Author Interviews, Global Health, Infections, Vaccine Studies / 24.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49864" align="alignleft" width="200"]CDC Image Based on electron microscopic (EM) imagery, this three-dimensional (3D) illustration provides a graphical representation of a single norovirus virion, set against a white background. Though subtle, the different colors represent different regions of the organism’s outer protein shell, or capsid. Illustrator: Alissa Eckert, MS CDC Image
Based on electron microscopic (EM) imagery, this three-dimensional (3D) illustration provides a graphical representation of a single norovirus virion, set against a white background. Though subtle, the different colors represent different regions of the organism’s outer protein shell, or capsid. Illustrator: Alissa Eckert, MS[/caption] Lisa Lindesmith, MS Research specialist Ralph S. Baric, PhD Professor, Departments of Epidemiology, Microbiology and Immunology Lineberger Comprehensive Cancer Center Gillings School of Global Public Health University of North Carolina MedicalResearch.com: What is the background for this study? Would you briefly explain the types of outbreaks caused by Norovirus infections? Response: Noroviruses cause about 20% of endemic and 50% of food-borne acute gastroenteritis, infecting all age groups, globally.  While may different strains of norovirus cause outbreaks primarily in community settings, since the mid-1990’s the GII.4 strains of norovirus have caused waves of pandemic disease every 2-7 years.  These pandemics are associated with emergence of a GII.4 strain that has changed key viral domains rendering the virus less susceptible to recognition by and protection from a person’s immune system.  For a vaccine to be efficacious against pandemic GII.4 strains, it must be able to train the immune system to focus on the part of the GII.4 virus that does not change over time.
Author Interviews, Compliance, Electronic Records, Lung Cancer, Race/Ethnic Diversity / 07.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47364" align="alignleft" width="200"]Samuel Cykert, MD Professor of Medicine and Director of the Program on Health and Clinical Informatics UNC School of Medicine, and Associate Director for Medical Education, NC AHEC Program Chapel Hill, NC Dr. Cykert[/caption] Samuel Cykert, MD Professor of Medicine and Director of the Program on Health and Clinical Informatics UNC School of Medicine, and Associate Director for Medical Education, NC AHEC Program Chapel Hill, NC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reports going as far back as the early 1990’s through reports published very recently show that Black patients with early stage, curable lung cancer are not treated with aggressive, curative treatments as often as White patients. These type of results have been shown in other cancers also. It’s particularly important for lung cancer because over 90% of these patients are  dead within 4 years if left untreated. In 2010, our group published a study in the Journal of the American Medical Association that showed that Black patients who had poor perceptions of communication (with their provider), who did not understand their prognosis with vs. without treatment, and who did not have a regular source of care ( a primary care doctor) were much less likely to get curative surgery. Also our results suggested that physicians who treated lung cancer seemed less willing to take the risk of aggressive treatments in treating Black patients (who they did not identify with as well) who had other significant illnesses. Because of the persisting disparities and our 2010 findings, we worked with a community group, the Greensboro Health Disparities Collaborative to consider potential solutions.  As these omissions were not overt or intentional because of race on the part of the patients or doctors, we came up with the idea that we needed transparency to shine light on treatment that wasn’t progressing and better communication to ensure that patients were deciding on good information and not acting on mistrust or false beliefs.  We also felt the need for accountability – the care teams needed to know how things were going with patients and they needed to know this according to race. To meet these specifications, we designed a system that received data from electronic health records about patients’ scheduled appointments and procedures. If a patient missed an appointment this umbrella system triggered a warning. When a warning was triggered, a nurse navigator trained specially on communication issues, re-engaged the patient to bring him/her back into care. In the system, we also programmed the timing of expected milestones in care, and if these treatment milestones were not reached in the designated time frame, a physician leader would re-engage the clinical team to consider the care options. Using this system that combined transparency through technology, essentially our real time warning registry, and humans who were accountable for the triggered warnings, care improved for both Black and White patients and the treatment disparity for Black patients was dramatically reduced. In terms of the numbers, at baseline, before the intervention, 79% of White patients completed treatment compared to 69% of Black patients. For the group who received the intervention, the rate of completed treatment for White patients was 95% and for Black patients 96.5%.