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MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
MedicalResearch.com:  Medical Research Interviews Month in Review
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MedicalResearch.com: Medical Research Interviews Month in Review

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MedicalResearch.com: Exclusive interviews with medical researchers from major and specialty medical journals.

MedicalResearch.com: Exclusive interviews with medical researchers from major and specialty medical journals.

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  • I have made treatment for all diabetes wound and it's work. the secret, the keratinocyte. very easy to take care of all diabetes complications. I did it.
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  • 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@Hemodialysis.com December 15 2013 For Informational Purposes Only: Not for Specific Medical Advice.
  • 2. Medical Disclaimer | Terms and Conditions • • • The contents of the Hemodialysis.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! If you think you may have a medical emergency, call your doctor or 911 immediately. Hemodialysis.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Hemodialysis.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is solely at your own risk. The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on Hemodialysis.com
  • 3. Elite Athletes Have Lower Risk of Later Life Diabetes MedicalResearch.com Interview with: Dr. Merja K. Laine Department of General Practice and Primary Health Care University of Helsinki • • • • • • • • • MedicalResearch.com: What is the background of your study? Answer: We were interesting to know does a top-level sport during young adulthood protect against disturbances in glucose regulation in later life. In Finland, a unique study program including former male elite athletes and their age- and area-matched controls already initiated in 1985. In 2008, we invited those subjects who participated in the study earlier and were still alive. MedicalResearch.com: What are the main findings of your study? Answer: According to our study findings, the elite athletes (especially endurance athletes: crosscountry skiing, long- distance running) had a significantly lower risk to type 2 diabetes and impaired glucose tolerance than the controls in later life. The volume of current self-reported leisure-time physical activity was inversely associated with the prevalence of type 2 diabetes. It is important to enable possibilities to physical exercise throughout the life course. Citation: A former career as a male elite athlete-does it protect against type 2 diabetes in later life? Laine MK, Eriksson JG, Kujala UM, Wasenius NS, Kaprio J, Bäckmand HM, Peltonen M, Mertsalmi TH, Sarna S. Department of General Practice and Primary Health Care, University of Helsinki, Tukholmankatu 8 B, PL 20, 00014, Helsinki, Finland, Diabetologia. 2013 Nov 21. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 4. ADHD: Using MRI to Measure Brain Iron MedicalResearch.com Interview with: Dr. Vitria Adisetiyo, Ph.D. Postdoctoral Research Fellow Medical University of South Carolina Center for Biomedical Imaging Charleston, SC 29425 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Adisetiyo: Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls. MedicalResearch.com: Were any of the findings unexpected? Dr. Adisetiyo: Although it is known that brain iron is required for dopamine metabolism, little is known about the mechanistic details. Thus, it was unexpected that our findings paralleled a recent meta-analysis of ADHD molecular imaging studies that identified reduced dopamine biomarkers in medication-naive ADHD patients and increased dopamine biomarkers in patients with a history of psychostimulant treatment. This suggests that brain iron levels may indirectly reflect the disrupted dopamine pathway in ADHD that is targeted by psychostimulant medication. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Adisetiyo: Although the findings remain preliminary and require replication in a larger longitudinal study, clinicians and patients should know that with the advent of improved technology, we are making progress in identifying promising non-invasive biomarkers of ADHD that may help inform traditional clinical diagnosis. These early findings suggest that low brain iron (and not blood iron) may represent a potential non-invasive ADHD diagnostic biomarker that responds to psychostimulant use. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Adisetiyo: Our report highlights the importance of accounting for medication history in studies that examine potential ADHD biomarkers as these biomarkers may adapt and change as a result of medication. Citation: Radiological Society of North America 2013 Abstract Medication Naïve Attention- deficit/Hyperactivity Disorder Subjects Have Low Brain Iron Levels as Detected by Magnetic Field Correlation Imaging Coauthors: F. Xavier Castellanos, M.D., Adriana Di Martino, M.D., Kevin M. Gray, M.D., Els Fieremans, Ph.D., Ali Tabesh, Ph.D., and Rachael L. Deardorff, M.S Read the rest of the interview on MedicalResearch.com
