Author Interviews, Cost of Health Care, JAMA, NYU, Ophthalmology, Pharmaceutical Companies / 02.08.2019

MedicalResearch.com Interview with: [caption id="attachment_50532" align="alignleft" width="150"] Dr. Thiel[/caption] Cassandra L. Thiel, PhD Assistant Professor NYU Langone School of Medicine Department of Population Health NYU Wagner Graduate School of Public Service NYU Tandon School of Engineering MedicalResearch.com: What is the background for this study? Response: Most healthcare professionals and researchers are aware that the healthcare sector makes up about 18% of the US Gross Domestic Product. What many do not realize is that all of that economic activity results in sizable resource consumption and environmental emissions. The healthcare industry is responsible for 10% of the US’s greenhouse gas (GHG) emissions and 9% of air pollutants.1 Sustainability in healthcare is a developing field of research and practice, and my lab offers data and information by quantifying resource use and emissions of healthcare delivery. We started looking at cataract surgery a few years ago, in part because operating rooms (ORs) typically represent the largest portion of spending and garbage generation in a hospital.2,3 Cataract surgeries are interesting because they are one of the most common surgeries performed in the world. In the US, we spend $6.8 billion on them each year. Any changes we can make to individual cases would have much larger, global impacts. I studied cataract surgeries at a world-renowned, high-volume eye surgery center in India and helped validate that clinical care could be designed in a way that was effective, cost-efficient, and resource efficient. Compared to the same procedure in the UK, this surgery center generates only 5% of the carbon emissions (with the same outcomes).2 This site’s standard policy is to multi-dose their eye drops, or use them on multiple patients until the bottle was empty. As such, the site generated very little waste. Returning to the US, I observed cataract cases and heard the complaints of OR staff that they had to throw out many partially used or unused pharmaceuticals. In reviewing the literature, we could not find a study that quantified how much we were throwing away and what it cost us to do so. We, therefore, set up a study to look at this particular issue.
Author Interviews, Environmental Risks, NYU, Pediatrics, Weight Research / 26.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50440" align="alignleft" width="200"]Melanie Jacobson, PhD, MPH Research Scientist at World Trade Center Health Registry New York City Department of Health and Mental Hygiene NYU School of Medicine in New York, N.Y. Dr. Jacobson[/caption] Melanie Jacobson, PhD, MPH NYU School of Medicine New York, N.Y.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study was about exposure to bisphenols, which are synthetic chemicals found in aluminum can linings, plastics, thermal paper receipts and other consumer products, and their association with obesity among a nationally representative sample of US children and adolescents. We found that children who had greater levels of these chemicals in their urine were more likely to be obese compared with children with lower levels.
Author Interviews, JACC, Kidney Disease, NYU / 13.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49703" align="alignleft" width="225"]David Charytan, MD MSc Chief, Nephrology Division NYU Langone Medical Center New York, NY 10010 Dr. Charytan[/caption] David Charytan, MD MSc Chief, Nephrology Division NYU Langone Medical Center New York, NY 10010  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Cardiovascular events are much more frequent in patients with impaired kidney function (chronic kidney disease), and cardiovascular disease is the most common cause of death in advanced chronic kidney disease. This risk remains high despite the use of standard medical therapies including statins, the most commonly used cholesterol lowering agents. The PCSK9 inhibitor evolocumab is a new class of highly potent cholesterol lowering medications that can further reduce the risk of cardiovascular events in patients already taking statins. We analyzed data from the FOURIER trial, which randomized study patients with clinically evident atherosclerosis and an LDL cholesterol level >=70 mg/dL or HDL cholesterol level >= while on a statin, to assess the safety and efficacy of evolocumab, a PCSK9 inhibitor, compared with placebo in individuals with mild to moderate chronic kidney disease. There were several major findings
  • a) evolocumab appears to be equally safe in individuals with preserved and mild to moderately impaired kidney function
  • b) evolocumab appears to have preserved efficacy at preventing cardiovascular events as kidney function declines.
  • c) We were unable to detect any significant impact on kidney function.
  • In addition, because the baseline risk of cardiovascular events is much higher in individuals with  chronic kidney disease, the absolute benefits of treatment with evolocumab appear  to be magnified as kidney function declines. 
ASCO, Author Interviews, Biomarkers, Melanoma, NYU / 02.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49317" align="alignleft" width="200"]David Polsky, MD, PhDDermatologist and Director of the Digmented Lesion Service Dr. Polsky[/caption] David Polsky, MD, PhD Dermatologist and Director of the Digmented Lesion Service Mahrukh M. Syeda, MS Research Associate Ronald O. Perelman Department of Dermatology NYU Langone Health MedicalResearch.com: What is the background for this study? Response: Several studies of metastatic melanoma patients have demonstrated that measuring circulating tumor DNA (ctDNA) associates with their disease burden and survival.  Generally, patients with detectable pre-treatment ctDNA levels and/or detectable ctDNA at various time intervals after starting treatment have shorter survivals than patients with lower pre-treatment or on-treatment ctDNA levels.  Studies have varied in their methods to detect ctDNA, the thresholds chosen to call a sample positive or negative, and the follow up time point for measurement, if any. In this study, we examined pre-treatment and week 4 on-treatment plasma samples from patients enrolled in Combi-D, the Phase III, randomized, double-blind trial of the BRAF and MEK inhibitors Dabrafenib and Trametinib, which led to FDA approval of the combination therapy for patients with unresectable stage III/IV melanoma. Only patients with BRAF V600E or V600K mutations identified from tumor genotyping were enrolled in the clinical trial.
