Author Interviews, Neurology, Sexual Health, STD / 06.11.2024

MedicalResearch.com Interview with: Sagar S. Patel, MBS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA 18509 MedicalResearch.com: What was the background for this research? Response: Syphilis is a sexually transmitted infection that is caused by a gram-negative bacterium called Treponema pallidum. This infection promotes the cell death of microglia and can cause a variety of symptoms. It is commonly observed in developing countries such as sub-Saharan Africa. Neurosyphilis is a complication of syphilis that affects the central nervous system (CNS). The CNS undergoes multiple stages of deterioration and can include personality changes and hearing abnormalities. Diagnosing neurosyphilis is challenging because its symptoms mimic other neurodegenerative diseases. Diagnosis relies on clinical studies, cerebrospinal fluid (CSF) analysis, and neuroimaging techniques. (more…)
Addiction, Author Interviews / 20.10.2024

MedicalResearch.com Interview with: Karen Arscott, DO Department of Medical Education Geisinger Commonwealth School of Medicine Scranton PA 18509 MedicalResearch.com: What is the background for this study? Response: “Substance Use Disorder Risk Assessment (SUDRA)” is a proposed screening tool and possible source of prevention for substance use disorder (SUD) and alcohol use disorder (AUD).  The US opioid overdose epidemic continues to escalate with over one-hundred thousand deaths in a single year. The current screening tools used for assessing SUD identifies persons already suffering with advanced disease. Our investigation brings to light a simple screening tool which can be used to identify a person with “Preaddiciton” potential. For many years I have asked persons (both patients and nonpatients) the question how they felt the first time they took an opioid. Their answers have been astonishing. Probably the one answer that struck me the strongest was a professional colleague who answered that when she was prescribed Vicodin following a surgical procedure it made her feel so amazing that it scared her, and she never took another opioid. She reported to me that it would have been too easy to take regularly for the wonderful feeling – she however, recognized the danger of that feeling and avoided a potential substance use disorder. What if this risk was provided to all – what if parents and patients understood the risk if faced with that “feeling”? How many lives could be saved? We are very confident that these timely findings will be discussed and presented widely. The paper will be highly downloaded and cited by many interested in the prevention of substance use disorder – a new concept and much improved over the current treatment of advanced disease. (more…)
Addiction, Mental Health Research / 06.08.2024

Luke Cavanah, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA 18509     MedicalResearch.com: What is the background for this study? Response:  “Selective” serotonin reuptake inhibitors (SSRI) are a class of medications that are first-line treatments for many anxiety, depressive, and other psychiatric disorders.1–3 Despite their name, SSRIs often have activity on other receptors and chemicals.4 One such SSRI that is known for being particularly nonselective is paroxetine.5 Paroxetine’s mechanisms of action are summarized in the figure below which shows binding not only to the serotonin transporter (SERT) but also to the norepinephrine transporter (NET), nitric oxide synthetase (NOS), the muscarinic (M1) receptor, and the liver cytochrome 2D6 enzyme. Paroxetine’s receptor promiscuity, especially its anticholinergic activity, can contribute to unfavorable adverse effects.5 Older adults (65+) are particularly vulnerable to some of these adverse effects. The American Geriatrics Society (AGS) regularly publishes an explicit list, called the Beer’s List, of what they call “potentially inappropriate medications (PIMs)”, which are medications they recommend avoiding in this demographic when having certain disorders/conditions or most clinical contexts. The AGS Beers Criteria, in 2012, 2019, and most recently in 2023, has identified paroxetine as a PIM due to its strong anticholinergic activity and high risk of sedation and orthostatic hypotension, and thus they recommend it should be avoided in this population in most circumstances.6–8 Given the recommendation against the use of paroxetine in older adults, we were interested in examining the utilization of paroxetine by U.S. Medicare beneficiaries. Medicare patients primarily consist of people 65+ and cover 94% of non-institutionalized people in this age group.9 (more…)
Addiction, Author Interviews, Cannabis / 05.08.2024

MedicalResearch.com Interview with: Luke Cavanah, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA 18509 MedicalResearch.com: What is the background for this study? Response: Amphetamine, lisdexamfetamine, and methylphenidate, are first-line treatments for attention-deficit hyperactivity disorder (ADHD) and are classified as Schedule II stimulants due to their risk of addiction. (1–3) There has been high and increasing use and misuse of these medications with inadequate explanation. (4)  Since chronic cannabis use can result in similar cognitive effects as ADHD 5–7, we wondered if more stimulants were prescribed for what appeared to be ADHD but was a consequence of chronic cannabis use. In other words, has the legalization of cannabis contributed to this inadequately explained increase in stimulant use? A recent study by our lab group that looked at the slopes of stimulant distribution rates over time -- before and after medical cannabis legalization -- did not support this.(8) Given the prevalence and increasing legalization of recreational cannabis, we wanted to determine how slopes of stimulant distribution rates compared before and after recreational cannabis legalization. (more…)
Addiction, Author Interviews, Opiods / 03.07.2024

MedicalResearch.com Interview with: Elena Stains Elena Stains Medical Student Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA   MedicalResearch.com: What is the background for this study? Response: Opioid use has been an increasing problem since the early 2000s in the United States (US) with a surge around 2010. Twenty-five percent of those having abused pain relievers in 2013 and 2014 got those drugs from physicians1. Physicians are particularly well-known for fueling the opioid crisis in Florida in the 2000s. Of the United States’ top 100 opioid prescribing physicians in 2010, an astounding 98 were prescribing in Florida2. Florida taking the main stage of the opioid crisis can be attributed to several factors, including ability of physicians to dispense opioids directly from their offices to patients (i.e. without pharmacists) and the presence of many infamous “pill mills” in the state3–6. The researchers at Geisinger Commonwealth School of Medicine aimed to analyze the amount of hydrocodone (including brand names of Vicodin and Lortab) and oxycodone (OxyContin and Percocet) distributed in Florida from 2006 to 2021, paying close attention to the peak year of the opioid crisis, 2010. The team used the Washington Post and the US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) databases to compile this compelling information. (more…)
Addiction, Author Interviews, Health Care Systems / 25.05.2024

MedicalResearch.com Interview with: Srivastava Kodavatiganti, MBS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA MedicalResearch.com: What is the background for this study? Response: Prescription and illicit opioid misuse and overdoses have continued to escalate in the U.S. with annual overdoses exceeding 110,000[1]. There was a substantial rise from 2013 to 2022 in the number of opioid-related overdoses due to synthetic opioids [2]. Even nonfatal opioid-involved overdoses increased 4% quarterly between January 2018 and March 2022 as observed by encounters by emergency medical services [3]. Although the eastern U.S. has been particularly impacted by fatal overdoses, annual increases have increased as of last year in the western states including in Nevada (+27.9%), Washington (+36.9%), Oregon (+38.6%), and Alaska (+45.9%).  In contrast, other states have seen more modest changes (New Mexico = +1.3%) including decreases (South Dakota = -2.4%, Nebraska = -19.5%) [1]. These findings underscore the importance for understanding patterns in usage of prevention and treatment strategies. Naloxone is an opioid antagonist which can reverse the effects of an opioid overdose. This crucial lifesaving tool is administered as an injection or as a nasal spray. This study characterized the patterns of naloxone prescriptions in Medicaid patients from 2018 – 2021 and Medicare patients for 2019. State level differences were also quantified as the fold difference in prescribing between the highest and lowest states when correcting for the number of enrollees in each state. (more…)
Author Interviews, Cannabis / 18.04.2024

MedicalResearch.com Interview with: Amy Kennalley, MBS First Year Medical Student Department of Medical Education Geisinger Commonwealth School of Medicine MedicalResearch.com: What is the background for this study Response: The legalization of medical marijuana (MMJ) and the number of qualifying conditions are expanding across the USA, emphasizing the need to understand the implications of MMJ dispensary distribution for equitable access. Pennsylvania (PA) legalized MMJ in 2016, with the first dispensary opening its doors in 2018. The state currently recognizes 24 medical conditions for MMJ use, including six for which there is insufficient or no evidence for their efficacy as a treatment. Prior research suggests that there is a link between proximity to dispensaries and overall MMJ use. However, a gap exists in our understanding of how dispensary locations might be associated with the specific qualifying conditions for which individuals receive their certification. In response to this knowledge gap, our study delved into the medical marijuana dispensary access in PA and explored associations with both MMJ certifications and the community demographics. Utilizing data from the Pennsylvania Department of Health, we investigated how proximity to MMJ dispensaries related to the proportion of individuals certified for MMJ use within a specific area or Zip Code Tabulation Area. Additionally, we analyzed the proportion of certifications for conditions with varying levels of evidence supporting the efficacy of MMJ. This pioneering study represents the first of its kind in PA, shedding light on the association between MMJ dispensary locations and certifications. Likewise, it is the first in the US to investigate the link between dispensary locations and specific qualifying conditions. By examining these dynamics, we aim to contribute vital insights to inform policy and practice, ensuring equitable access to MMJ treatment for individuals with diverse medical needs. (more…)
Author Interviews, Infections / 01.04.2024

