Do Hospitals Designated as Centers of Excellence Have Better Outcomes? Interview with:

Sameed Khatana, MDFellow, Cardiovascular Medicine, Perleman School of MedicineAssociate Fellow, Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania

Dr. Khatana

Sameed Khatana, MD
Fellow, Cardiovascular Medicine, Perleman School of Medicine
Associate Fellow, Leonard Davis Institute of Health Economics
University of Pennsylvania What is the background for this study?

Response: There has been a growing use of quality metrics and indices in the US healthcare system. Much attention has been paid to quality measurement programs used by public payors, however, the use of such programs by commercial payors is much less studied. “Centers of excellence” are one type of quality designation program that is growing in use by commercial payors where certain hospitals are determined to be “high quality” for a certain disease state or procedure based on meeting certain criteria. For some people, this is even impacting the choice of providers and hospitals they can use by payors.

We evaluated centers of excellence programs from three large commercial payors, Aetna, Cigna and Blue Cross Blue Shield, targeted at cardiovascular diseases and interventions and examined publicly reported outcomes for all hospitals performing percutaneous coronary interventions (cardiac stenting) in New York State. 

Continue reading

Dialysis Unit Profit Primarily From Small Percentage of Privately Insured Patients Interview with:

Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095

Dr. Childers

Chris Childers, MD, PhD
Division of General Surgery
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095 What is the background for this study?

Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market.  A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit.

Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age.  Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics’ costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.

Continue reading

Excessive Supplements Linked to Increased Risk of Hip Fractures Interview with:

Prof. Haakon E Meyer, PhDDepartment of Public Health and Global HealthNorwegian Institute of Public HealthOslo, Norway

Prof. Meyer

Prof. Haakon E Meyer, PhD
Department of Public Health and Global Health
Norwegian Institute of Public Health
Oslo, Norway What is the background for this study? What are the main findings?

Response: The use of high dose vitamin supplementation is popular in parts of the population, often without any clear indication and in the absence of clear evidence of benefit.

However, side effects can occur, and in a previous published secondary analysis of double blinded randomized controlled trials, we found to our surprise an increased risk of hip fracture in those supplemented with high doses of vitamin B6 in combination with vitamin B12.

This finding was re-assessed in the current study employing data from the large observational Nurses’ Health Study. As in the previous study, we found that a combined high intake of vitamin B6 and B12 was associated with increased risk of hip fracture. Continue reading

Circulating Tumor DNA Linked to Recurrence After Colon Cancer Surgery Interview with:

Louise OlssonSenior researcherDepartment of Molecular Medicine and SurgeryColorectal SurgeryKarolinski InstituteStockholm, Sweden

Dr. Olsson

Louise Olsson MD PhD
Senior researcher
Department of Molecular Medicine and Surgery
Colorectal Surgery
Karolinski Institute
Stockholm, Sweden What is the background for this study? What are the main findings?

Response: I read a very interesting paper back in 2006 “Detection and quantification of mutation in the plasma of patients with colorectal cancer”. Only some 60 % of patients with early colorectal cancer were detectable in this way whereas patients with stage IV disease all had a high concentration of APC mutations in their plasma. So the prospects of using the method for example, screening of primary colorectal cancer seemed limited but I thought wow, this is the test to detect recurrences and generalized disease during follow-up after surgery for colorectal cancer. After some discussion we started to collect plasma samples from patients at the hospital where I worked and that´s how my research began.

Continue reading

COPD: Aclidinium Bromide (Tudorza Pressair) Has Favorable Safety Profile in Patients with CVD Interview with:

Robert A. Wise, M.D.Professor of MedicinePulmonary and Critical CareJohns Hopkins University School of MedicineBaltimore, MD 

Dr. Wise

Robert A. Wise, M.D.
Professor of Medicine
Pulmonary and Critical Care
Johns Hopkins University School of Medicine
Baltimore, MD What is the background for this study? What are the main findings?

