Author Interviews, JAMA, Kidney Disease, Race/Ethnic Diversity, UCSF / 17.07.2021
MedicalResearch.com Interview with: Chi-yuan Hsu, MD, MSc (he/him/his) Professor and Division Chief Division of Nephrology University of California, San Francisco San Francisco, CA 94143-0532 MedicalResearch.com: What is the background for this study? Response: There has been a great deal of controversy recently about how race should be considered in medicine, including its use in estimating kidney function (e.g. https://jamanetwork.com/journals/jama/fullarticle/2769035). A recent paper published in JAMA Network Open by Zelnick et al suggested that removing the race coefficient improves the accuracy of estimating kidney function (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775076) in the Chronic Renal Insufficiency Cohort, a NIH-funded study (www.cristudy.org). We are core investigators of the Chronic Renal Insufficiency Cohort Study and were not involved in the Zelnick’s study that was based on a public use dataset. Because we were surprised by the methodological approach they took and the conclusion they came to, we implemented our own analysis of the data. (more…)
AHA Journals, Author Interviews, Obstructive Sleep Apnea, UCSF / 21.06.2021
MedicalResearch.com Interview with: Yerem Yeghiazarians, MD Professor of Medicine Leone-Perkins Family Endowed Chair in Cardiology San Francisco Board Past-President, American Heart Association Co-Director, Adult Cardiac Catheterization Laboratory Director, Peripheral Interventional Cardiology Program Director, Translational Cardiac Stem Cell Program Cardiovascular Research Institute Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research Associate Member in Experimental Therapeutics, UCSF Helen Diller Cancer Center University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea is very common, undiagnosed and undertreated. The AHA Scientific Statement was prepared to increase awareness amongst physicians and patients about this condition and to encourage more screening and therapy as appropriate. Obesity is certainly one of the significant risk factors for sleep apnea and we highlight this in the Scientific Statement: “The risk of OSA correlates with body mass index, and obesity remains the one major modifiable risk factor for OSA. In a population-based cohort study of 690 subjects, a 10% weight gain was associated with nearly 32% increase in the apnea-hypopnea index (AHI), and even modest weight control was effective in reducing the new occurrence of sleep-disordered breathing. An even stronger correlation exists between OSA and increased waist circumference and neck size. Neck sizes predisposing to OSA are usually >17 and 16 in for men and women, respectively.” (more…)
Anesthesiology, Author Interviews, Cognitive Issues, Heart Disease, JAMA, Surgical Research, UCSF / 22.05.2021
MedicalResearch.com Interview with: Elizabeth L. Whitlock, MD, MSc John W. Severinghaus Assistant Professor In Residence Anesthesia & Perioperative Care UCSF Medical Center MedicalResearch.com: What is the background for this study? Response: We have known for a while that, rarely, some older adults suffer substantial, durable cognitive decline after surgery, particularly after coronary artery bypass grafting (CABG) surgery; a larger proportion experience a decline in cognitive test performance which doesn't necessarily affect function, but which has caused concern among researchers. This cognitive decline was attributed, in part, to the cardiac bypass pump. Many of the studies had methodological limitations which made it difficult to be sure that the cognitive change was due to surgery and not due more generally to heart problems or atherosclerotic disease, which may also imply cerebrovascular atherosclerosis. Using a large database of older adults who undergo regular cognitive testing, we identified individuals who underwent CABG and compared them to those who underwent percutaneous coronary intervention (PCI), a minimally invasive, non-surgical method of opening blocked coronary arteries. This allowed us to model the rate of memory decline before surgery - which hadn't been done in previous studies - and compare it to the rate of memory decline after surgery in older adults who had serious heart disease (some of whom were treated with CABG, and some treated with PCI). (more…)
Author Interviews, Orthopedics, Radiology, Rheumatology, UCSF, Weight Research / 18.11.2020
MedicalResearch.com Interview with: Silvia Schirò MD Department of Radiology and Biomedical Imaging University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Knee osteoarthritis (OA) is worldwide the second most frequent cause of lower extremity disability, and it has a global incidence of 199 cases per 100.000, including over 14 million people with symptomatic knee OA in the US. Overweight and obese individuals have a higher incidence of knee OA due to excessive knee joint load. The association between physical activity and knee OA, has not been systematically addressed in overweight and/or obese subjects and its association seems to be controversial. On the one hand, mild to non-weight-bearing physical activities have been found to be beneficial in the management knee homeostasis, the physiologic knee joint load providing an optimized environment for the joint tissues. On the other hand, excessive fast-paced physical activity with high load-joint torsion such as racquet sports, ball sports and running have been found to have an increased incidence of knee injury compared to mild-moderate exercise such as swimming, bicycling and low-impact aerobics independent of body weight. (more…)