MedicalResearch.com Interview with: Maria Y. Tian, MBS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton PA MedicalResearch.com: What is the background for this study? Response: The antibiotic crisis continues to worsen in the United States (U.S.), which has seen an increasing number of deaths associated with antibiotic resistance, becoming one of the most pressing threats to public health. Concurrently, the availability of effective antibiotics are decreasing, which increases the rates and severity of infections, particularly in patients with respiratory tract infections. Unfortunately, a persistent and pernicious contributing factor to the crisis is the unnecessary prescription of antibiotics. In a previous study, 25% of antibiotics prescribed in the outpatient setting to Medicaid beneficiaries were not associated with a provider visit [2]. Furthermore, among 298 million prescriptions filled by 53 million Medicaid patients between 2004 and 2013, 45% of the prescriptions for antibiotics were made without any clear rationale [2]. In our study, we aimed to provide an up-to-date analysis of antibiotic prescribing in the U.S. through examining the temporal profile of outpatient antibiotic use reported by Medical Expenditure Panel System (MEPS) and geographical patterns of antibiotic prescribing rates among US Medicaid program beneficiaries. This will help identify potentially unnecessary prescriptions and inform stewardship efforts. (more…)
Addiction, Author Interviews, Cancer Research, Cannabis / 23.03.2024

MedicalResearch.com Interview with: Brian J. Piper, PhD Associate Professor of Neuroscience Geisinger Commonwealth School of Medicine Scranton PA 18411 MedicalResearch.com: What is the background for this study? Response: Many cancer patients use marijuana to treat pain, nausea, or anxiety, often without communicating this with their health care providers. Two observational studies (1, 2) from a single institution in Israel purporting to find a dangerous drug interaction between medical cannabis and immunotherapy have been cited hundreds of times, including by clinical practice guidelines. The cannabinoid CB2 receptor is found on immune tissues so it is biologically possible that marijuana could make immunotherapies like nivolumab less effective. However, there were anonymous reports on PubPeer (3-5) of many irregularities in the data-analysis. If there were unappreciated differences on other important variables at baseline besides subsequent cannabis use, this could change the interpretation of these influential reports (1, 2). This investigation involved attempting to repeat and verify the data-analysis. (more…)
Addiction, Author Interviews, Gastrointestinal Disease, Opiods / 03.02.2024

MedicalResearch.com Interview with: Joshua D. Madera, MD Department of Medical Education Geisinger Commonwealth School of Medicine Scranton PA What is the background for this study? Response: The US population continues to be drastically impacted by the opioid epidemic, with opioid-related deaths significantly increased compared to European countries. While prescription opioid distribution has gradually declined since its peak in 2011 [1], the rate of opioid prescriptions remains increased compared to 2000. Furthermore, there is considerable interstate variability in opioid distribution across the US. Identifying patterns in this variability may guide public health efforts to reduce opioid-related harms. Therefore, the primary objective of this study [2] from Geisinger Commonwealth School of Medicine was to explore variations in production quotas and state-level distribution of ten prescription opioids between 2010 and 2019. (more…)
Author Interviews, Mental Health Research, Pharmaceutical Companies / 14.01.2024

MedicalResearch.com Interview with: Lauren Davis Lauren C. Davis, MBS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA 19409   MedicalResearch.com: What is the background for this study? Response: Financial conflicts of interest (COIs) resulting from ties between academia and industry have been under scrutiny for their potential to hinder the integrity of medical research. COIs can lead to implicit bias, compromise the research process, and erode public trust (1-6). The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), standardizes symptom criteria and codifies psychiatric disorders. This manual contributes to the approval of new drugs, extensions of patent exclusivity, and can influence payers and mental health professionals seeking third-party reimbursements. Given the implications of the DSM on public health, it is paramount that it is free of industry influence. Previous research has shown a high prevalence of industry ties among panel and task force members of the DSM-IV-TR and DSM-5, despite the implementation of a disclosure policy for the DSM-5 (7,8). This study (9) determined the extent and type of COIs received by panel and task-force members of the DSM-5-TR (2022) (10). As the DSM-5-TR did not disclose COI, we used the Center for Medicare and Medicaid Services Open Payments (OP) database (11) to quantify them. (more…)
Author Interviews, Gender Differences / 03.01.2024

