Author Interviews, Cost of Health Care, JAMA, University of Pennsylvania / 09.09.2018

MedicalResearch.com Interview with: Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients. Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched. The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  (more…)
Author Interviews, JAMA, Pain Research, Surgical Research / 09.09.2018

MedicalResearch.com Interview with: David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids. In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons. Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills. We believe patients experienced less pain than surgeons anticipated. (more…)
Author Interviews, Brain Injury, CDC, JAMA, Pediatrics / 05.09.2018

MedicalResearch.com Interview with: Matt Breiding, PhD Team Lead, Division of Unintentional Injury Prevention Center for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Caused by a bump, blow or jolt to the head or body, a mild traumatic brain injury (mTBI) can lead to short- or long-term problems that can affect how a child thinks, acts, feels, and learns. CDC’s Pediatric mTBI Guideline is based on the most comprehensive review of the science on pediatric mTBI diagnosis and management to date—covering 25 years of research. The guideline consists of 19 sets of clinical recommendations that cover diagnosis, prognosis, and management and treatment. These recommendations are applicable to healthcare providers who care for pediatric patients with mTBI in all practice settings and outline actions healthcare providers can take to improve the health of their patients with this injury. The CDC Pediatric mTBI Guideline outlines specific actions healthcare providers can take to help young patients and includes 5 key recommendations.  Specifically, they recommend that physicians:
  1. Refrain from routinely imaging pediatric patients to diagnose mTBI.
  2. Use validated, age-appropriate symptom scales to diagnose mTBI.
  3. Assess for risk factors for prolonged recovery, including: history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).
  4. Provide patients with instructions on returning to activity customized to their symptoms.
  5. Counsel patients to return gradually to non-sports activities after no more than a 2-3 days of rest.
(more…)
Author Interviews, Dermatology, Education, Gender Differences, JAMA / 03.09.2018

MedicalResearch.com Interview with: Lia E. Gracey, MD, PhD Department of Dermatology Baylor Scott & White Health Austin, Texas  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The co-authors and I were interested in this issue as new parent leave (or the lack thereof) is increasingly being examined in many professions.  As a mother who had children during dermatology residency, I felt the pressure to take a short new parent leave to avoid having to make up time at the end of my training. I came back to work only 3 ½ weeks after having my first baby. Anecdotally, other new parent residents (both men and women) reported similar concerns and we noticed a lack of data about new parent leave policies in dermatology residency training programs. We distributed surveys to dermatology residency program directors and residents and were struck by a basic lack of awareness by residents for whether their institution even offered new parent leave.  Less than 50% of surveyed residents were aware of a written new parent leave policy for their residency program, yet over 80% of program directors stated they had a policy in place. We also found discrepancies between resident and program director perceptions of sufficiency of new parent leave and the availability of pumping facilities for breastfeeding mothers.  (more…)
Anesthesiology, Author Interviews, ENT, Heart Disease, JAMA / 03.09.2018

MedicalResearch.com Interview with: Henry E. Wang, MD, MS Professor and Vice Chair for Research University of Texas Health Science Center at Houston Department of Emergency Medicine Houston, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Response: For over three decades, paramedics have performed endotracheal intubation (ETI) as the standard advanced airway management strategy in cardiac arrest. However, intubation is a difficult and error-prone intervention. Newer supraglottic airways such as the laryngeal tube (LT) offer easier insertion technique with comparable ventilation. However, intubation and laryngeal tubes have not been tested head-to-head in a randomized trial. Our study - the Pragmatic Airway Resuscitation Trial (PART) - tested intubation vs laryngeal tube for airway management in adult out-of-hospital cardiac arrests. The trial included 27 EMS agencies from the Birmingham, Dallas-Fort Worth, Milwaukee, Portland and Pittsburgh communities. The trial randomized a total of 3,004 adult cardiac arrests to airway management with ETI or LT. We found that compared with traditional ETI, LT was associated with almost 3% better survival. Out-of-hospital cardiac arrest survival in the US is less than 10%, so the observed difference is important.  (more…)
Author Interviews, JAMA, Stroke / 29.08.2018

MedicalResearch.com Interview with: Larry B. Goldstein, MD, FAAN, FANA, FAHA Ruth L. Works Professor and Chairman, Department of Neurology Co-Director, Kentucky Neuroscience Institute KY Clinic - University of Kentucky Lexington, KY 40536 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Extensive work in laboratory models over several decades show that d-amphetamine, combined with task-relevant experience, can facilitate recovery after stroke and traumatic brain injury affecting the cerebral cortex. Results from clinical trials have been inconsistent, in part because preclinical data indicate that the effect of amphetamines as part of a regimen for stroke recovery is biologically complex.  We conducted this multicenter pilot study to explore some of that complexity. (more…)
Author Interviews, Environmental Risks, JAMA, Pediatrics, Toxin Research / 29.08.2018

