn Tamblyn BScN Msc PhD
James McGill Chair
Departments of Medicine and Epidemiology and Biostatistics
McGill University and Scientific Director
Institute of Health Services and Policy Research
Canadian Institutes of Health Research
MedicalResearch.com: What are the main findings of the study?
Dr. Tamblyn: Higher drug costs are associated with a higher probability of primary non-adherence, whereas better follow-up by the prescribing physician, and a policy to provide medication at no cost for the very poor increase the likelihood of adherence
MedicalResearch.com Interview with:
Christian Hampp PhD
Senior Staff Fellow/Epidemiologist at FDA
Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
MedicalResearch.com: What are the main findings of the study?
Dr. Hampp: Our study described U.S. market trends for antidiabetic drugs, focusing on newly approved drugs, concomitant use of antidiabetic drugs, and effects of safety concerns and restrictions on thiazolidinedione use.
We found that since 2003, the number of adult antidiabetic drug users increased by approximately 43% to 18.8 million in 2012. During 2012, 154.5 million prescriptions for antidiabetic drugs were filled in outpatient retail pharmacies. Since 2003, metformin use increased by 97% to 60.4 million prescriptions dispensed in 2012. Among antidiabetic drugs newly approved for marketing between 2003 and 2012, the dipeptidyl-peptidase-4 (DPP-4) inhibitor sitagliptin had the largest share with 10.5 million prescriptions in 2012.
Possibly triggered by safety concerns, the use of pioglitazone declined in 2012 to approximately 52% of its peak in 2008, when 14.2 million prescriptions were dispensed in outpatient retail pharmacies and the use of rosiglitazone use decreased to fewer than 13,000 prescriptions dispensed in retail or mail-order pharmacies in 2012.
MedicalResearch.com Interview Invitation
Dr. Christian Fynbo Christiansen
Clinical Associate Professor
Department of Clinical Epidemiology
Aarhus University Hospital
MedicalResearch.com: What are the main findings of the study?
Dr. Christiansen: We included 24,179 critically ill nonsurgical patients receiving mechanical ventilation in intensive care units in Denmark, and matched comparison groups of hospitalized patients and the general population. We assessed psychiatric diagnoses and medication prescriptions before and after critical illness.
We found an increased prevalence of psychiatric diagnoses in the 5 year period before critical illness, compared to both other hospitalized patients and the general population.
MedicalResearch.com Interview Invitation with:
Dr. Brian C. Callaghan MD
Department of Neurology
University of Michigan Health System, Ann Arbor
MedicalResearch.com: What are the main findings of the study?
Dr. Callaghan: The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time.
MedicalResearch.com Interview with:
Maryann Mazer-Amirshahi PharmD, MD
The Department of Emergency Medicine, The George Washington University
The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC
MedicalResearch.com: What are the main findings of the study?
Answer: We found a significant increase in the prescribing of opioid pain medications in the emergency department. At the same time, this was not accounted for by a similar increase in pain-related visits and prescribing patterns of non-opioid analgesics did not change.
MedicalResearch.com Interview with:
Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, Texas
MedicalResearch.com: What are the main findings of the study?
Dr. Morris: There are concerns that an increasing percentage of patients are receiving narcotics by “doctor shopping” or seeking narcotics from multiple providers. One in five of our postoperative orthopedic trauma patients received narcotics from one or more additional providers other than the treating surgeon.
Patients that doctor-shopped postoperatively had a significant increase in narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day.
MedicalResearch.com Interview with:
Dr. Jerome A. Leis, MD, MSc
Sunnybrook Health Sciences Centre
Toronto, ON, M4N 3M5, Canada
MedicalResearch.com: What are the main findings of the study?
Dr. Leis: We know that positive urine cultures from patients who lack signs and symptoms of urinary tract infection are a trigger FOR unnecessary antibiotic prescriptions in hospitals. This problem has not improved despite many educational initiatives. We identified a subset of patients in our hospital where only 2% of all urine specimens sent to the laboratory were associated with symptomatic infection and decided to no longer routinely report positive results from these specimens on the electronic medical record, unless a special telephone request was made. We found that with this simple change, unnecessary antibiotic prescriptions declined markedly and this did not require any education of care providers. Most importantly, based on our safety audits, patients who had a urinary tract infection all received appropriate treatment.
MedicalResearch.com Interview with:
Marsha A. Raebel, PharmD, BCPS, FCCP
Investigator in Pharmacotherapy
Institute for Health Research
10065 E. Harvard Ave Suite 300
Denver, CO 80231.
MedicalResearch.com: What are the main findings of the study?
Answer: We found that in a group of patients who took chronic opioids for non-cancer pain and who underwent bariatric surgery there was greater chronic use of opioids after surgery compared with before surgery, findings that suggest the need for proactive management of chronic pain in these patients after surgery.
MedicalResearch.com Interview with:
Richard Saitz, MD MPH
Professor of Medicine and Epidemiology
Boston University Schools of Medicine and Public Health
Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?
Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence.