Author Interviews, Cost of Health Care, Health Care Systems / 06.09.2019

MedicalResearch.com Interview with: Vivian Ho, PhD The James A. Baker III Institute Chair in Health Economics Director of the Center for Health and Biosciences Rice's Baker Institute for Public Policy MedicalResearch.com: What is the background for this study? Response: In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care. As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care. When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare / 06.09.2019

MedicalResearch.com Interview with: Md Momotazur Rahman PhD Associate Professor of Health Services, Policy and Practice Margot Schwartz MPH Doctoral program Brown University MedicalResearch.com: What is the background for this study? Response: Although one third of Medicare beneficiaries are currently enrolled in Medicare Advantage (MA), it is difficult to assess the quality of healthcare providers that serve MA beneficiaries, or to compare them to providers that serve Traditional Medicare (TM) beneficiaries. While Medicare Advantage plans are required to cover the same minimum healthcare services as TM, MA beneficiaries receive care from their plan’s network of preferred providers, while TM beneficiaries may select any Medicare-certified provider. The objective of this study is to compare the quality of Home health Agencies (HHAs) that serve Medicare Advantage and TM beneficiaries. Approximately 3.5 million Medicare beneficiaries receive home health care annually.   (more…)
Author Interviews, Cost of Health Care, JAMA, Medical Imaging, UCSF / 05.09.2019

MedicalResearch.com Interview with: Rebecca Smith-Bindman, MD Professor, Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics Philip R. Lee Institute for Health Policy Studies University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Medical imaging increased rapidly from 2000 to 2006. The rise in imaging can be attributed to improvements in technical aspects of imaging, strong physician and patient demand, and strong financial incentives. While imaging contributes to accurate disease diagnosis and improved treatment, imaging can also increase costs and patient harms, such as incidental findings, overdiagnosis, anxiety, and radiation exposure associated with increased risk of cancer. Potential overuse of diagnostic testing has been addressed by the American Board of Internal Medicine Foundation’s Choosing Wisely Campaign and initiatives by payers to reduce imaging through payment reductions, but there remains uncertainty in the impact of these initiatives on imaging rates.The objective of our study was to evaluate recent trends in medical imaging. Our study assessed imaging from 2000 through 2016 among individuals enrolled in diverse U.S. integrated healthcare systems and among individuals residing in Ontario, Canada and assessed changes in medical imaging utilization over time by country, health system, and patient demographic factors. (more…)
Author Interviews, Global Health, Health Care Systems / 29.08.2019

healthcare health care
At least one half of the world’s 7.7 billion population do not have proper access to crucial health services. Even high-income countries with accessible and affordable healthcare are finding it difficult to meet the needs of their citizens. Meanwhile, in other parts of the world, millions of people spend a significant part of their household budget to be able to access health services -- some are even pushed into poverty as a consequence. Given these facts and statistics, a comprehensive understanding of health insurance can be crucial in encouraging people to seek healthcare services as well as avoid complications from preventable conditions. If you want to know more about the status of healthcare all over the world, here’s a look at the healthcare systems of three top nations. The State of Healthcare In The United States The United States is considered the most powerful country in the world; however, its healthcare system still lags behind other high-income countries. Currently, there is no universal healthcare for U.S. citizens. There are federal-funded programs such as Medicaid that provides health insurance to low-income populations, the elderly and people with disabilities. The Affordable Care Act, which aimed to provide health insurance to all, was enacted in 2010 under the Obama administration. However, this is being challenged by the Trump administration’s American Health Care Act of 2017, which also seeks major reforms to healthcare in the United States. Currently, U.S. citizens who are employed full-time receive private insurance through their employers. While some self-employed individuals and part-time employees opt for private health insurance, many of them have to pay for health services out-of-pocket. In many cases, these expenses are beyond their means. As it stands, healthcare has become one of the hottest issues in the lead-up to the country’s upcoming 2020 elections. (more…)
Author Interviews, Hospital Acquired, JAMA / 20.08.2019

MedicalResearch.com Interview with: Todd Campbell Lee MD MPH FACP FIDSA Consultant in Internal Medicine and Infectious Diseases Director, MI4 Clinical Trials Platform Associate Professor of Medicine, McGill University Montreal, Quebec  MedicalResearch.com: What is the background for this study? Response: For a number of years people have been advocating for a move towards single-patient rooms in hospital design.  This was articulately argued for in an opinion piece by Detsky and Etchells in 2008 (https://jamanetwork.com/journals/jama/article-abstract/182433) as being important for a move to safe and patient-centered design. One of the major selling points has always been a reduction in the risk of nosocomial, or hospital-associated, infections given reduced opportunities for contamination between patients; however, only a few studies have specifically looked at this issue.  Overall, despite some strong work, many of these studies were limited by only looking at specific units, over limited periods of time,  and using before-after comparisons which did not account for change over time either within or outside of the institution. We knew that in 2015 our old hospital would close and within the same day all patients would be moved to a brand new hospital with 100% single patient rooms -- most of which have a private bathroom for patients and a separate hand-washing sink for staff.  So in 2014, we designed this study, obtained ethics review, and then waited patiently for several years to pass after the move so that we could rigorously evaluate the impact.  We looked at monthly rates of vancomycin-resistant Enterococcus (VRE) colonizations and infections, methicillin-resistant Staphylococcus aureus (MRSA) colonization and infections, and Clostridium (now Clostrideroides) difficile infections (CDI). We chose these because we had good long term data on their rates and because we could compare the rates over time before and after the move and contrast them with the province of Quebec as a whole. (more…)
Author Interviews, Cost of Health Care, Medicare / 14.08.2019

MedicalResearch.com Interview with: ABT-AssociatesMatthew Trombley, Ph.D. Associate/Scientist Abt Associates  MedicalResearch.com: What is the background for this study?   Response: CMS developed the Accountable Care Organization (ACO) Investment Model (AIM) as part of the Medicare Shared Savings Program (MSSP) to encourage the growth of ACOs in rural and underserved areas.  The goal of our study was to see if AIM ACOs could successfully decrease Medicare spending in these areas. (more…)
Author Interviews, Cost of Health Care / 12.08.2019

MedicalResearch.com Interview with: Erin L. Duffy, PhD, MPH Adjunct Policy Researcher RAND  MedicalResearch.com: What is the background for this study?   Response: A patient treated at a hospital in his or her insurer’s network may be involuntarily treated by out-of-network (OON) physicians. In these cases, the OON physician can seek to collect full billed charges from the patient’s insurer and, if the insurer does not pay the full amount, the physician can bill the patient for the remaining balance. These unexpected bills from out-of-network physicians are known as “surprise medical bills” and most result from anesthesiology, radiology, and pathology services. California implemented a comprehensive policy (AB-72) addressing surprise medical billing for out-of-network nonemergency physician services at in-network hospitals in 2017 for patients in fully-insured health plans. AB-72 limits patients’ cost sharing to in-network levels, unless patients provide written consent to billing 24 hours in advance of services. Insurers and health plans pay out-of-network physicians at in-network hospitals the greater of the payer’s local average contracted rate or 125% of Medicare’s fee-for-service reimbursement rate.  (more…)
Author Interviews, Cost of Health Care, Medicare, UCLA / 08.08.2019

MedicalResearch.com Interview with: Auyon Siddiq PhD Assistant Professor/INFORMS Member Decisions, Operations & Technology Management UCLA Anderson School of Management MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medicare Shared Savings Program (MSSP) was created under the Patient Protection and Affordable Care Act to control escalating Medicare spending by incentivizing providers to deliver healthcare more efficiently. Medicare providers that enroll in the MSSP earn bonus payments for reducing spending to below a risk-adjusted financial benchmark that depends on the provider's historical spending. To generate savings, a provider must invest to improve efficiency, which is a cost that is absorbed entirely by the provider under the current contract. This has proven to be challenging for the MSSP, with a majority of participating providers unable to generate savings due to the associated costs. This study presents a predictive analytics approach to redesigning the MSSP contract, with the goal of better aligning incentives and improving financial outcomes from the MSSP. We build our model from data containing the financial performance of providers enrolled in the MSSP, which together accounted for 7 million beneficiaries and over $70 billion in Medicare spending. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Technology / 07.08.2019

MedicalResearch.com Interview with: Kang Lee, PhD Dr Eric Jackman Institute of Child Study University of Toronto Toronto, Canada MedicalResearch.com: What is the background for this study? Response: We use a technology called transdermal optical imaging I and my postdoc invented to record facial blood flow using a regular video camera on the smartphone. This technology capitalizes on the fact that light travels beneath the facial skin and reflect off the hemoglobin under the skin. Our technology captures the minute reflected photons to decode facial blood changes due to our pulses and other physiological activities. Using machine learning, a neural network model learns to use the facial blood flow to predict blood pressures taken with a FDA approved scientific blood pressure measurement instrument. We then use the final model to predict the blood pressures of a new group of participants whose data had never been used in the model training. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Race/Ethnic Diversity / 05.08.2019

MedicalResearch.com Interview with: Muhammad Ali Chaudhary, MD Research Scientist Center for Surgery and Public Health Department of Surgery Brigham and Women’s Hospital Harvard Medical School Harvard T. H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: Many studies have documented disparities in cardiovascular care for minorities, specifically African Americans compared to white patients. Coronary artery bypass grafting (CABG) is a common procedure in the United States, and the outcomes and post-surgical care for African Americans tend to be worse. We examined whether patients insured through TRICARE — a universal insurance and equal-access integrated healthcare system that covers more than 9 million active-duty members, veterans and their families — experienced these disparities. We found no racial disparities in quality-of-care outcomes, providing insights about the potential impacts of universal insurance and an equal-access health care system. The study included 8,183 TRICARE patients, aged 18-64, who had undergone CABG. The study took its data from TRICARE health care claims from the Military Health System Data Repository for the years of 2006 to 2014. (more…)
BMJ, Gender Differences / 25.07.2019

MedicalResearch.com Interview with: Dr Crystal Lee BMedSc(Hons), MIPH, PhD, MBiostat Senior Research Fellow School of Psychology and Public Health La Trobe University Honorary Research Fellow The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders The University of Sydney Adjunct Senior Research Fellow School of Public Health | Curtin University  MedicalResearch.com: What is the background for this study? Response:  Coronary heart disease (CHD) is a leading cause of death and disability worldwide. Primary care has been shown to play an important role in the secondary prevention of cardiovascular disease. Yet, studies in Australia and elsewhere from as far back as two decades ago identified gaps in the management of CHD patients in primary care. We analysed records of 130,926 patients with a history of CHD from 438 general practices across Australia to determine whether sex disparities exist in the management of CHD according to current clinical guidelines. (more…)
Author Interviews, JAMA, Johns Hopkins, OBGYNE, Race/Ethnic Diversity / 20.07.2019

MedicalResearch.com Interview with: Alison Gemmill, PhD Assistant Professor Johns Hopkins Bloomberg School of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A growing body of evidence suggests that the circumstances surrounding the 2016 presidential election may have had a uniquely negative impact on the health of U.S. Latino population. Few studies, however, have evaluated the population health implications of the election for Latina mothers and their children. We used national data and methods that control for temporal patterning to test the hypothesis that preterm birth rose above otherwise expected levels among Latina women in the U.S. following the election of Donald Trump. We find that the number of preterm births among Latina women increased above expected levels following the election. Specifically, we find 3.5 percent more preterm births among Latinas than projected for nine months following election. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Mental Health Research, Outcomes & Safety / 16.07.2019

MedicalResearch.com Interview with: MedicalResearch.com Interview with: Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. MedicalResearch.com: What are the main findings? Response: Disappointingly, studies evaluating the effectiveness and safety of flexible ICU visiting hours are scarce. To date, no large randomized trials have assessed the impact of a flexible visiting model on patients, family members, and ICU staff, and this evidence gap may constitute a barrier to the understanding of the best way to implement and improve ICU visiting policies. In the present pragmatic cluster-randomized crossover trial (The ICU Visits Study), we engaged 1,685 patients, 1,295 family members, and 826 ICU professionals from 36 adult ICUs in Brazil to compare a flexible visitation model (12 hours/day plus family education) vs. the standard restricted visitation model (median 90 minutes per day). We found that the flexible visitation did not significantly reduce the incidence of delirium among patients, but was associated with fewer symptoms of anxiety and depression and higher satisfaction with care among family members in comparison to the usual restricted visitation. Also, the flexible visitation did not increase the incidence of ICU-acquired infections and ICU staff burnout, which are major concerns when adopting this intervention. MedicalResearch.com: What should readers take away from your report? Response: Considering the evidence suggesting that most adult ICUs restrict the presence of family members, our results provide useful and relevant information that may influence the debate about current ICU visitation policies around the world. First, a flexible visitation policy that permits flexible family visitation in ICU (up to 12 hour per day) is feasible, given the high adherence of participant ICUs to implementation in The ICU Visits Study. Second, the flexible family supported by family education is safe regarding the occurrence of infections, disorganization of care or staff burnout. Third, family members - a commonly missing piece of the critical care puzzle - seem to benefit from the flexible visitation model through higher satisfaction with care and less symptoms of anxiety and depression. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research might focus on the following topics: 1) methods of implementation of flexible visiting models in ICUs; 2) Family support interventions in the context of flexible ICU visiting hours (e.g.: psychological and social support, support for shared decision making, peer support, and comfort); and 3) How flexible ICU visiting hours affects patient, family member and staff outcome at long-term. Disclosures: The ICU Visits study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program (PROADI-SUS). Citation: Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento  MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction.  (more…)
Author Interviews, Brain Injury, Pediatrics / 11.07.2019

MedicalResearch.com Interview with: Sean C. Rose, MD Pediatric sports neurologist and co-director of the Complex Concussion Clinic Nationwide Children’s Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Very limited data has been collected in children while they are playing contact sports to study the relationship between repetitive head impacts and neurocognitive outcomes.  We previously published a 1-year analysis of youth tackle football players and found no association between the number or severity of head impacts and performance on neurocognitive testing before to after the football season.  We are now reporting the results from the 2nd year of our study, tracking children through two seasons of football participation. We measured head impacts using helmet sensors during the 2016 and 2017 football seasons.  In the total group of 166 players age 9-18, one outcome measure (processing speed), out of the 23 outcome measures studied, declined over time.  However, several other measures that also assessed processing speed did not decline.  Neither the total burden of head impacts nor the intensity of individual impacts were associated with changes in testing performance over the course of the two seasons. (more…)
Annals Internal Medicine, Author Interviews, Supplements, Vitamin C, Vitamin D / 09.07.2019

MedicalResearch.com Interview with: Safi U. Khan, MD Department of Internal Medicine Robert Packer Hospital Sayre, PA 18840  MedicalResearch.com: What is the background for this study? Response: There is substantial body of observational data favoring use of vitamins, supplements and special diets for improving cardiovascular health. However, such type of data is limited by various biases. Randomized controlled trial (RCT) is considered gold standard to evaluate effects of a therapy.  (more…)
Annals Internal Medicine, Author Interviews, Infections, University of Michigan / 09.07.2019

MedicalResearch.com Interview with: Valerie M. Vaughn, MD MSc Assistant Professor of Medicine and Research Scientist, Division of Hospital Medicine The Patient Safety Enhancement Program and Center for Clinical Management Research Michigan Medicine and the Ann Arbor VA Medical Center  MedicalResearch.com: What is the background for this study? Response: Pneumonia is one of the top causes for hospitalization and one of the main reasons for antibiotic use in US hospitals. In the past decade, studies have suggested that patients can be safely treated with short course antibiotic therapy instead of the prolonged courses we used to prescribe. Our study looked at prescribing practices in 43 hospitals across the state of Michigan to see if we were appropriately prescribing short course therapy, and if so, how that affected patients. (more…)
Author Interviews, End of Life Care, JAMA, Kidney Disease / 08.07.2019

MedicalResearch.com Interview with: Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA  MedicalResearch.com: What is the background for this study? Response: We know that survival for people undergoing dialysis is generally quite limited.  Only a few studies have attempted to elicit how patients undergoing dialysis understand prognosis and how their prognostic awareness might be related to their interest in planning for the future, their preferences for resuscitation and the kind of care they would want if they were seriously ill or dying. (more…)
Author Interviews, JAMA / 04.07.2019

MedicalResearch.com Interview with: Lucy Schulson, MD MPH Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in healthcare. Since those studies were published, California has made concerted efforts at the state and local level to address health equity; these efforts may have impacted perceptions of discrimination in health care. However, it is not known how perceptions of discrimination in healthcare have changed over the last ten years overall and for specific groups. This study sought to compare perceptions of discrimination in health care in 2003-2005 compared to 2015-2017 overall, for racial and ethnic minorities, among immigrants, and among those with Limited English Proficiency (LEP).  (more…)
Author Interviews, Opiods / 26.06.2019

