Author Interviews, Cost of Health Care, JAMA, Kidney Disease, UCSF / 27.12.2018

MedicalResearch.com Interview with: Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF MedicalResearch.com: What is the background for this study? Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD. A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured.  (more…)
Accidents & Violence, Author Interviews, JAMA, Sexual Health, UCSD / 26.12.2018

MedicalResearch.com Interview with: John W. Ayers, PhD, MA Vice Chief of Innovation | Assoc. Professor Div. Infectious Disease & Global Public Health University of California San Diego MedicalResearch.com: What is the background for this study?   Response: The greatest barrier to understanding trends around sexual violence is they are largely hidden because victims are unable speak up publicly. Moreover, ongoing monitoring relies on proxies that underreport the scale of the problem such as police or medical records where only the most severe instances or a fraction of all instances of sexual violence are represented. As a result, we know very little about the scale of America's sexual violence problem. It was this backdrop that inspired #MeToo to call on victims to publicly voice their stories thereby revealing the scale of the problem. Our goal was to, for the first time, assess how this change inspired the public to engage with sexual violence issues. By tracking private aggregate internet search query trends we can begin to understand the scale of public engagement with issues around sexual violence including the precise motivation for a search, such as reporting episodes of sexual violence or learning how to prevent sexual violence. (more…)
Author Interviews, Dental Research, JAMA, Opiods, Pediatrics / 03.12.2018

MedicalResearch.com Interview with: Alan Schroeder MD Associate Chief for Research Division of pediatric hospital medicine Lucile Packard Children’s Hospital Stanford MedicalResearch.com: What is the background for this study? What are the main findings? Response: Third molar “wisdom teeth” extractions are one of the most common surgeries performed in adolescents and young adults, but an adequate appraisal of risks and benefits is lacking. Most patients who undergo this procedure are exposed to opioids post-operatively. We demonstrate that, for privately-insured opioid-naïve patients 16-25 years of age, exposure to opioids from a dental provider is associated with persistent use at 90-365 days in 7% of patients and a subsequent diagnosis relating to abuse in 6% of patients. In contrast persistent use and abuse were significantly lower in control patients not exposed to dental opioids (0.1% and 0.4%, respectively). The median number of pills dispensed for the initial prescriptions was 20. (more…)
Author Interviews, Geriatrics, JAMA, Pharmacology / 17.10.2018

MedicalResearch.com Interview with: Dr. Emily Reeve BPharm(Hons) PhD NHMRC-ARC Dementia Research Fellow Northern Clinical School University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: Older adults commonly take multiple medications. All medications carry the potential for both benefit and harm. When a medication is started a decision has been made between the healthcare professional and the patient that the likely benefits outweigh the potential risks. But over time the potential benefits and harms can change. So, part of good clinical care is discontinuation of medications when the benefit no longer outweighs the risks – for example when it is no longer needed or high risk. This is called “deprescribing”. Previously we knew that older adults could have mixed feelings about their medications, that is, they believe that all their medications are necessary but also feel that they are a burden to them. Qualitative research has explored this further, finding that there are a number of barriers and enablers to deprescribing from the patient perspective. For example, someone might have fear of deprescribing because they are worried that their symptoms may come back. But if they know that deprescribing is a trial and they will be monitored and supported by their physician or other healthcare professional they might be more open to deprescribing. From the physician perspective, there were concerns that older adults and their families were resistant to deprescribing and so there was fear that discussing possible medication discontinuation could damage the doctor-patient relationship. In this study of almost 2000 older adults in the United States, we found that over 90% were willing to stop one of more of their medications if their doctor said it was possible. Additionally, one third of participants wanted to reduce the number of medications that they were taking.  (more…)