Author Interviews, Brigham & Women's - Harvard, Gender Differences, JAMA, Surgical Research / 16.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48523" align="alignleft" width="200"]Nelya Melnitchouk, MD,MScDirector, Program in Peritoneal Surface Malignancy, HIPECDr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and instructor of surgery at Harvard Medical Schoo Dr. Melnitchouk[/caption] Nelya Melnitchouk, MD,MSc Director, Program in Peritoneal Surface Malignancy, HIPEC Dr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and instructor of surgery at Harvard Medical School. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current literature on women in surgery show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home. We hypothesized that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties. In our study, we found that physician mothers in procedural specialties who had more domestic responsibilities were more likely to report a desire to change careers than those in nonprocedural specialties. 
Author Interviews, Brigham & Women's - Harvard, Ebola, Global Health, Lancet / 28.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48164" align="alignleft" width="142"]Patrick Vinck, PhDResearch Director, Harvard Humanitarian InitiativeAssistant Professor, Global Health and Population T.H. Chan Harvard School of Public Health; Emergency MedicineHarvard Medical SchoolLead Investigator, Brigham & Women's Hospital  Dr. Vinck[/caption] Patrick Vinck, PhD Research Director, Harvard Humanitarian Initiative Assistant Professor, Global Health and Population T.H. Chan Harvard School of Public Health; Emergency Medicine Harvard Medical School Lead Investigator, Brigham & Women's Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The second worst epidemic of Ebola on record is currently unfolding in the eastern part of the Democratic Republic of the Congo. Whether or not safe practices are implemented to prevent the spread of the epidemic is influenced by the behavior of individuals at-risk of contracting the Ebola Virus Disease (EVD) - Will they follow the recommendations of health professionals? Will they report suspected cases and deaths? Will they seek treatment from health professionals? Will they accept vaccines and adopt preventive behaviors? We find that belief in misinformation about Ebola is widespread and trust in authorities is generally low, likely as a result of decades of violence and poor governance and, more recently, the politicization of the Ebola response. Our analysis shows that trust and (mis-)information influence adherence to risk avoidance behavior and acceptance of vaccination.
Author Interviews, Brigham & Women's - Harvard, Flu - Influenza, Heart Disease, JAMA / 27.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48142" align="alignleft" width="150"]Sonja Kytomaa MAResearch AssociateBrigham and Women’s Hospital Sonja Kytomaa[/caption] Sonja Kytomaa MA Research Associate Brigham and Women’s Hospital [caption id="attachment_48143" align="alignleft" width="126"]Scott D. Solomon, MDThe Edward D. Frohlich Distinguished ChairProfessor of MedicineHarvard Medical SchoolSenior PhysicianBrigham and Women’s HospitalInternational Associate Editor, European Heart Journal Dr. Scott Solomon[/caption] Scott D. Solomon, MD The Edward D. Frohlich Distinguished Chair Professor of Medicine Harvard Medical School Senior Physician Brigham and Women’s Hospital International Associate Editor, European Heart Journal   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Influenza is associated with an increased risk of cardiovascular events, yet few studies have explored the temporal association between influenza activity and hospitalizations, especially due to heart failure (HF). Our aim with this study was to explore the temporal association between influenza activity and hospitalizations for HF and myocardial infarction (MI) in the general population. We related the number of MI and HF hospitalizations by month, which were sampled from 4 US communities and adjudicated in the surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, to monthly influenza-like illness activity, as reported by the Centers for Disease Control and Prevention. We found that a 5% increase in influenza activity was associated with a 24% increase in HF hospitalizations rates, while overall influenza was not significantly associated with MI hospitalizations. Influenza activity in the months before hospitalization was not associated with either outcome.
Allergies, Author Interviews, Brigham & Women's - Harvard, Pharmacology / 23.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48094" align="alignleft" width="128"]Daniel Reker, PhDKoch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology Dr. Reker[/caption] Daniel Reker, PhD Koch Institute for Integrative Cancer Research Massachusetts Institute of Technology MedicalResearch.com: What is the background for this study? Response: We started thinking more about this topic following a clinical experience five years ago that Dr. Traverso was involved in where a patient suffering form Celiac disease received a prescription of a drug which potentially had gluten. This experience really opened our eyes for how little we knew about the inactive ingredients and how clinical workflows do not currently accommodate for such scenarios. We therefore set up a large scale analysis to better understand the complexity of the inactive ingredient portion in a medication as well as how frequently critical ingredients are included that could potential affect sensitive patients.