Author Interviews, Pediatrics, Pediatrics, Tobacco Research / 08.10.2020
MedicalResearch.com Interview with: Tsu-Shuan Wu University of California, San Francisco San Francisco, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study involves the associations of household rules and parental awareness with youth tobacco use using data from the Population Assessment Tobacco and Health Study. Health concerns regarding non-cigarette tobacco products, specifically e-cigarettes, have been on the rise. We wanted to explore whether parents are up to date with the trends of popular tobacco products today and what role they may play in youth tobacco cessation and prevention. The main findings of the study revealed that parents less often suspected their children’s tobacco use if their children reported using only e-cigarettes, and other non-cigarette tobacco products, when compared with cigarettes. Additionally, we found that youth who agreed with their parents that their home has strict rules for tobacco use were less likely to initiate of tobacco use compared to youth who had different understanding of the rules from their parents or youth from households with more permissive household rules. (more…)
Author Interviews, Heart Disease, JAMA, Lipids, Metabolic Syndrome, UCSF / 12.08.2020
MedicalResearch.com Interview with: Prakash Deedwania, MD, FACC,FAHA,FASH,FHFSA,FESC Professor of Medicine, UCSF School of Medicine, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: This paper describes the findings form the FOURIER study, a very large study evaluating the efficacy of evolocumab, a PCSK9 inhibitor in patients with metabolic syndrome and preexisting atherosclerotic cardiovascular disease (ASCVD) who were already being treated with statins. In this largest study of its kind of 27,000 patients we found that 60% of patients with ASCVD had metabolic syndrome. We also found that the presence of metabolic syndrome identified a higher risk of future cardiac & coronary events in these patients despite them receiving maximum tolerated doses of statin. Furthermore, study treatment with evolocumab was efficacious in reducing the increased risk during the median follow up of nearly 3 years . Unlike treatment with statins there was no risk of new-onset diabetes with evolocumab, which was generally well tolerated. What was interesting thatpatients without metabolic syndrome had much less benefit with PCSK9 inhibition. These findings suggest that the presence of metabolic syndrome can help the clinicians identify the ASCVD patients who are most likely to benefit from treatment with PCSK9 inhibitors. This will be of great help for the cost containment of therapeutic strategy as PCSK9 inhibitors as a class are still quite expensive drugs. (more…)
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Neurology, UCSF / 10.08.2020
MedicalResearch.com Interview with: Laure Rouch, PharmD PhD Department of Psychiatry Dr. Kristine Yaffe, MD (Senior Author) Departments of Psychiatry, Neurology, and Epidemiology University of California San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA MedicalResearch.com: What is the background for this study? Response: Worldwide, around 50 million people have dementia and this number is set to triple by 2050. Prevention of dementia and identification of potentially modifiable risk factors are, therefore, critically important. Postural changes in blood pressure increase with advancing age and affect 20% to 30% of older adults. Yet it has not been explored deeply how orthostatic hypotension and blood pressure postural changes variability over time are associated with dementia risk. As multiple pharmacologic and nonpharmacologic interventions may improve orthostatic symptoms, this question has major public health implications. (more…)
Author Interviews, JAMA, OBGYNE / 05.06.2020
MedicalResearch.com Interview with: Anjali Kaimal, MD, MAS, Maternal-Fetal Medicine Specialist Associate Professor in the Departments of Obstetrics Massachusetts General Hospital Miriam Kuppermann, PhD, MPH Professor Vice Chair Clinical and Translational Research Director Program for Clinical Perinatal UCSF MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reducing the rate of cesarean delivery is an important public health goal. Nearly one third (31.9%) of deliveries in the US are via cesarean, and dramatic increases in the cesarean rate since the 1990s have been associated with substantial increases in maternal morbidity. One of the reasons for the increased rate of cesarean delivery is the decreasing rate at which women attempt to have a vaginal birth after cesarean (VBAC). Although having a “trial of labor” (in the hopes of giving birth vaginally) after cesarean is safe, and many women say they would prefer a vaginal delivery, most women who have had a previous cesarean plan a scheduled repeat cesarean delivery. While some hospitals do not offer trial of labor after cesarean, even at institutions where this is an option. VBAC rates remain low. We created a patient-facing “decision tool” that provides detailed information on both trial of labor and scheduled repeat cesarean, a personalized risk assessment of the likelihood that the a trial of labor would end in a VBAC, and a series of values clarification exercises, to help women think through their options and engaged in informed, shared decision making with their providers. We then conducted a randomized study in three geographic areas (San Francisco, Boston, and Chicago) to determine whether use of the decision tool affected rates of trial of labor and vaginal birth after cesarean, as well as several aspects of decision quality (knowledge, shared decision making, decisional conflict, and decision satisfaction). (more…)