  • 5. Diabetes: Hyperglycemia Suppresses TGF, Contributing to Delayed Wound, Corneal Healing MedicalResearch.com Interview with: Fu-Shin X. Yu, Ph.D. Professor and Director of Research Kresge Eye Institute/Department of Ophthalmology Wayne State University School of Medicine Detroit, MI 48201 • • • • • • • • MedicalResearch.com: What are the main results of your study? Dr. Fu-Shin X. Yu: Using genome-wide cDNA array, we identified a large group of gene differentially expressed in healing corneal cells of diabetes mellitus, when compared to normoglycemia, corneas. Gene ontology analysis suggests transforming growth factor (TGFβ) signaling as a major signaling pathway affected by hyperglycemia in diabetes mellitus corneal epithelial cells. Surprisingly, we found that wound-induced upregulation of TGFβ3, but not TGFβ1, is dampened by hyperglycemia and that by adding TGFβ3 to the wound, epithelial wound closure was accelerated. This discovery may provide new treatment options for diabetic wound healing in tissues such as the cornea and the skin. Citation: Genome-wide transcriptional analysis of differentially expressed genes in diabetic, healing corneal epithelial cells: hyperglycemia-suppressed TGFβ3 expression contributes to the delay of epithelial wound healing in diabetic corneas Ilham Bettahi, Haijing Sun, Nan Gao, Feng Wang, Xiaofan Mi, Weiping Chen, Zuguo Liu, and Fu-Shin Yu Diabetes published ahead of print December 4, 2013, doi:10.2337/db13-1260 Read the rest of the interview on MedicalResearch.com
  • 6. ADHD: Environmental Risk Factors MedicalResearch.com Interview with: Professor Desiree Silva MB BS, FRACP, MPH Consultant Paediatrician Suite 210 Specialist Centre, Joondalup Health Campus 60 Shenton Avenue, Joondalup WA 6027 • • MedicalResearch.com: What are the main findings of the study? Prof. Silva: Our study is one of the largest population based studies of 12,991 children with ADHD. We found that smoking in pregnancy, maternal urinary infections, preeclampsia, being induced and threatened pre-term labour increases the risk of ADHD with little gender differences. Prematurity also increased the risk of ADHD including babies born late preterm and early term marginally increased the risk of ADHD. • • MedicalResearch.com: Were any of the findings unexpected? Prof. Silva: Oxytocin augmentation of labour appears protective for girls which is an unexpected finding and warrants further research. Oxytocin has recently received more interest in the literature, especially its role in social behaviour, although there still remain a number of unanswered questions about plausible mechanisms and actions. Contrary to other studies we found no increased risk for low birth weight, being born post term and low Apgar scores including fetal distress. The rare cord prolapse had nearly a three- fold increased risk of ADHD in females only. MedicalResearch.com: What should clinicians and patients take away from your report? Prof. Silva: There is a genetic predisposition to ADHD, as well as some evidence of environmental factors playing a part. Maternal smoking in pregnancy increased the risk of ADHD in their offspring. Females should be advised not to smoke in pregnancy. Attention to inflammatory processes like preeclampsia and urinary tract infections. Early inductions for no obstetric reason should be discouraged. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof. Silva: Future research on the risk of early inflammatory processes on ADHD which also include the early post natal period. Studies designed to disentangle possible mechanisms, confounders and/or moderators of these risk factors are warranted. Citation: Environmental Risk Factors by Gender Associated With Attention-Deficit/Hyperactivity Disorder Desiree Silva, Lyn Colvin, Erika Hagemann, and Carol Bower Pediatrics peds.2013-1434; published ahead of print December 2, 2013, doi:10.1542/peds.2013-1434 • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 7. Adolescent Girls: Early Puberty, Negative Peer Influence, and Problem Behaviors MedicalResearch.com Interview with: Sylvie Mrug, PhD Departments of Psychology and Health Behavior University of Alabama at Birmingham, Birmingham, Alabama; • • MedicalResearch.com: What are the main findings of the study? Dr. Mrug: Experiencing early puberty and having a best friend who misbehaves at age 11 both contribute to more aggressive and delinquent behavior in adolescent girls. Although most of these effects are transient and disappear by age 16, early maturing girls are at risk for continually higher delinquent behavior. Early puberty also seems to make girls more vulnerable to negative peer influences. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Mrug: Most of the main findings were not surprising, but it was somewhat unexpected that many of the effects of early puberty and friend’s problem behavior dissipated over the 5-year follow up period. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Mrug: First, the study shows that it may not be unusual for early maturing girls to show more problem behaviors in early adolescence, but that most of these problem behaviors will decrease over time. Second, the behavior of children’s and teens’ friends matters, and limiting friendships with peers who misbehave may help prevent problem behavior in the child. Third, girls who start puberty earlier than others are more vulnerable and may benefit from greater support and protection from their parents and other important people in their lives. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mrug: The findings indicate that it is important to evaluate the long-term effects of various risk factors for problem behavior, including early puberty and deviant friends. We also do not have solid understanding of why and how early puberty increases behavioral and emotional problems in girls, so more research on the mechanisms behind these effects is needed. • • • • • • • • • Citation: Early Puberty, Negative Peer Influence, and Problem Behaviors in Adolescent Girls Sylvie Mrug, Marc N. Elliott, Susan Davies, Susan R. Tortolero, Paula Cuccaro, and Mark A. Schuster Pediatrics peds.2013-0628; published ahead of print December 9, 2013, doi:10.1542/peds.2013-0628 Read the rest of the interview on MedicalResearch.com