Author Interviews, Heart Disease / 19.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47945" align="alignleft" width="200"]Mandeep R. Mehra, MD, MSc, FRCP (London)The William Harvey Distinguished Chair in Advanced Cardiovascular MedicineMedical Director, Heart and Vascular Center, Brigham and Women’s HospitalExecutive Director, Center for Advanced Heart DiseaseBrigham and Women’s HospitalProfessor of Medicine, Harvard Medical School Dr. Mehra[/caption] Mandeep R. Mehra, MD, MSc, FRCP (London) The William Harvey Distinguished Chair in Advanced Cardiovascular Medicine Medical Director, Heart and Vascular Center Brigham and Women’s Hospital Executive Director Center for Advanced Heart Disease Brigham and Women’s Hospital Professor of Medicine, Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The MOMENTUM 3 trial is the largest study of LVAD therapy in Advanced Heart Failure with over 1000 randomized patients followed to at least 2 years. This trial tested a novel fully magnetically levitated LVAD, the HeartMate 3 pump against a mechanical bearing containing LVAD, the HeartMate II pump in patients suffering from advanced heart failure (85% of whom were on continuous intravenous Inotropic therapy or IABP device at the time of randomization). While LVADs have improved survival for such patients, the morbidity has remained excessive due to serious complication as a result of problems with hemocompatibility. The principal concerns revolve around complications of pump thrombosis requiring surgical replacement, strokes and bleeding events, especially gastrointestinal bleeding. The trial has previously reported two interim analyses which suggested signals for superiority on pump replacement and even a decrease in ischemic stroke. This final full report concludes convincingly that all three domains of hemocompatibility related adverse events are reduced with the novel LVAD with near elimination of pump thrombosis, halving of strokes of any kind and any severity and a marked decrease in bleeding complications.
Author Interviews, Brigham & Women's - Harvard, Critical Care - Intensive Care - ICUs, Infections, JAMA / 12.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47886" align="alignleft" width="125"]Chanu Rhee, MD,MPHAssistant Professor of Population MedicineHarvard Medical School / Harvard Pilgrim Health Care InstituteAssistant Hospital EpidemiologistBrigham and Women’s Hospital Dr. Rhee[/caption] Chanu Rhee, MD,MPH Assistant Professor of Population Medicine Harvard Medical School / Harvard Pilgrim Health Care Institute Assistant Hospital Epidemiologist Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? Response: Sepsis is the body’s reaction to a serious infection that results a cascade of inflammation in the body and organ dysfunction, such as low blood pressure, confusion, or failure of the lungs, kidneys, or liver.   Sepsis is a major cause of death, disability, and cost in the U.S. and around the world.  Growing recognition of this problem has led to numerous sepsis performance improvement initiatives in hospitals around the country.  Some of these efforts have also been catalyzed by high-profile tragic cases of missed sepsis leading to death, which may have contributed to a perception that most sepsis deaths are preventable if doctors and hospitals were only better at recognizing it. However, the extent to which sepsis-related deaths might be preventable with better hospital-based care is unknown.  In my own experience as a critical care physician, a lot of sepsis patients we treat are extremely sick and even when they receive timely and optimal medical care, many do not survive.  This led myself and my colleagues to conduct this study to better understand what types of patients are dying from sepsis and how preventable these deaths might be. 