Accidents & Violence, Author Interviews, Brain Injury, JAMA, Pediatrics, UCSF / 08.01.2020
MedicalResearch.com Interview with: Benjamin N. Breyer MD, MAS, FACS Associate Professor Departments of Urology and Epidemiology and Biostatistics University of California, San Francisco Vice-Chair of Urology Chief of Urology, Zuckerberg San Francisco General Hospital and Trauma Center Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship MedicalResearch.com: What is the background for this study? Response: There has been a large increase in upright scooter usage among adults as a mode of transportation. It's convenient for commuters and may encourage greater use of public transit leading to less car traffic in cities. (more…)
Author Interviews, Heart Disease, Pediatrics, Smoking, UCSF / 23.09.2019
MedicalResearch.com Interview with: Gregory M Marcus, MD, MAS Professor of Medicine in Residence Endowed Professor in Atrial Fibrillation Research University of California, San Francisco Associate Chief of Cardiology for Research, UCSF Health University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Smoking remains the most common preventable cause of death and disability. We previously found evidence that tobacco smoke exposure in the young may lead to atrial fibrillation, the most common heart rhythm disturbance, later in life. Here we leveraged the multi-generational nature of the Framingham Heart Study to demonstrate that parental smoking was a risk factor for offspring atrial fibrillation. At least some of this relationship was explained by a greater propensity to smoke in offspring of smoking parents. These findings demonstrate a potentially new harmful effect of smoking pertinent to the most vulnerable population, our children. It also demonstrates how parental behaviors can have meaningful adverse consequences to their children decades later. (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, Electronic Records / 02.07.2019
MedicalResearch.com Interview with: Ming Tai-Seale, PhD, MPH Professor Department of Family Medicine and Public Health University of California San Diego School of Medicine MedicalResearch.com: What is the background for this study? Response: The electronic health record (EHR) potentially creates a 24/7 work environment for physicians. Its impact on physicians’ wellness has become a challenge for most health care delivery organizations. Understanding the relationships between physicians’ well-being and “desktop medicine”1 work in the EHR and work environment is critical if burnout is to be addressed more effectively. (more…)
Author Interviews, JAMA, Mental Health Research, Surgical Research, UCSF / 27.05.2019
MedicalResearch.com Interview with: Carter Lebares, MD Assistant Professor of Surgery Director, Center for Mindfulness in Surgery Department of Surgery, UCSF MedicalResearch.com: What is the background for this study? Response: This study was inspired by extensive evidence of the effectiveness of mindfulness-based interventions (MBIs) for mitigating stress and enhancing performance in other high-stress populations like police and the military. We know that overwhelming stress is related to burnout and to cognitive errors - two critical issues within surgery, today. This prompted us to tailor and streamline an MBI specifically for surgeons, and to test it in our trainees. (more…)
Author Interviews, Gender Differences, JAMA, Mental Health Research, UCSF / 31.01.2019
MedicalResearch.com Interview with: Christina Mangurian, MD MAS Professor Department of Psychiatry, Weill Institute for Neurosciences Center for Vulnerable Populations, University of California, San Francisco Veronica Yank, MD Assistant Professor Division of General Internal Medicine Department of Medicine University of California San Francisco MedicalResearch.com: What is the background for this study? Response: This article is about the behavioral health and burnout consequences among physician mothers who are caring for seriously ill loved ones. Our work was inspired, in part, by some of the authors’ own experiences caring for loved ones with serious illnesses while also being physician mothers themselves. We sought to determine the proportion of physician mothers with such caregiving responsibilities beyond their patients and children and the how these additional responsibilities affected the women’s health and practice. (more…)
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Kidney Disease, UCSF / 23.10.2018
MedicalResearch.com Interview with: Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center MedicalResearch.com: What is the background for this study?
- Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
- The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
- The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
- Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
- In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
- In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
- In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group.