  • 8. Medical Research: Men Received More Funding Than Women MedicalResearch.com Interview with: Mike Head Network Manager Infectious Disease Research Network • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: The differences in total funding received between male and female principal investigators (PIs) is considerable. This can be partially explained by there being far more male senior scientists than female. But this in itself is not ideal, and there are two further causes for concern: 1. The median award size – male PIs receive larger awards than female PIs, across virtually every topic area and type of science. 2. The differences in median award size and total funding awarded by gender remain virtually unchanged across the fourteen years of this dataset. The gap is not closing. MedicalResearch.com: Were any of the findings unexpected? Answer: The two findings above are perhaps unexpected, and certainly concerning. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: The topic is of less immediate relevance to patients; however, clinicians who do research should be involved in discussions to close the clear gender gap in research. There are roughly equal numbers of men and women as early career researchers, but it appears to be harder for women to reach senior positions where they are able to apply for their own funding. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We strongly urge policy-makers, funders and scientists to urgently investigate the factors leading to the observed differences and develop policies developed to address them, in order to ensure that women are appropriately supported in scientific endeavour. Excellent scientific minds are currently being lost to biomedical research, and this simply must be investigated. Citation: Differences in research funding for women scientists: a systematic comparison of UK investments in global infectious disease research during 1997–2010 Michael G Head, Joseph R Fitchett, Mary K Cooke, Fatima B Wurie, Rifat Atun BMJ Open 2013;3:12 e003362 doi:10.1136/bmjopen-2013-003362 Read the rest of the interview on MedicalResearch.com
  • 9. Hepatitis C: Does Chemotherapy Cause Viral Relapse? MedicalResearch.com Interview with: Harrys A. Torres, MD, FACP Assistant Professor, Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center • • MedicalResearch.com: What are the main findings of the study? Dr. Torres: The main findings of the study were that patients with hepatitis C virus (HCV) infection who were successfully treated with antivirals and attained sustained virologic response (SVR) did not have a relapse of HCV infection after receiving immunosuppressive chemotherapy for cancer. Patients in the study received different chemotherapeutic agents, including rituximab and systemic corticosteroids. Durability of SVR was maintained up to 14 years after chemotherapy in cancer patients. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Torres: The current data on the durability of SVR are conflicting. Researchers have detected HCV RNA in liver cells and peripheral blood mononuclear cells after achievement of SVR. In theory, administration of cancer chemotherapy should create an immunosuppressive state and facilitate replication of this occult HCV infection. However, none of our HCV-infected patients had a relapse of their infection after chemotherapy. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Torres: Our observational data suggests that successful treatment of HCV infection leads to eradication of virus without relapse after post-SVR chemotherapy. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Torres: A prospective study with a large sample size can be conducted in HCV-infected cancer patients who have attained SVR. Serial HCV RNA levels can be measured during and after chemotherapy to determine HCV relapse. Citation: Does Chemotherapy Cause Viral Relapse in Cancer Patients with Hepatitis C Infection Successfully Treated with Antivirals? Mahale P, Okhuysen PC, Torres HA. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas School of Public Health, Houston, Texas. Clin Gastroenterol Hepatol. 2013 Nov 7. pii: S1542-3565(13)01726-6. doi: 10.1016/j.cgh.2013.10.034. [Epub ahead of print] • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 10. Pediatric Liver Transplant Outcomes: Racial, Socioeconomic Disparities MedicalResearch.com Interview with: Rachel Patzer, PhD, MPH Assistant Professor Emory University School of Medicine Department of Surgery, Division of Transplantation • • MedicalResearch.com: What are the main findings of the study? Dr. Patzer: We found significant racial/ethnic differences in important health outcomes among pediatric and adolescent patients who received a liver transplantation at a large transplant center in the Southeastern U.S., where rates of mortality and graft failure were higher among minorities compared to white patients. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Patzer: We expected that poverty would play a role in poor health outcomes for patients, which we did find in this study. Poverty explained some of the racial disparities we observed. However, we found that even after accounting for differences in poverty among patients, we still found racial differences in outcomes. For example, we observed racial disparities even among patients who were wealthier or had better access to care. It is unclear why these racial/ethnic differences persist. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Patzer:We hope that clinicians recognize that identifying patients who are at high risk for poor health outcomes, including mortality and graft failure, is important in ensuring equitable and quality healthcare. Identifying patients who are at higher risk will allow for closer monitoring of these patients to prevent poor health outcomes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Patzer: The results of our study were from one large transplant center in the Southeast. It is unclear whether these disparities exist on a national level, but we expect that there is likely to be regional variation in disparities in outcomes among pediatric liver transplant recipients. We hope to examine this question using national data. In addition, more research is needed to identify the potential causes of racial/ethnic differences in outcomes, even after accounting for differences in poverty. Citation: Racial and Socioeconomic Disparities in Pediatric and Young Adult Liver Transplant Outcomes Thammana RV, Knechtle SJ, Romero R, Heffron TG, Daniels CT, Patzer RE. Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Department of Epidemiology, Atlanta, GA. Liver Transpl. 2013 Oct 17. doi: 10.1002/lt.23769. [Epub ahead of print] • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 11. Sexual Lifestyles Through Life Course: Attitudes Have Changed MedicalResearch.com Interview with: Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K. • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mercer: Firstly, the National Surveys of Sexual Attitudes and Lifestyles, Britain’s nationallyrepresentative surveys of sexual behaviour (or Natsal for short), have captured substantial changes in sexual attitudes and lifestyles over the past 60 years, having collected data from over 45,000 people born between the 1930s and the 1990s – a period spanning much of the 20th Century. Secondly, the recent changes in behaviour that we have observed – so over the past decade – have however been considerably more marked for women than men, with the gender gap in reported behaviour narrowing, and in some cases, disappearing altogether. Thirdly, we’ve seen a greater acceptance of more diverse sexual lifestyles, such as same-sex sexual partnerships, but greater intolerance of what many people might consider as ‘disrespectful’ sexual partnerships, including non-exclusivity in marriage. MedicalResearch.com: Were any of the findings unexpected? Dr. Mercer: Between 1990 and 2000, so between the first and second Natsal studies, we witnessed almost universal increases – among men and women – in the number of sexual partners reported, in the reporting of same-sex behaviours, as well as a number of STI/HIV risk behaviours such as paying for sex and having unsafe sex. However, between Natsal-2 and Natsal-3, so since 2000, the picture is less clear-cut (see response to next question). Read the rest of the interview on MedicalResearch.com
  • 12. Sexual Lifestyles Through Life Course: Attitudes Have Changed MedicalResearch.com Interview with: Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K. • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Mercer: While data from the latest Natsal study, Natsal-3, suggest that STI/HIV risk behaviours have not increased further since 2000, many have not declined, and so sexual health promotion messages, including encouraging safer sex and STI testing, remain a public health priority in Britain. Furthermore, from collecting data this time from people aged 16-74 years, we can see that sexual risk behaviour, although more prevalent among younger people, occurs throughout the lifecourse. Demographic trends such as increasing rates of partnership breakdown, and the new opportunities for people to meet and interact (e.g. via social media and the internet), mean that new sexual partnerships are formed at all ages, and so there is a need for protection from STIs, if not unplanned pregnancy, at all ages. However, sexual relationships, and sexual health more broadly, are not just about safe sex; as the other 5 papers in the Lancet series show, their focus needs to be broadened to promote informed, consensual, respectful, pleasurable, as well as safe, sexual relationships. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mercer: The scientific study of sexual behaviour needs to consider sex across the lifecourse, and to recognise that people have sexual health needs at all ages, although these needs may change. It is vital that population-based surveys of sexual behaviour continue in order that sexual health policy and practice – and public health policy and practice more broadly – are based on representative and reliable data. Although technological advances provide new opportunities for undertaking these studies, e.g. the use of computer-assisted self-interview, and the opportunities presented by web-surveys, consistent methods are essential to ensure that like can be compared to like, as this will ensure that there remains a strong evidencebase. Citation: Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal) Dr Catherine H Mercer PhD,Clare Tanton PhD,Philip Prah MSc,Bob Erens MA,Pam Sonnenberg PhD,Soazig Clifton BSc,Wendy Macdowall MSc,Ruth Lewis PhD,Nigel Field MBPhD,Jessica Datta MSc,Andrew J Copas PhD,Andrew Phelps BA,Prof Kaye Wellings FRCOG,Prof Anne M Johnson MD The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1781-1794 ) DOI: 10.1016/S0140-6736(13)62035-8 Read the rest of the interview on MedicalResearch.com
  • 13. Resistant Hypertension: Better Control With Therapeutic Drug Monitoring MedicalResearch.com Interview with; Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section, Cardiology Division UT Southwestern Medical Center • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Vongpatanasin: We found that more than 50% of patients with resistant hypertension were non-adherent to at least one drug prescribed by their primary care physicians for blood pressure control. When we provided this information back to the patients, as part of care in our hypertension specialty clinic, we found that many patients report difficulty taking prescribed medications due to either associated side effects or cost of the medication. When we adjusted patient’s medications to fit their needs, BP levels were substantially improved during subsequent visits without increasing the number of medications. MedicalResearch.com: Were any of the findings unexpected? Dr. Vongpatanasin: Yes, previous studies in the hypertension referral centers indicated that the prevalence of medication non-adherence is about 10%-20%. However, adherence was assessed by patient self-report or questionnaire, which may in fact underestimate the numbers. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Vongpatanasin: Non-adherence to medication is common in patients who appear to have resistant hypertension. Physicians caring for patients with resistant hypertension should be cognizant of the magnitude of the problem and maintain open communication with the patients to avoid factors that predispose to non-adherence, such as drug side effects or complex regimen with high co-payment. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Vongpatanasin: Therapeutic drug monitoring is a useful screening tool in clinical practice to uncover non- adherence in hypertension. This should be considered in patients with persistently elevated BP despite multiple medications. The cost effectiveness of therapeutic drug monitoring in improving adherence and BP in hypertensive patients in the primary care setting needs to be further tested in larger studies. Citation: Therapeutic drug monitoring facilitates blood pressure control in resistant hypertension Brinker S, Pandey A, Ayers C, et al. Therapeutic drug monitoring facilitates blood pressure control in resistant hypertension. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.10.067. Read the rest of the interview on MedicalResearch.com
  • 14. Sugar-Sweetened Beverages and Endometrial Cancer MedicalResearch.com Interview with: Maki Inoue-Choi, PhD, MS, RD Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institute on Minority Health and Health Disparities, NIH Rockville, MD 20850 • • MedicalResearch.com: What are the main findings of the study? Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Although we are the first to show this association, it is not surprising that women who drank more sugar-sweetened beverages had higher risk of type I endometrial cancer but not estrogen-independent type II endometrial cancer. Other studies have shown that the increasing consumption of sugar-sweetened beverages has paralleled the increase in obesity. Obese women are likely to have higher circulating levels of estrogens and insulin, which are known risk factors for type I endometrial cancer. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Although our study findings are interesting, we are the first to show the association between sugar-sweetened beverage consumption and the risk of endometrial cancer. Because ours is an observational study, it is not possible to establish a causal link between sugar-sweetened beverages and endometrial cancer. Therefore, our findings need to be replicated. Individuals should follow current dietary guidelines to avoid sugar-sweetened beverages. Too much added sugar from any source can elevate person’s overall calorie intake and may increase the risk of a number of health conditions such as obesity, diabetes, heart disease as well as cancer. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Because this study is the first to show the association between high sugar-sweetened beverage consumption and endometrial cancer, such findings may be due to chance and need replication in other studies. Citation: Cancer Epidemiol Biomarkers Prev. 2013 Nov 22. [Epub ahead of print] Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women. Inoue-Choi M, Robien K, Mariani A, Cerhan JR, Anderson KE. Authors’ Affiliations: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine; Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota; and Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, District of Columbia Cancer Epidemiology, Biomarkers & Prevention, November 2013 • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 15. Prostate Cancer: Potential Biological Factor Contributing to Racial Disparities MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 • • • • • MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 MedicalResearch.com: What are the main findings of the study? Dr. Turner: Our research has identified a potential mechanistic link between sugar derived metabolites and cancer associated pathways which may be a biological consequence of the socioeconomic and biological factors that are known to drive cancer health disparity. African Americans develop and die more frequently of cancer than any other population in the US. We examined the levels of reactive metabolites known as advanced glycation end-products, or AGEs for short, in serum and tumor samples from African American and Non-Hispanic White prostate cancer patients. In both the serum and tumor tissue, the levels of AGE metabolites were consistently higher in the African American prostate cancer patients than their White counterparts. AGE functions as a ligand for the receptor for AGEs, or RAGE for short. We also identified that RAGE protein levels were higher in African Americans with prostate cancer. MedicalResearch.com: Were any of the findings unexpected? Dr. Turner: AGEs are a consequence of normal metabolism and due to poor clearance accumulate within our tissues and organs as we grow older with pathogenic consequences. Low income, obesity and an inactive/sedentary lifestyle are established factors driving cancer health disparity. Significantly, apart from their production during normal metabolism, AGE’s are also formed through the ingestion of food and by external environmental factors such as lack of exercise. AGE content in the Western Diet has consistently increased over the last 50 years due to increased consumption of sugar laden and cheap processed/manufactured foods which are high in reactive AGE metabolites and can promote obesity. Due to the common links between the factors that drive health disparity and the increased accumulation of AGE metabolites we expected that AGEs may be higher in African Americans, what was unexpected was the particularly high levels of AGE metabolites observed in the prostate cancer tumor tissue. Read the rest of the interview on MedicalResearch.com
  • 16. Prostate Cancer: Potential Biological Factor Contributing to Racial Disparities MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Turner: These preliminary studies indicate that increased activation of the AGE-RAGE signaling axis may represent a biological mechanism promoting prostate cancer and cancer health disparity. This has significant connotations for community education and outreach. As AGE accumulation is linked to poor lifestyle choices such as poor diet and a lack of physical activity, small changes to our everyday habits may make a significant contribution to reducing how much AGE metabolite accumulates in our bodies. Avoiding foods high in protein, sugar and fat as well as manufactured foods can reduce our everyday intake of AGEs. Poaching foods rather than frying also reduces the number of AGEs we consume form food. Moderate regular exercise can also maintain and even reduce AGE accumulation levels. Clinicians should be aware of the potential impact of these factors on their patient population and address them as part of their clinic/practice MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Turner: This study needs to be repeated in a larger cohort of samples to confirm our findings. We also need to further examine the mechanistic consequence of AGE accumulation and AGERAGE signaling on cancer associated processes and the effects of existing and novel therapeutics on AGE metabolite levels. Potential Biological Factor Contributing to Racial Disparities in Prostate Cancer Presented at: Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9 2013 Read the rest of the interview on MedicalResearch.com
  • 17. Obesity: Sleep Quality, Anxiety-Depression, and Quality of Life MedicalResearch.com Interview with: Dr G. Neil Thomas, Regional Director, NIHR Research Design Service West Midlands Deputy Director, Master of Public Heath Programme Reader in Epidemiology Department of Public Health, Epidemiology and Biostatistics School of Health and Population Sciences
 College of Medical and Dental Sciences The University of Birmingham Edgbaston, Birmingham, B15 2TT • MedicalResearch.com: What are the main findings of the study? • Dr. Thomas: This population of severely obese individuals (mean BMI 47kg/m2) from a regional specialist weight management service poor sleep quality (Pittsburgh Sleep Quality Index, PSQI) and daytime sleepiness (Epworth Sleepiness Scale) were strongly associated with poorer quality of life (Impact of Quality of Life-Lite (IWQOL-Lite) • MedicalResearch.com: • ere any of the findings unexpected? • Dr. Thomas: The levels of problems in these patients was very high; 3/4 (74.8%) were poor sleepers (PSQI≥5), 52% were anxious (HADS-anxiety subscore>7) and 43% were depressed (HADS-depression subscore>7) which are much higher than in the UK general population (15-35%, 