Author Interviews, Hearing Loss, JAMA, NIH, NYU / 24.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49355" align="alignleft" width="150"]Jan Blustein, MD PhDProfessor of Health Policy and MedicineWagner Graduate School and School of MedicineNew York University, New York Dr. Blustein[/caption] Jan Blustein, MD PhD Professor of Health Policy and Medicine Wagner Graduate School and School of Medicine New York University, New York MedicalResearch.com: What is the background for this study?   Response: The National Institutes of Health (NIH), the nation’s largest public funder of health research, provides annual reports about levels of funding for many diseases and conditions.  These reports, issued as part of the NIH’s Research, Condition and Disease Categorization (RCDC) process, allow members of the public to track funding across key conditions and across time. Hearing loss is not included among the reported conditions. This runs counter to two of the NIH’s stated goals, according to researcher Jan Blustein (M.D., Ph.D.), professor of health policy and medicine at New York University’s Robert F. Wagner Graduate School of Public Service, in a Research Letter in the May 15th issue of the Journal of the American Medical Association Otolaryngology and Head & Neck Surgery. “First, the NIH is committed to transparency about how it divides funds across diseases and conditions,” said Dr. Blustein.  “Second, it has said that it will prioritize its funding to those conditions that cause the greatest disease burden.”  Hearing loss causes great disease burden, ranking 10th in the U.S. among all conditions as a contributor to Disability Adjusted Life Years (a widely-used measure of disease burden), according to the World Health Organization.
Author Interviews, Education, Neurology, NYU / 17.05.2019

MedicalResearch.com Interview with: Dr. Rebecca Stainman Dr. Arielle Kurzweil MD Adult Neurology Program Director New York University School of Medicine NYU Langone Health MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Physician burnout is prevalent. Neurologists have among the highest burnout rates, ranked third among specialties in a 2011 study, and over half of US Neurologists report at least 1 symptom of burnout in a 2016 survey.  Efforts to address burnout in training programs have mostly been aimed at implementing wellness curricula and offering mental health resources. Training neurology residents to effectively identify, address, and help impaired colleagues is equally crucial in these efforts, yet there is a paucity of literature on this topic. We used simulation as a means of addressing this topic, via identifying and addressing an impaired colleague through an objective structured clinical examination (OSCE). 
Author Interviews / 07.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49033" align="alignleft" width="200"]Lana Zhovtis Ryserson, MDAssistant Professor, Department of NeurologyNYU Langone Health Dr. Zhovtis Ryserson[/caption] Lana Zhovtis Ryserson, MD Assistant Professor, Department of Neurology NYU Langone Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Natalizumab is an effective therapy of relapsing remitting multiple sclerosis dosed at 300mg every 4 weeks. However it is associated with a potentially deadly infection - progressive multifocal leukoencephalopathy. In order to mitigate this risk, clinicians have adopted an approach of infusing the medication less frequently, a strategy which has become known as Extended Interval Dosing (EID). The TOUCH database is US mandatated risk evaluation and mitigation program which is the largest database available to assess PML risk for patients on EID schedule. Previous analysis of this database in 2017, showed a significant risk reduction of PML in patients utilizing extended interval dosing schedule. The aim of the current study was to update on this analysis with another year of data.
Author Interviews, NYU, PTSD, Technology / 22.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48742" align="alignleft" width="200"]Charles R. Marmar, MDThe Lucius N. Littauer Professor Chair of the Department of PsychiatryNYU Langone School of Medicine Dr. Marmar[/caption] Charles R. Marmar, MD The Lucius N. Littauer Professor Chair of the Department of Psychiatry NYU Langone School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Several studies in recent years have attempted to identify biological markers that distinguish individuals with PTSD, with candidate markers including changes in brain cell networks, genetics, neurochemistry, immune functioning, and psychophysiology. Despite such advances, the use of biomarkers for diagnosing PTSD remained elusive going into the current study, and no physical marker was applied in the clinic. Our study is the first to compare speech in an age and gender matched sample of a military population with and without PTSD, in which PTSD was assessed by a clinician, and in which all patients did not have a major depressive disorder. Because measuring voice qualities in non-invasive, inexpensive and might be done over the phone, many labs have sought to design speech-based diagnostic tools 
Author Interviews, Cancer Research, Cannabis, End of Life Care, NYU / 28.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48264" align="alignleft" width="200"]Arum Kim, MDAssistant professor of Medicine and Rehabilitation MedicineNYU School of MedicineDirector of the Supportive Oncology ProgramPerlmutter Cancer Center Dr. Kim[/caption] Arum Kim, MD Assistant Professor Medicine and Rehabilitation Medicine NYU School of Medicine Director of the Supportive Oncology Program Perlmutter Cancer Center MedicalResearch.com: What is the background for this study?   Response: There is increasing interest in medical marijuana and its applications for patients with cancers. Despite increasing access, little is known regarding doses of cannabinoids - specifically tetrahydrocannabinol (THC)  and cannabidiol (CBD), methods of drug delivery, and differences in patterns of use between cancer and non-cancer patients.