Response: There has been a lingering controversy about the safety of long-acting anti-muscarinic agents (LAMA) as maintenance treatment for COPD in patients who have increased cardiovascular risk.  This study enrolled participants with COPD who also had increased cardiovascular risk or known cardiovascular disease.  Participants were randomly treated with either aclidinium bromide (Tudorza Pressair) or placebo.

Over 3 years of follow up there was no increased risk of adverse cardiovascular events.  Moreover, the medication had a significant benefit in terms of reducing exacerbations and COPD hospitalizations. Continue reading

Could Aspirin Improve Stool Testing for Colon Cancer Screening? Interview with:
Prof. Dr. med. Hermann Brenner
Clinical Epidemiology and Aging Research
Division Head
German Cancer Research Center
Foundation under Public Law
Germany What is the background for this study?

Response: Colorectal cancer is the third most common cancer globally, accounting for almost 900.000 deaths every year. Most of these deaths could be prevented by screening colonoscopy with early detection and removal of precursors of the cancer. However, capacities and use of screening colonoscopy are limited in most parts of the world, and low-cost but reliable noninvasive screening tests are important alternative primary screening tests.

The currently best established noninvasive tests are fecal immunochemical tests for hemoglobin (FITs) which are offered for colorectal cancer screening in an increasing number of countries. Although FITs detect the majority of colorectal cancers they detect approximately one out of four advanced adenomas only, the precursors of most colorectal cancers.

We hypothesized that this proportion could be increased by taking a single pill of aspirin two days prior to collecting the stool sample for FIT, because the well-established antithrombotic effects of aspirin might favor detecting occult bleeding from colorectal cancer or its precursors.

Continue reading

Fetal and Early Infant Growth Linked to Persistent Body Fat Patterns Interview with:

Vincent W. V. Jaddoe, MD, PhDAdjunct Professor of EpidemiologyDepartment of Epidemiology

Dr. Jaddoe

Vincent W. V. Jaddoe, MD, PhD
Adjunct Professor of Epidemiology
Department of Epidemiology What is the background for this study? What are the main findings? 

Response: Childhood body fat may be affected by patterns of fetal and infant weight change. Children born small for gestational age (SGA) tend to have infant growth acceleration, whereas those born large for gestational age (LGA) tend to have infant growth deceleration. Little is known about fetal and infant growth patterns affecting visceral, liver, and pericardial fat, which are strongly associated with cardiometabolic disease in later life.

We assessed in a large population cohort study whether fetal and infant weight change was associated with not only general, but also organ fat at school age. We observed that fetal and infant weight change patterns were both associated with childhood body fat, but weight change patterns in infancy tended to have larger effects. Fetal growth restriction followed by infant growth acceleration was associated with increased visceral and liver fat.  Continue reading

Early Childhood Infections Associated With Eating Disorders In Adolescence Interview with:

Lauren Breithaupt, PhDDepartment of PsychologyGeorge Mason UniversityFairfax, Virginia

Dr. Breithaupt

Lauren Breithaupt, PhD
Department of Psychology
George Mason University
Fairfax, Virginia What is the background for this study? What are the main findings? 

Response: Our study provides novel insight into the relationship between the immune system and eating disorders characterized by chronic restriction (e.g., anorexia nervosa) and binge eating and/or purging (e.g., binge eating disorder, bulimia nervosa). These findings also add to the growing body of literature linking the immune systems broadly and mental disorders.

We found that infections in early childhood were associated with an increased risk of anorexia nervosa, bulimia nervosa, and other eating disorders such as binge eating disorder in adolescence. These relationships appear to be both time and dose-dependent, meaning that the onset of eating disorder diagnosis is greatest in the first three months following the infection, and the more infections, the greater the risk.    Continue reading

“Magic Mouthwash” Can Decrease Mouth Pain from Radiation Therapy Interview with:

Robert C. Miller, MD, MS, MBADepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FloridaUniversity of Maryland School of Medicine, Baltimore

Dr. Miller

Robert C. Miller, MD, MS, MBA
Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
University of Maryland School of Medicine, Baltimore What is the background for this study? What are the main findings?