33%, and 11%, respectively), yet there was a clear association between the sleep problems such as short sleep duration and the psychological disorders and with the quality of life. These associations remained significant even after adjusting for a range of potential confounders. • • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Thomas: Despite the very high levels of problems in these patients, those involved with their care usually do not ask about sleep problems and often pay little heed to the psychological issues underlying the obesity. The focus is often on treating the obesity and its consequences, such as diet and exercise interventions, rather than addressing its underlying cause, which may be psychological in nature, such as an unhappy marriage, job stresses etc. • This may also in part contribute to the difficulty in maintaining weight loss if the drivers of the increasing adiposity are not removed it is unlikely that long term weight loss will be successful. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Thomas: There are issues of inferring causality in our study due to its cross-sectional nature in that the obesity may be leading to shorter sleep eg associated pains from joints, breathing disorders may disturb sleep leading to a shorter duration rather than the short sleep leading to increasing adiposity. Both approaches are possible, so we will need longitudinal data to help confirm the observations, those that have previously investigated this do support the contention that short sleep can contribute to the development of psychological conditions such as depression. That said, there is clearly an important problem in these patients that needs addressing. • Citation: • Araghi MH; Jagielski A; Neira I; Brown A; Higgs S; Thomas GN; Taheri S. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. SLEEP 2013;36(12):1859-1865. Read the rest of the interview on MedicalResearch.com
  • 18. Sleep disordered breathing as predictor of readmission and mortality MedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan • • • • • • • • • • • MedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan MedicalResearch.com: What are the main findings of the study? Dr. Kasai: Sleep disordered breathing, determined using predischarge nocturnal pulse oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kasai: They should know that before hospital discharge just a non-invasive assessment using quite simple device can be a predictor of patients’ post-discharge prognosis. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kasai: Interventions to alleviate intermittent hypoxia will be particularly important. So, in a future research, the effectiveness of positive airway pressure therapy including continuous positive airway pressure (CPAP) or adaptive servo ventilation (ASV) should be assessed and compared between CPAP and ASV. Citation: Impact of Pre-discharge Nocturnal Pulse Oximetry (Sleep-Disordered Breathing) on Post-discharge Clinical Outcomes in Hospitalized Patients with Left Ventricular Systolic Dysfunction after Acute Decompensated Heart Failure Takayasu Ohmura, Yoshitaka Iwama, Takatoshi Kasai, Takao Kato, Shoko Suda, Atsutoshi Takagi, Hiroyuki Daida The American Journal of Cardiology Available online 23 November 2013 (10.1016/j.amjcard.2013.10.048) Read the rest of the interview on MedicalResearch.com
  • 19. Probiotics Ineffective in Preventing Childhood Asthma MedicalResearch.com Interview with: Dr. Meghan Azad, PhD Banting Postdoctoral Fellow Department of Pediatrics University of Alberta • • MedicalResearch.com: What are the main findings of the study? Dr. Azad: In this study, our goal was to evaluate the clinical evidence for using probiotics (live “healthy bacteria”) to prevent childhood asthma. We reviewed the results of 20 clinical trials involving over 4000 infants, where probiotics were administered during pregnancy or the first year of life, and found no evidence to support the use of probiotics for asthma prevention. Children receiving probiotics were just as likely to develop asthma as children receiving placebo. Similarly, there was no effect of probiotic supplementation on the development of wheezing. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Azad: Yes, somewhat. We know that gut microbes help ‘educate’ the developing immune system, and that disruption of the gut microbiota is associated with allergic diseases (disorders of the immune system), including asthma. Using probiotcs to promote a healthy gut microbiota has therefore been proposed as a new strategy to prevent allergic disorders. In fact, there is good evidence that probiotics can prevent allergic eczema in young infants. However, our results show that – at least so far – probiotics are not effective in asthma prevention. Read the rest of the interview on MedicalResearch.com