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Hepatitis - Liver Disease, JAMA / 22.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47600" align="alignleft" width="200"]Xuehong Zhang, MD, ScD Assistant Professor in Medicine | Harvard Medical School Associate Epidemiologist | Brigham and Women's Hospital Boston, MA Dr. Xuehong Zhang[/caption] Xuehong Zhang, MD, ScD Assistant Professor in Medicine Harvard Medical School Associate Epidemiologist Brigham and Women's Hospital Boston, MA MedicalResearch.com: What is the background for this study? Response: In the United States., liver cancer incidence is rapidly increasing and over 42,200 new cases were projected to be diagnosed in 2018. The majority of individuals with liver cancer are diagnosed at a late stage, are not eligible for curative therapy, and die within 1 year of diagnosis. Established risk factors for liver cancer are limited to hepatitis B and C virus (HBV/HCV) infections, metabolic disorders, and smoking. Clearly, identification of novel risk factors, particularly those that are modifiable, is urgently needed. Dietary factors have been suspected as important, but only excessive alcohol use and aflatoxin-contaminated foods are considered to be established dietary risk factors for hepatocellular carcinoma (HCC). Consumption of whole grains and dietary fiber, especially cereal fiber, have been associated with lower risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease, which are known predisposing factors for HCC. We thus hypothesized that long-term intake of whole grains and dietary fiber may lower the risk of developing hepatocellular carcinoma (HCC) and tested this hypothesis using data from two large prospective cohort studies, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS).
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Frailty, Heart Disease, Surgical Research / 05.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47274" align="alignleft" width="173"]Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center Dr. Dae Hyun Kim[/caption] Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of older adults undergoing aortic valve replacement is increasing.  Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes.  Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures.  Many patients are not adequately informed about what their daily life would be like after the procedure. In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement.  We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline.  We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index.  Delirium and postoperative complications were also strongly associated with undesirable functional trajectories. 
ALS, Author Interviews, Brigham & Women's - Harvard, Cognitive Issues, JAMA, Multiple Sclerosis / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46832" align="alignleft" width="200"]Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine, St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto  PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University Dr. Fralick[/caption] Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This medication is a pill that combines two ingredients: dextromethorphan (the active ingredient in cough syrup) and quinidine (used to increase the concentration of dextromethorphan). The medication was primarily studied and evaluated in patients with amyotrophic lateral sclerosis (ALS)   or (multiple sclerosis) MS, but anecdotal evidence suggested it was being prescribed to patients with dementia. We used data from two nationwide healthcare databases to understand how the medication was being used in routine care.
Author Interviews, Brigham & Women's - Harvard, JAMA, OBGYNE, Pediatrics / 19.12.2018

MedicalResearch.com Interview with: [caption id="attachment_27170" align="alignleft" width="179"]Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120 Dr. Krista Huybrechts[/caption] Krista F. Huybrechts, MS PhD Associate Professor of Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA 02120  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Pregnant women often experience nausea and vomiting, particularly during the first trimester.  Early treatment is recommended to relieve symptoms and prevent progression to hyperemesis gravidarum.  Although not formally approved for this indication, ondansetron is the most frequently prescribed treatment for nausea and vomiting in pregnancy in the US: 22% of pregnant women reportedly used ondansetron in the US in 2014. Despite this common use, the available evidence on the fetal safety of ondansetron is limited and conflicting, and the possibility of a doubling in risk of cleft palate and cardiac malformations has been raised. We therefore evaluated the association between ondansetron exposure during the first trimester of pregnancy, the period of organogenesis, and the risk of congenital malformations in a cohort of 1,816,414,publicly insured pregnancies using the nationwide Medicaid Analytic eXtract data for 2000-2013.  A total of 88,467 women (4.9%) were exposed to ondansetron during the first trimester.  After adjusting for a broad range of potential confounding variables, we found no association with cardiac malformations (RR = 0.99; 95% CI, 0.93 – 1.06)  and congenital malformations overall (RR = 1.01; 95% CI, 0.98 – 1.05). For oral clefts, we found a 24% increase in risk (RR=1.24; 95% CI, 1.03 – 1.48), which corresponds to an absolute risk of 2.7 per 10,000 births (95% CI, 0.2 – 5.2 per 10,000 births).  These findings were consistent across sensitivity analyses, conducted to address potential misclassification and confounding bias. 
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Mediterranean Diet, Women's Heart Health / 10.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46414" align="alignleft" width="117"]Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA Dr. Mora[/caption] Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit. Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors. Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites. 