Response: “Magic Mouthwash” is one of the most commonly prescribed medications for oral mucositis pain during cancer therapy, but there has not been good evidence in the past to support its use.

This trial is the first large randomized controlled trial to demonstrate that both “Magic” mouthwash and doxepin rinse reduce patient reported pain during cancer therapy.

Continue reading

Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 What is the background for this study? What are the main findings? 

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states.  Continue reading

Dietary Cholesterol from Eggs Linked to Cardiovascular and All-Cause Mortality Interview with:

Victor Wenze Zhong, Ph.D.Postdoctoral fellowDepartment of Preventive MedicineFeinberg School of MedicineNorthwestern University 680 N Lake Shore Dr, Suite 1400Chicago, IL 60611

Dr. Zhong

Victor Wenze Zhong, Ph.D.
Postdoctoral fellow
Department of Preventive Medicine
Feinberg School of Medicine
Northwestern University
Chicago, IL 60611 What is the background for this study?

Response: Dietary cholesterol is a common nutrient in human diet. Eggs, specially egg yolks, are the single richest source of dietary cholesterol among all commonly consumed foods. The associations between dietary cholesterol consumption and cardiovascular disease and mortality remain controversial despite decades of research. Eating less than 300 mg of dietary cholesterol per day was the guideline recommendation before 2015. However, the most recent 2015-2020 Dietary Guidelines for Americans no longer include a daily consumption limit for dietary cholesterol and recommend weekly egg consumption as part of the healthy US-style eating pattern. Whether these recommendations are appropriate have been intensely debated.

Continue reading

Flu Linked to Marked Increase in Heart Failure Admissions Interview with:

Sonja Kytomaa MAResearch AssociateBrigham and Women’s Hospital

Sonja Kytomaa

Sonja Kytomaa MA
Research Associate
Brigham and Women’s Hospital

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

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 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.

Continue reading

Central Care Improved Survival of Extremely Premature Infants Interview with:

Mikael Norman, MD, PhD, ProfessorKarolinska Institutet & Karolinska University HospitalStockholm, Sweden 

Dr. Norman

Mikael Norman, MD, PhD, Professor
Karolinska Institutet & Karolinska University Hospital
Stockholm, Sweden What is the background for this study?

Response: So far, preterm birth has been difficult to predict and prevent. In particular, extremely preterm birth has continued to be an issue in terms of optimal care before and after birth, costs and long term health outcomes. Therefore, studies on how the management and outcome varies over time in these patients are important.

Continue reading

Mesenchymal Stem Cells May Reduce Complications in Heart Failure Patients with LVAD Interview with:

Annetine C. Gelijns, PhDChair, Department of Population Health Science & PolicyEdmond A. Guggenheim Professor of Health PolicyCo-Director, InCHOIR

Dr. Gelijns

Annetine C. Gelijns, PhD
Professor and System Chair
Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

Alan J Moskowitz, MDProfessor, Population Health Science and PolicyDepartment of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew York, NY 10029-6574

Dr. Moskowitz

Alan J Moskowitz, MD

Professor of Population Health Science and Policy
Icahn School of Medicine at Mount Sinai What is the background for this study? Where do these mesenchymal cells come from? 

Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery.

Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients.

Continue reading

Lowering Blood Pressure Target Would Greatly Increase Number of People Diagnosed with Hypertension Interview with:

Alexander A. Leung, MD, MPHDepartment of Community Health SciencesDepartment of MedicineUniversity of CalgaryCalgary, Alberta, Canada

Dr. Leung

Alexander A. Leung, MD, MPH
Department of Community Health Sciences
Department of Medicine
University of Calgary
Calgary, Alberta, Canada What is the background for this study?

Response: The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines redefined hypertension according to a blood pressure cutoff of ≥130/80 mm Hg, compared to the traditional cutoff of ≥140/90 mm Hg.