MedicalResearch.com Interview with: John Holaday, PhD Chairman and CEO of DisposeRx Dr. Holaday discusses the recentannouncement that Walgreen's has added DisposeRx to its safe medication drop off kiosks.  MedicalResearch.com: What is the background for this study? How big is the problem of unused risky medications leftover after the need or indication period has passed? Response: Keeping leftover medications in the home significantly increases the risk of accidental poisonings as well as diversion, which can lead to addiction, overdoses and death. According to the Centers for Disease Control & Prevention (CDC), accidental medicine poisonings send nearly 60,000 children under 5 years old to emergency rooms annually. And, a study by the National Institute on Drug Abuse found that the first opioid used by 70% of individuals with heroin-use disorder was a prescription pain medication, often remaining in their medicine cabinet well after the pain subsided and then a remaining temptation for abuse. This is a pervasive problem across the country. In an independent survey DisposeRx sponsored, it was found that 4 out of 10 Americans are keeping leftover prescriptions—including opioids – in their medicine cabinets. Other results of the survey include: 62% of respondents who said they stored medications in case a condition returns; and 37% said they save prescription drugs in case a friend or family member needs them. Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs These consumers need to be educated about all the potential harm resulting from saving leftover medications. Leading pharmacy chains such as Walgreens are committed, as responsible corporate citizens, to making DisposeRx available upon request for their customers and to educate them about its use in getting rid of leftover drugs before they cause harm. Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs as an additional method to reduce risks and exposure. (more…)
Author Interviews, CT Scanning, JAMA, Surgical Research, Technology / 21.06.2019

MedicalResearch.com Interview with: Christian Krautz, MD Department of Surgery, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen Nürnberg Erlangen, Germany  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this preclinical study that included 720 case evaluations, visualization with Cinematic Rendering allowed a more correct and faster comprehension of the surgical anatomy compared to conventional CT imaging independent from the level of surgical experience. Therefore,Cinematic Rendering is a tool that may assist HPB surgeons with preoperative preparation and intraoperative guidance through an improved interpretation of computed tomography imaging data. (more…)
Author Interviews, JAMA, Outcomes & Safety, Surgical Research / 19.06.2019

MedicalResearch.com Interview with: William Cooper, M.D., M.P.H. Cornelius Vanderbilt Professor Pediatrics and Health Policy Associate Dean for Faculty Affairs Director, Center for Patient and Professional Advocacy Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study?   Response: For surgical teams, high reliability and optimal performance are dependent on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may contribute to undermining a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Medical Imaging / 17.06.2019

MedicalResearch.com Interview with: Quinn R Pack, MD Assistant Professor of Medicine University of Massachusetts Medical School - Baystate Adjunct Assistant Professor of Medicine Tufts University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Because echocardiograms are non-invasive, very low risk, and nearly universally available, it is easy to over-use this technique.  In myocardial infarction, echo is also recommended in guidelines. However, in our lab, we frequently find echocardiograms that are ordered purely out of routine, without any thought as to the likelihood of finding an abnormality.   Prior studies also suggested that as many as 70% of echocardiograms provide no additional diagnostic value. When spread across the approximate 600,000 patients in the United States each year, this low diagnostic yield represents an opportunity to reduce costs by reducing echocardiograms.  (more…)
Author Interviews, Psychological Science / 16.06.2019

MedicalResearch.com Interview with: Zachary Witkower University of British Columbia PhD Student   MedicalResearch.com: What is the background for this study? Response: When we form judgments about other people –what their personality is like, or how they are feeling at the moment– we tend to focus our attention towards their face. This is not surprising, as facial shape and facial expressions contain all kinds of information that can be used to inform judgments. However, faces are almost never viewed in isolation. Instead, faces are almost always viewed as they rest upon the face’s physical foundation: the head. Yet little is known about how head position might influence judgments about personality or social status, or – importantly – how head position might change the way faces are perceived. In the present research, we examined how and why head position might influence social judgments made from the face.  (more…)
Author Interviews, Education, Opiods, Social Issues / 16.06.2019

MedicalResearch.com Interview with: Arline T. Geronimus Sc.D Professor, Health Behavior and Health Education School of Public Health Research Professor Population Studies Center Institute for Social Research University of Michigan Member, National Academy of Medicine  MedicalResearch.com: What is the background for this study? Response: The gap in life expectancy between less and more educated Americans grew over the last 30 years, a deeply troubling fact. We are alone among western nations in these trends. We aimed to determine what causes of death account for this growing educational gap in life expectancy and whether the gap has continued to grow in the most recent years. Disturbingly, we found the educational gap in life expectancy has continued to grow. Why? A common theory is that this growing inequality is due to the opioid epidemic. Some even speculate that the less educated are dying from a composite of what they call “deaths of despair” – opioid and other drug overdose, suicide and alcoholic liver disease – with the theory being that as less educated and working class Americans have faced job loss and stagnating wages, they experience hopelessness and despair and turn to drugs, alcohol, or even suicide to ease or end their pain and feelings of hopelessness. However, while opioid, suicide and alcoholic liver disease deaths have increased among white youth and young adults and is cause for concern, this does not imply that these deaths should be grouped together as “deaths of despair” (DOD) or that they explain the growing educational gaps in life expectancy across all groups – men, women, whites, blacks, or older as well as younger adults. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, University of Pennsylvania / 07.06.2019