MedicalResearch.com Interview with: Joseph M. Braun, MSPH, PhD Associate Professor of Epidemiology Epidemiology Master's Program Director Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: Childhood lead poisoning continues to be a problem in the United States and residential lead hazards are the major source of Pb exposure in young children. However, no studies have attempted to prevent exposure to lead hazards through primary prevention. Thus, we randomized 355 pregnant women to a comprehensive residential intervention and followed their children for up to 8 years to determine if childhood lead poisoning and associated cognitive deficits and behavior problems can be prevented. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 27.08.2018

MedicalResearch.com Interview with: Amine Mazine, MD, MSc Associate Editor, BMC Surgery PGY-4 Cardiac Surgery PhD Candidate, Institute of Biomaterials and Biomedical Engineering McEwen Center for Regenerative Medicine Surgeon-Scientist Training Program University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure). The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival. (more…)
Author Interviews, Heart Disease, Infections, JAMA / 27.08.2018

MedicalResearch.com Interview with: Pr. Didier Raoult Directeur de l'IHU Méditerranée-Infection Marseille  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This work represents the sum of data accumulated over several decades of studies on Q fever. Our reference center contacts each of the physicians in charge and ensures patient follow-up, which allows obtaining data, that is not comparable to those used automatically in databanks. Four people exclusively dedicated their time to manage these specific data on Q fever. The main data confirm the need to perform a cardiac ultrasound for all patients with Q fever and acute endocarditis (to detect valvulopathy) and to give a prophylactic treatment to avoid fixation on the heart in patients with valvulopathy. This work helps clarify the evolution of Q fever by eliminating the term of chronic Q fever, which is based on non-clinical elements, and defining persistent Q fever for which there is an identifiable focus of infection. Furthermore, this work makes it possible to recommend systematic detection of antiphospholipid antibodies in order to limit the risk of thrombosis and the risk of cardiac fixation. (more…)
Aging, Author Interviews, Genetic Research, JAMA / 27.08.2018

MedicalResearch.com Interview with: Yi Zeng, Ph.D.| Professor, Center for Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University Professor, National School of Development, Chief Scientist of Raissun Institute for Advanced Studies, Peking University Distinguished Research Scholar, Max Planck Institute for Demographic Research Foreign member of the Royal Netherlands Academy of Arts and Science MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sex differences in genetic associations with human longevity remain largely unknown; investigations on this topic are important for individualized healthcare. (more…)
Anesthesiology, Author Interviews, JAMA, Stroke / 18.01.2018

MedicalResearch.com Interview with: Dr. Claus Z. Simonsen, MD, PhD Department of Neurology Aarhus University Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Retrospective studies find worse outcome when performing (Endovascular Therapy) EVT under General Anesthesia (GA). The main finding is that infarct growth in the Conscious Sedation (CS) and GA are not different. And that patients who had EVT under GA had a better outcome after 90 days. This is probably explained by better reperfusion rates under GA which was another part of the study that was surprising. Our neurointerventionalist are comfortable performing EVT under CS, but our study indicates that maybe it is easier to achieve reperfusion it the patient is anesthesized. (more…)
Author Interviews, Diabetes, JAMA, Mayo Clinic, Outcomes & Safety / 21.09.2016

MedicalResearch.com Interview with: Victor M. Montori, MD MSc Knowledge and Evaluation Research Unit in Endocrinology Mayo Clinic, Rochester, Minnesota MedicalResearch.com: What is the background for this study? Response: Hypoglycemia can acutely disrupt patients’ lives through symptoms ranging from bothersome to life-threatening; worsen quality of life; and hinder medication adherence and glycemic control. Hypoglycemia is now known to increase risk of mortality, cognitive impairment, and cardiovascular events. In order to improve the quality of diabetes care, healthcare organizations use publicly reported performance measures for quality measurement and improvement, and pay-for-performance initiatives. The degree to which existing performance measures are aligned with guidelines, particularly in regard to hypoglycemia avoidance, is uncertain. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 14.09.2016

MedicalResearch.com Interview with: Gillian D. Sanders-Schmidler Ph.D. Professor of Medicine Duke Evidence Synthesis Group, Director Duke Evidence-based Practice Center, Director Duke Clinical Research Institute Duke University MedicalResearch.com: What is the background for this study? Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations. This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers. (more…)
Addiction, CMAJ, JAMA, Pharmacology, Primary Care / 19.09.2013

Richard Saitz, MD MPH Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MassachusettsMedicalResearch.com Interview with: Richard Saitz, MD MPH Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence. (more…)