Continue reading

High-Dose Vitamin D During Pregnancy Did Not Reduce Risk of Childhood Asthma Interview with:

Bo Chawes, MD, PhD, DMScAssociate ProfessorC‌openhagen Prospective Studies on Asthma in ChildhoodH‌erlev and G‌entofte H‌ospitalU‌niversity of C‌openhagen

Dr. Chawes

Bo Chawes, MD, PhD, DMSc
Associate Professor
C‌openhagen Prospective Studies on Asthma in Childhood
H‌erlev and G‌entofte H‌ospital
U‌niversity of C‌openhagen What is the background for this study? What are the main findings?

Response: There has been a global surge in vitamin D deficiency happening in parallel with an increase in prevalence of childhood asthma, which suggests that low maternal vitamin D levels during pregnancy may increase asthma risk in the child.

Due to that we conducted a randomized double-blinded controlled trial within the Danish COPSAC2010 cohort ( of 7-fold (2,800 IU/d) vs. standard dose (400 IU/d) of vitamin D supplementation from pregnancy week 24 aiming to reduce offspring asthma risk. At age 3, we observed a non-significant 24% reduced risk of recurrent asthma-like symptoms, ie. recurrent wheeze, in the high-dose vitamin D group. In the current study, we followed 545 of the 581 children in the study till age 6, where an asthma diagnosis can be established and observed no effect of the high-dose vitamin D supplement on the child’s risk of asthma. 

Continue reading

Most Deaths From Sepsis Occur in Frail Older Adults and Are Not Preventable Interview with:

Chanu Rhee, MD,MPHAssistant Professor of Population MedicineHarvard Medical School / Harvard Pilgrim Health Care InstituteAssistant Hospital EpidemiologistBrigham and Women’s Hospital

Dr. Rhee

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 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.  Continue reading

Supplements Did Not Prevent Depression in Study of Obese Adults Interview with:

Prof. Marjolein Visser PhDProfessor of Healthy AgingHead section Nutrition and HealthDepartment of Health Sciences, Vrije Universiteit AmsterdamAmsterdam Public Health research institute

Dr. Visser

Prof. Marjolein Visser PhD
Professor of Healthy Aging
Head section Nutrition and Health
Department of Health Sciences, Vrije Universiteit Amsterdam
Amsterdam Public Health research institute What is the background for this study? What are the main findings?

Response: More than 40 million Europeans experience a major depressive disorder. One in ten men, and one in five women suffer from clinical depression at least once during their lifetime. Depression is one of the most prevalent and disabling disorders in the EU.

Given the increasing prevalence of depression, more people are actively searching for ways to decrease their risk through lifestyle modification, but are often overwhelmed by confusing and contradictory information.

The MooDFOOD prevention trial is the largest randomized clinical trial to study the effects of nutritional strategies on the prevention of major depressive disorder. Over 1000 overweight or obese participants identified as being at elevated risk for depression but who were not currently depressed, from four European countries -the Netherlands, the United Kingdom, Germany and Spain, took part in the study. Participants were randomized to either take nutritional supplements containing folic acid, vitamin D, zinc, selenium or to a pill placebo, and half of participants also received a behavioral lifestyle intervention intended to change dietary behaviors and patterns.

Continue reading

Medical Research Metaanalyses Can Contain Corrupted Data Interview with:

Craig Alexander Garmendia, PhDOffice of Bioresearch Monitoring Operations, Office of Regulatory AffairUS Food and Drug AdministrationMiami, Florida

Dr. Garmendia

Craig Alexander Garmendia, PhD
Office of Bioresearch Monitoring Operations
Office of Regulatory Affairs
US Food and Drug Administration
Miami, Florida What is the background for this study? What are the main findings? 

Response: Clinical trials under the U.S. Food and Drug Administration’s (FDA) purview have been shown to suffer from falsified data. While the FDA warns researchers when falsified data are discovered, these data still make their way into medical literature.