MedicalResearch.com Interview with: Sameed Khatana, MD, MPH Fellow, Cardiovascular Medicine, Perleman School of Medicine Associate Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania  MedicalResearch.com: What is the background for this study?   Response: The Affordable Care Act (ACA) led to the largest increase in Medicaid coverage since the beginning of the program. However, a number of states decided not to expand eligibility. Studies of prior smaller expansions in Medicaid, such as in individual states, have suggested evidence of improved outcomes associated with Medicaid expansion. Additionally, studies of Medicaid expansion under the ACA of certain health measures such as access to preventive care and medication adherence have suggested some improvements as well. However, there have been no large, population-level studies to examine whether Medicaid expansion under the ACA led to changes in mortality rates. Given, a high burden of cardiovascular risk factors in the uninsured, we examined whether states that had expanded Medicaid had a change in cardiovascular mortality rates after expansion, compared to states that have not expanded Medicaid. (more…)
Accidents & Violence, Author Interviews, Cost of Health Care, JAMA, Surgical Research, University of Michigan / 05.06.2019

MedicalResearch.com Interview with: Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Traumatic injury has a tendency to be thought of as a disease that preferentially impacts younger people.  We wanted to explore the prevalence and impact of traumatic injury within the population of patients for whom Medicare is the third party payer.  (more…)
ASCO, Author Interviews, Education, Gender Differences, Surgical Research / 04.06.2019

MedicalResearch.com – Responses Marina Stasenko, MD Memorial Sloan Kettering Cancer Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sexual harassment is a form of discrimination that includes gender harassment, unwanted sexual attention, and sexual coercion. A recent report in Fortune magazine noted that over half of US women have experienced sexual harassment at some point in their lives. Until recently, much of the conversation about sexual harassment in the workplace has been relegated to private discussions behind closed doors. However, the MeToo movement has shined a spotlight on the pervasive nature of sexual harassment in various fields, like media and business world. Although there are more female physicians in practice today than ever before, with women accounting for over 50% of young physicians, sexual harassment and gender disparities continue to plague the field of medicine. Despite the large female representation, gynecologic oncology is not immune from gender disparities. The Society of Gynecologic Oncology is a professional organization of over 2000 physicians, scientists, allied health professionals, nurses, and patient advocates dedicated to the care of patients with gynecologic cancer. As of 2015, 46% of members of the SGO were women, and that number is steadily growing. SGO leadership is also increasingly female – with 2 of the last 3 presidents being women. Despite the large female representation, gynecologic oncology is not immune from gender disparities. The 2015 SGO practice survey noted that while 22% of male Gynecologic Oncologists held the rank of professor, only 11% of their female counterparts held the title. They also noted that the mean annual salary for male physicians was nearly 150,000$ greater than salary for female physicians. Given the fact that there is little objective data on sexual harassment in gynecologic oncology, the objective of our study was to evaluate perceptions of sexual harassment and gender disparities among physician members of the Society of Gynecologic Oncology. (more…)
Accidents & Violence, Author Interviews, Pediatrics, Pediatrics, Toxin Research / 03.06.2019

MedicalResearch.com Interview with: Dr. Gary Smith, MD MPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our 2016 study (https://pediatrics.aappublications.org/content/137/5/e20154529) investigated calls to US poison control centers related to laundry and dishwasher detergent exposures among children younger than 6 years old from 2013 through 2014 and found that poison control centers received more than 30 calls a day about children who had been exposed to a laundry detergent packet, which is about one call every 45 minutes. The current study investigated trends in calls to poison control centers across the country for exposure to liquid laundry detergent packets in order to evaluate the impact of the voluntary safety standard for this product with a focus on young children. The study found only a modest decrease (18%) in calls for children younger than 6 years of age following adoption of a 2015 product safety standard as well as an increase in calls for older children and adults. Exposures to the eyes also continued to climb. The observed decrease in exposures among young children is considerably less than the 40% to 55% decrease in toxic ingestions seen after passage of the Poison Prevention Packaging Act. This demonstrates that the current liquid laundry detergent safety standard is inadequate and needs to be strengthened. (more…)