Anesthesiology, Author Interviews, Dermatology, JAMA, NYU, Pediatrics / 14.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47880" align="alignleft" width="150"]Roy G. Geronemus, M.D.Director, Laser & Skin Surgery Center of New YorkClinical Professor of DermatologyNew York University Medical CenterNew York, NY 10016 Dr. Geronemus[/caption] Roy G. Geronemus, M.D. Director, Laser & Skin Surgery Center of New York Clinical Professor of Dermatology New York University Medical Center New York, NY 10016 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We made the observation in clinical practice that port wine stain birthmarks can be safely and effectively treated in early infancy without the need for general anesthesia. This observation is particularly important because of the FDA warnings regarding multiple exposures to general anesthesia under the age of 3 and the potential impact on neurocognitive development as these patients require multiple treatments.
Author Interviews, Dermatology, JAMA, NYU / 19.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46657" align="alignleft" width="200"]Nicholas A. Soter, MD The Ronald O. Perelman Department of Dermatology New York University School of Medicine New York, New York Dr. Nicholas Soter[/caption] Nicholas A. Soter, MD The Ronald O. Perelman Department of Dermatology New York University School of Medicine New York, New York MedicalResearch.com: What is the background for this study? Response: Nearly 50% of patients with chronic spontaneous urticarial (CSU) (hives) incompletely respond to first-line therapy with H-1 antihistamines. However, in the current literature, there is limited evidence to guide the treatment of CSU after maximal therapy with antihistamines fails.  Two small, randomized, controlled trials suggest that dapsone, which is an antimicrobial therapeutic agent with anti-inflammatory properties, may be a useful second-line therapeutic agent.
Author Interviews, Gastrointestinal Disease, NYU, Surgical Research, Weight Research / 10.10.2018

MedicalResearch.com Interview with: [caption id="attachment_45159" align="alignleft" width="160"]Violeta Popov, MD PhD FACG Assistant Professor of Medicine Director of Bariatric Endoscopy, NY VA Harbor Healthcare(Manhattan) Division of Gastroenterology NYU Langone Medical Center  Dr. Popov[/caption] Violeta Popov, MD PhD FACG Assistant Professor of Medicine Director of Bariatric Endoscopy, NY VA Harbor Healthcare(Manhattan) Division of Gastroenterology NYU Langone Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Bariatric surgery is the most effective method currently available for durable weight loss. In the first few months after surgery, patients typically experience significant weight loss. Rapid weight reduction though can lead to the development of gallstones and biliary disease, described in up to 40% of post-bariatric patients. To avoid these complications, the gallbladder was removed during open bariatric procedures in the past. However, with the advent of laparoscopic surgery, concomitant cholecystectomy with bariatric surgery is no longer performed for many reasons.  The aim of is study is to assess if biliary diseases such as acute pancreatitis, acute cholecystitis, acute cholangitis, and cholecystectomy have increased with this change in practice. This is a retrospective cohort analysis of the National Inpatient Sample (NIS), the largest publicly available inpatient database in the United States of nonfederal institutions, with approximately 1000 hospitals participating and information on over 7 million inpatient admissions. We found that from 2006 to 2014 there has been an approximately 10-fold increase in hospital admissions for biliary diseases, as well as similar increase in cholecystectomies, in patients who have a history of bariatric surgery. There was no significant change in admissions in patients without bariatric surgery between 2006 and 2014 admitted for the same biliary diseases. 
Author Interviews, Lung Cancer, Nature, NYU, Technology / 17.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44584" align="alignleft" width="142"]Aristotelis Tsirigos, Ph.D. Associate Professor of Pathology Director, Applied Bioinformatics Laboratories New York University School of Medicine Dr. Tsirigos[/caption] Aristotelis Tsirigos, Ph.D. Associate Professor of Pathology Director, Applied Bioinformatics Laboratories New York University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pathologists routinely examine slides made from tumor samples to diagnose cancer types. We studied whether an AI algorithm can achieve the same task with high accuracy. Indeed, we show that such an algorithm can achieve an accuracy of ~97%, slightly better than individual pathologists. In addition, we demonstrated that AI can be used to predict genes that are mutated in these tumors, a task that pathologists cannot do. Although the accuracy for some genes is as high as 86%, there is still room for improvement. This will come from collecting more training data and also from improvement in the annotations of the slides by expert pathologists.  
Author Interviews, Cost of Health Care, JAMA, Medicare, NYU, Prostate Cancer / 22.08.2018

MedicalResearch.com Interview with: [caption id="attachment_44063" align="alignleft" width="200"]Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York Dr. Makarov[/caption] Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement. In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer. We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA. Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.