In this novel study, Dr. Garmendia and colleagues conducted a systematic review to examine the effects of publications containing falsified data on meta-analyses using sensitivity analyses. Almost half of all meta-analyses had conclusions altered by publications containing falsified data, while nearly one-third of all analyses had considerable changes in outcomes. Continue reading

Is Behavioral Change Among Overweight Diabetics Feasible and Sustainable? Interview with:
Giuseppe Pugliese, MD, PhD
for the Italian Diabetes and Exercise Study 2 (IDES_2) Investigators
Department of Clinical and Molecular Medicine
‘‘La Sapienza’’ University
Diabetes Unit, Sant’Andrea University Hospital
Rome, Italy What is the background for this study?

Response: There is a growing epidemic of obesity and type 2 diabetes worldwide,
which are causally related to the increasing prevalence of “physical
inactivity”, i.e., an insufficient amount of moderate-to-vigorous
physical activity according to current guidelines, and
“sedentariness”, i.e., too many hours, especially if uninterrupted,
spent in a sitting or reclined position.  These two unhealthy
behaviors exert their detrimental effects independently of each other
and are very common among people suffering from type 2 diabetes, who
would therefore benefit from increasing physical activity and reducing
sedentary time, as recommended by current guidelines.

However, such a behavior change is generally difficult for a number of
internal and external barriers and requires behavioral interventions
targeting both physical activity and sedentary habits.  Unfortunately,
there is no definitive evidence that this is indeed feasible and,
particularly, that, if adopted, change in behavior can be maintained
in the long term.  Continue reading

How Does a Stroke Affect Cognitive Function? Interview with:

Sarah Parish, MSc, DPhil Professor of Medical Statistics and Epidemiology MRC Population Health Research Unit Nuffield Department of Population Health University of Oxford

Dr. Parish

Sarah Parish, MSc, DPhil
Professor of Medical Statistics and Epidemiology
MRC Population Health Research Unit
Nuffield Department of Population Health
University of Oxford What is the background for this study?

Response: Acquiring reliable randomized evidence of the effects of cardiovascular interventions on cognitive decline is a priority. In this secondary analysis of 3 randomized intervention trials of cardiovascular event prevention, including 45 029 participants undergoing cognitive testing, we estimated the association of the avoidance of vascular events with differences in cognitive function in order to understand whether reports of non-significant results exclude worthwhile benefit.  Continue reading

Lung Cancer: Screening Model Including Low-Dose CT Can Improve Risk Prediction Interview with:

Martin C. Tammemägi   PhDSenior Scientist | Cancer Care Ontario | Prevention & Cancer Control | Scientific Lead | Lung Cancer Screening Pilot for People at High RiskProfessor (Epidemiology) | Brock University | Department of Health SciencesOntario  Canada

Dr. Tammemägi

Martin C. Tammemägi PhD
Senior Scientist
Cancer Care Ontario | Prevention & Cancer Control
Scientific Lead
Lung Cancer Screening Pilot for People at High Risk
Professor (Epidemiology) | Brock University Department of Health Sciences
Ontario, Canada What is the background for this study?

Response: Some prediction models can accurately predict lung cancer risk (probability of developing lung cancer during a specified time). Good model predictors include sociodemographic, medical and exposure variables. In recent years, low dose computed tomography (LDCT) lung cancer screening has become widespread in trials, pilots, demonstration studies, and public health practice.

It appears that screening results provides added valuable, independent predictive information regarding future lung cancer risk, aside from the lung cancers directly detected from the diagnostic investigations resulting from positive screens. Continue reading

Low-Value Health Care: Measuring Hospital-Acquired Complications Interview with:

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostatResearch Fellow,Value in Health Care Division,Menzies Centre for Health Policy

Mr. Badgery-Parker

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostat
Research Fellow,Value in Health Care Division
Menzies Centre for Health Policy What is the background for this study?

Response: This is part of a large program of work at the Menzies Centre for Health Policy on low-value care in the Australian health system. We have previously published rates of low-value care in public hospitals in Australia’s most populous state, New South Wales, and a report on rates in the Australian private health insurance population is due for publication shortly. We have also done similar analyses for other Australian state health systems.

This particular paper extends the basic measurement work to focus on what we call the ‘cascade’ effects. That is, looking beyond how much low-value care occurs to examine the consequence for patients and the health system of providing these low-value procedures.