Author Interviews, Brigham & Women's - Harvard, Weight Research / 09.11.2018

MedicalResearch.com Interview with: "Compare-the-Use-of-Carbohydrates-and-Lipids-in-Energy-Storage" by Zappys Technology Solutions is licensed under CC BY 2.0Kirsi-Marja Zitting, Ph.D. Instructor in Medicine, Harvard Medical School Division of Sleep and Circadian Disorders Departments of Medicine and Neurology Brigham and Women’s Hospital Boston, MA 02115 MedicalResearch.com: What is the background for this study? Response: This study is a follow-up study to our previous study where we found that chronic insufficient sleep together with chronic jet lag is associated with adverse changes in metabolism, including increase in blood sugar levels (Buxton et al. Science Translational Medicine, 2012). The present study focuses on the influence of the time of day on metabolism, which has not been investigated in humans independent of the effects of sleep, physical activity and diet.
Author Interviews, Brigham & Women's - Harvard, JAMA, Melanoma / 14.10.2018

MedicalResearch.com Interview with: [caption id="attachment_45286" align="alignleft" width="160"]Caroline C. Kim, M.D. Associate Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director, Cutaneous Oncology Program Beth Israel Deaconess Medical Center Boston, MA 02215 Dr. Kim[/caption] Caroline C. Kim, M.D. Associate Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director, Cutaneous Oncology Program Beth Israel Deaconess Medical Center Boston, MA 02215 MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: Atypical/dysplastic nevi have been identified as risk factors for melanoma, however the majority of melanomas arise as new lesions on the skin. Unlike other models of dysplasia having a clear trajectory towards cancer as seen in cervical dysplasia, dysplastic nevi are not proven to be obligate precursors for melanoma.  However, there is little evidence to guide the management of biopsied dysplastic nevi with positive margins, with much clinical variation in the management of moderately dysplastic nevi in particular. In this multi-center national study of 9 U.S. academic centers, we examined outcomes of 467 moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins with at least 3 years of clinical follow-up.  We found that no cases developed into a same-site melanoma with a mean follow-up time of 6.9 years. However, 22.8% of our patients went on to develop a future separate site melanoma.
Author Interviews, Brigham & Women's - Harvard, Diabetes, Heart Disease, JACC / 02.10.2018

MedicalResearch.com Interview with: [caption id="attachment_44844" align="alignleft" width="200"]Scott David Solomon, MD Director, Noninvasive Cardiology Professor, Harvard Medical School Brigham and Women's Hospital Dr. Solomon[/caption] Scott David Solomon, MD Director, Noninvasive Cardiology Professor, Harvard Medical School Brigham and Women's Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The sodium glucose transport proteins are known to be important in regulating uptake of glucose. SGLT-1 is predominantly located in the gut and is responsible for uptake of glucose and galactose in the small intestine. Individuals born with severe mutations of this gene have severe malabsorption syndrome. We looked at genetic variants that lead to reduced function of the protein, but not complete loss of function, in a large cohort of individuals in the NIH funded Atherosclerosis Risk in Communities Study. We found that those with mutations in the gene had reduced glucose uptake, as measured by an oral glucose tolerance test, as well as less obesity, diabetes, heart failure and death.
Author Interviews, Brigham & Women's - Harvard, JAMA, Pediatrics / 01.10.2018

MedicalResearch.com Interview with: [caption id="attachment_44926" align="alignleft" width="180"]Matthew D. Weaver, PhD Instructor in Medicine · Harvard Medical School Associate Epidemiologist · Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston, MA 02215 Dr. Weaver[/caption] Matthew D. Weaver, PhD Instructor in Medicine · Harvard Medical School Associate Epidemiologist · Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston, MA 02215 MedicalResearch.com: What is the background for this study? Response: We were interested whether high school students who tended to sleep less than 8 hours per night reported more risk-taking behaviors compared to high school students who slept at least 8 hours per night on a school night. We utilized a nationally representative dataset from the CDC of surveys that were completed by high school students between 2007 and 2015. Over that time, approximately 67,000 students were surveyed. Students were asked about the hours of sleep that they obtained on an average school night. They were also asked how often, in the month prior to the survey, they engaged in a number of risk-taking behaviors. Some behaviors were related to driving, like driving without a seatbelt or driving drunk, while others were related to using alcohol, doing drugs, or being involved in a fight. They were also asked about their mood, including whether they felt sad or hopeless, considered suicide, and whether they had attempted suicide. 
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 22.08.2018

MedicalResearch.com Interview with: [caption id="attachment_44084" align="alignleft" width="135"]Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital Dr. Sacks[/caption] Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications. Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products. For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen. The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product.