MedicalResearch.com Interview with: Christian Carbe, PhD Department of Medical Educatio Geisinger Commonwealth School of Medicine Scranton, PA 18509   MedicalResearch.com: What is the background for this study? Response: Transgender patients often experience pronounced healthcare disparities compared to their cisgender counterparts. Disparities in the treatment of transgender patients resulting from deficiencies in cultural competency perpetuate poor health outcomes, such as suicide, substance misuse, depression, harassment, and victimization. Individuals within the transgender community often face systemic barriers within the medical field, including a lack of comprehensive access to health insurance, discrimination from providers, and incompetent provider training in transgender-specific health needs. This report evaluated the changes in knowledge, attitudes, and beliefs of the psychosocial and medical needs of the transgender community among first-year undergraduate medical students that attended the Northeastern Pennsylvania Trans Health Conference. Our broader goal is to develop and refine longitudinal interventions to improve skills and sensitivity of future physicians to provide compassionate and competent gender diverse and transgender healthcare. (more…)
Author Interviews, Cannabis / 30.08.2023

MedicalResearch.com Interview with: Luke Cavanah, BS Geisinger Commonwealth School of Medicine Scranton, PA MedicalResearch.com: What is the background for this study? Response: It is well-known that schedule II stimulants, which are those that are highly addictive and include amphetamine, methylphenidate, and lisdexamfetamine, have had increasing use and misuse in the US. Despite understanding the presence of this phenomenon, the reason for it is poorly understood. The purpose of this study was to see if rising rates of schedule II stimulants are related to the legalization of medical marijuana. We were interested in this because schedule II stimulants are primarily used as the treatment for attention-deficit hyperactivity disorder (ADHD), chronic cannabis use has been demonstrated to cause neurocognitive deficits resembling that of ADHD, and the conditions have been shown to affect similar brain regions. (more…)
Author Interviews, Cannabis / 07.07.2023

MedicalResearch.com Interview with: Edward Liu, BA Second year medical student Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA MedicalResearch.com: What is the background for this study? Response: The use pattern of two FDA approved cannabinoids, dronabinol (Marinol) and cannabidiol (Epidiolex) has not been previously studied. Dronabinol has been approved in the United States since 1985 for chemotherapy induced nausea as well as vomiting and HIV-induced anorexia,1,2 whereas cannabidiol has been approved since 2018 to treat childhood epileptic disorders, Lennox-Gastaut and Dravet syndrome.3 This longitudinal study examined Medicaid claims between 2016-2020 for these two prescription cannabinoids to better comprehend the state-level pharmacoepidemiologic trends and distribution of these drugs in US Medicaid amidst the increasing use of non-pharmaceutical formulations of cannabis. (more…)
Author Interviews / 25.04.2023

MedicalResearch.com Interview with: Mariah W Panoussi, BS, MBS Second-year medical student at Saba University School of Medicine, Saba, Dutch Caribbean Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA MedicalResearch.com: What is the background for this study? Response: Clinical guidelines currently state that the atypical antipsychotic clozapine effectively treats patients with treatment-resistant schizophrenia (TRS) 1. TRS occurs in up to one-third of patients with schizophrenia.2,3 However, there is evidence that demonstrates a lack of clozapine utilization by providers.2 This underutilization has been attributed to clozapine’s numerous adverse effects, in particular agranulocytosis.4 Other barriers include close monitoring for agranulocytosis, changes in administration and registry programs, as well as concerns regarding physician’s attitude toward and knowledge about clozapine.4,5 These barriers have thus caused a sizable variation in clozapine usage throughout the US. Using Medicaid data from 2015-2019, we conducted a secondary data analysis to examine the varied usage of clozapine in the US Medicaid programs.6 (more…)
Author Interviews / 13.04.2023

Medicalresearch.com Interview with: Edward Liu, BA Second year medical student Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA Medicalresearch.com: What is the background for this study? Response: The United States’ opioid epidemic continues to rise because of increasing opioid use and availability, contributing to prescription opioid misuse, mortality, and rising cost.1 The worsening health and economic impact of opioid use disorder in the US warrants further attention on the adverse effects and distribution pattern of commonly prescribed opioids like oxycodone (OxyContin), fentanyl (Duragesic), and morphine (MS-Contin). Using the Automated Reports and Consolidated Ordering System (ARCOS) database,2 a comprehensive data collection system of pharmacies and hospitals distribution of Schedule II and III controlled substances in the US with the FDA Adverse Event Reporting System (FAERS)3 has never been done before. This approach may provide a more complete picture of the risks of prescription opioids which can include drowsiness, nausea, and potentially fatal respiratory depression.  (more…)
Author Interviews, Depression / 05.03.2023