Continue reading

Not All Polypharmacy for Schizophrenia is Bad Interview with:

Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden

Dr. Tiihonen

Jari Tiihonen, MD, PhD
Professor, Department of Clinical Neuroscience
Karolinska Institutet
Stockholm, Sweden What is the background for this study?

Response: The effectiveness of antipsychotic combination therapy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being. But the evidence for this are weak and antipsychotic polypharmacy is widely used.

Continue reading

Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes Interview with:

Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor

Alexis G. Antunez

Alexis G. Antunez MS
University of Michigan Medical School, Ann Arbor
Center for Healthcare Outcomes and Policy
University of Michigan, Ann Arbor What is the background for this study?

Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations.  Continue reading

Rheumatoid Arthritis: Study Finds No Benefit to MRI-Guided Treatment Interview with:

Signe Møller-Bisgaard MD, PhD Rigshospitalet Center for Rheumatology and Spine Diseases Copenhagen Center for Arthritis Research 

Dr. Møller-Bisgaard

Signe Møller-Bisgaard MD, PhD
Center for Rheumatology and Spine Diseases
Copenhagen Center for Arthritis Research What is the background for this study? 

Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression.

In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.  Continue reading

Does EEG Brain Monitoring During Surgery Reduce Post-Op Delirium? Interview with:

Michael Avidan, MBBCh, FCA SA Dr. Seymour and Rose T. Brown Professor of Anesthesiology Chief of the Division of Clinical and Translational Research Director of the Infrastructure of Quality Improvement, Research and Informatics Washington University School of Medicine St Louis, MO

Dr. Avidan

Michael Avidan, MBBCh, FCA SA
Dr. Seymour and Rose T. Brown Professor of Anesthesiology
Chief of the Division of Clinical and Translational Research
Director of the Infrastructure of Quality Improvement, Research and Informatics
Washington University School of Medicine
St Louis, MO What is the background for this study?

Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death.

Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery.

Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery.

Continue reading

Self-Compression During Mammography Evaluated Interview with:
"Kiki Gets a Mammogram" by kristiewells is licensed under CC BY-NC-SA 2.0. To view a copy of this license, visit: Henrot, MD
Radiology Department
Institut de Cancerologie de Lorraine
Vandoeuvre-les-Nancy What is the background for this study? What are the main findings?

Response: The initial observation was that daily practice of mammography shows a substantial proportion of women that report a negative experience after having a mammogram. Compression of the breast before delivering X-rays is mandatory to achieve the best image quality and to detect small cancers. Unfortunately, compression is uncomfortable, even sometimes painful.

We took into consideration a study of PJ Kornguth et al. published in 1993 reporting the self-compression technique. In this study one breast was compressed by the radiographer and the other with self-compression. The author reported a high level of patient satisfaction, and a lower discomfort, without compromising image quality. We performed a multicenter prospective randomized trial to demonstrate the feasibility of the self-compression technique in condition similar to routine screening or follow-up, compared with standard compression. The primary outcome was to demonstrate that self-compression did not lead to compress the breast less than standard compression, and that was done. The secondary outcomes were to evaluate pain, compression force and image quality.

The results indicated that compression force was higher when the women controlled themselves the compression of their breast, and the pain measured on a visual analogue scale was lower. Moreover, image quality was not compromised compared with standard compression.  Continue reading

Federal Incentives Did Not Reduce Catheter Infections in Hospitals Interview with:

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Dr. Hsu

Heather Hsu, MD MPH
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118 What is the background for this study? What are the main findings? 

Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015.

Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown.

Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example.

We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.

Continue reading

Should Hospitalized Asthma Patients Receive Antibiotics? Interview with:
Mihaela S Stefan, MD, PhD FACP

Research Scientist, Institute for Healthcare Delivery and Population Science
Associate Professor, UMMS-Baystate
Director of Perioperative Clinic and Medical Consultation Program
Academic Hospitalist
Director Quality Assessment, Division of Healthcare Quality
Springfield MA What is the background for this study? What are the main findings?

Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death.

We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. Continue reading