Editor's note: This piece discusses suicide. If you have experienced suicidal thoughts or have lost someone to suicide and want to seek help, you can contact the Crisis Text Line by texting "START" to 741-741 or call the Suicide Prevention Lifeline at 800-273-8255. MedicalResearch.com Interview with: Alexia Aguilar Geisinger Commonwealth School of Medicine Scranton, PA     MedicalResearch.com: What is the background for this study? Response: Traditional antidepressants like Zoloft and Lexapro have three major drawbacks.
  • First, they have a therapeutic lag and take at least a couple weeks to begin to improve mood.
  • Second, they do not work very well for many patients with only about one-third experiencing a remission.1
  • Third, they carry a Food and Drug Administration black box warning for increasing the risk of suicide in young-adults. There is tremendous enthusiasm for the anesthetic ketamine and esketamine because they overcome all three of these limitations. The brand name of esketamine is Spravato. Spravato received conditional approval from the FDA in March of 2019 as a nasal spray for treatment resistant depression or acute suicidality.  The goal of this study was to examine prescriptions for ketamine and esketamine in 2019 and 2020.

(more…)

Author Interviews, COVID -19 Coronavirus, Race/Ethnic Diversity, Vaccine Studies / 10.02.2023

MedicalResearch.com Interview with: Kenya Colvin, MBS Department of Medical Education Scranton, PA MedicalResearch.com:  What is the background for this study?  Response: Vaccine hesitancy is a major driver of COVID-19 vaccination disparities between minority and non-Hispanic White communities. Our goal was to understand what factors influenced vaccine hesitancy among individuals in Eastern Pennsylvania to identify more effective ways to promote vaccine uptake within minority communities. (more…)
Addiction, Author Interviews, COVID -19 Coronavirus, Opiods / 07.02.2023

MedicalResearch.com Interview with: Brian Piper, PhD MS Assistant Professor of Neuroscience Center for Pharmacy Innovation & Outcomes Geisinger School of Graduate Education MedicalResearch.com: What is the background for this study? Response: Methadone is an evidence-based treatment of opioid use disorder (OUD) and pain. However, this Schedule II opioid can also cause respiratory depression, which can result in lethality. The need for supervised administration is a long-standing source of frustration in the U.S. for many opioid use disorder (OUD) methadone patients. However, there was an accommodation in early 2020 thanks to the COVID-19 pandemic. This involved extending the take-home supply to up to 28-days for stable patients and 14 days for less stable patients. Prior research found that the implementation of supervised administration in England greatly reduced methadone overdoses [1]. The primary objective of this study [2] from Geisinger Commonwealth School of Medicine was to determine if the relaxation of the take-home rules resulted in more methadone overdoses. (more…)
Author Interviews, Education, JAMA, Pharmaceutical Companies / 06.07.2022

MedicalResearch.com Interview with: SooYoung VanDeMark, MBS Geisinger Commonwealth School of Medicine Scranton, Pennsylvania MedicalResearch.com:  What is the background for this study?   Response: Health care providers utilize subscription-based, point-of-care databases such as DynaMed and UpToDate to provide clinical care guidance and remain current on the latest evidence-based findings. Both of these websites maintain this content through a cadre of physician contributors who write and edit articles for these sites. These physician contributors are required to self-report any conflicts of interest (COI) as outlined by the respective policies on each website. However, prior COI research into similarly self-regulated areas, such as medical and pharmacology textbooks, and clinical practice guidelines, has found both appreciable potential COI and inconsistencies between self-reported and industry mandated disclosures (1-3). This study (4) explored the accuracy of physician contributors to DynaMed and UpToDate by comparing their self-reported disclosure status with the financial remunerations they received from the healthcare industry (e.g., pharmaceutical companies) as reported to the U.S. Centers for Medicare and Medicaid Services’ Open Payments database. Physician contributors who reported “nothing to disclose” on their respective article topic but had an entry on Open Payments for having received money from industry, were classified as discordant and, thus, as having the potential for a COI. Additionally, total remuneration, gender, and payment category were investigated more in depth for each database. (more…)
Addiction, Author Interviews, Opiods, Race/Ethnic Diversity / 10.09.2021

John A. Furst BS Geisinger Commonwealth School of Medicine MedicalResearch.com: What is the background for this study? Response: Methadone is an evidence-based pharmacotherapy for opioid detoxification, maintenance therapy, and pain management. However, accessibility of this treatment remains variable across much of the country. Methadone for the treatment of opioid use disorder (OUD) is exclusively provided by federally regulated opioid treatment programs (OTPs) and has provoked significant community-based and legal controversy regarding its role in the management of this condition. This has created disparities related to the distribution and access of methadone throughout the United States (U.S.). The goal of this study1 was to highlight the most recent pharmacoepidemiologic trends associated with methadone in the face of unique restrictions at the local, state, and federal levels. (more…)