  • 20. Probiotics Ineffective in Preventing Childhood Asthma MedicalResearch.com Interview with: Dr. Meghan Azad, PhD Banting Postdoctoral Fellow Department of Pediatrics University of Alberta • • • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Azad: Probiotics cannot be recommended for asthma prevention at this time. Of course, probiotics remain useful for other purposes (for example, they are beneficial for preventing bowel disease among premature infants), but there is currently insufficient evidence to recommend probiotics for asthma prevention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Azad: Our findings highlight the need for additional research. While there is currently insufficient evidence to recommend probiotics for asthma prevention, this strategy may still have potential. New studies are needed to address the following: First, we know relatively little about how probiotics work, and which ones are effective. It will be important to study the infant gut microbiota to better understand how gut microbes contribute to asthma development, in order to develop improved strategies for prevention. This is an objective of our research at the Canadian Healthy Infant Longitudinal Development (CHILD) Study (www.canadianchildstudy.ca). Second, studies have varied widely in the type, dose and duration of probiotic supplementation (among 20 trials, over 15 probiotic strains were tested, with a 1000-fold range in dose, administered for 1 to 24 months). It is possible that some strains are effective while others are not, or that a single strain may be effective with long-term, but not short-term supplementation. The dose may also be important. These issues need to be addressed in new basic and clinical studies. Third, most trials were not originally designed to detect asthma, so they did not follow the children long enough to accurately diagnose this condition. Asthma diagnosis is difficult before age 6, and only 5 of 20 trials conducted follow up beyond 6 years. This issue could be addressed by extended follow up of existing studies, or with new long-term trials. Finally, it is also worth exploring whether probiotics are particularly effective among specific patient groups. For example, one study found that probiotics were especially beneficial among infants delivered by cesarean section (who are known to have a disrupted gut microbiota). Infants receiving antibiotics may also stand to benefit, but more research is needed to establish whether targeting these specific patient groups would impact asthma development. Citation: Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and metaanalysis Azad MB ,Coneys JG ,Kozyrskyj AL ,Field CJ ,Ramsey CD ,Becker AB ,et al. Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis. BMJ 2013;347:f6471 Read the rest of the interview on MedicalResearch.com
  • 21. Diabetes Increases Risk of Stillbirth and Infant Death MedicalResearch.com Interview with: Mr Peter Tennant Research Associate (Epidemiology) Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX. • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: For women with type 1 or type 2 diabetes, the prevalence of stillbirth or late miscarriage (3%) was around four times greater than in women without the condition, while the risk of their infant dying during the first year of life (0.7%) was nearly twice as high. There was no difference in risk between women with type 1 or type 2 diabetes. A woman’s blood glucose concentration around the start of pregnancy, estimated from her glycated haemoglobin concentration (HbA1c), was the most important predictor of risk. The risk increased by 2% for each 1mmol/mol (0.1% in traditional DCCT units) increase in HbA1c above the target of 53mmol/mol (7%) recommended by the American Diabetes Association (ADA). If all the women in our study had achieved that ADA target before pregnancy, we estimate that around 40% of the stillbirths, late miscarriages, and infant deaths could have been avoided. MedicalResearch.com: Were any of the findings unexpected? Answer: We were quite surprised to find that the association between HbA1c around the start of pregnancy and the risk of stillbirth, late miscarriage or infant death followed a J-shaped pattern. For almost all women, any reduction in their blood glucose levels – even a small one – is likely to be good for their baby. However, our results also suggest that repeated episodes of severe hypoglycaemia may also be harmful. It was also surprising to see that the risk of stillbirth, late miscarriage, and infant death appeared to be halved in women who took folic acid supplements before pregnancy. We already know that folic acid reduces the risk of certain congenital anomalies, such as spina bifida or cleft lip, which is why women with diabetes are advised to take high-dose supplements of 5 milligrams daily. This finding suggests there may be additional benefits even for babies without these conditions. Finally, it was disappointing to see that there was no apparent reduction over time in the excess risk of stillbirth, late miscarriage, and infant death; especially considering that – with the right care – most women with diabetes can and will have a healthy baby. Read the rest of the interview on MedicalResearch.com
  • 22. Diabetes Increases Risk of Stillbirth and Infant Death MedicalResearch.com Interview with: Mr Peter Tennant Research Associate (Epidemiology) Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX. • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Any woman with type 1 or type 2 diabetes who is thinking of having a baby should seek advice, as early as possible, from their diabetes team, who can help them to improve their blood glucose control. Even if they can’t manage to achieve the target of 7%; any reduction in blood glucose concentration towards that level is likely to be good for their baby. All women with diabetes should also try to take 5mg of folic acid per day for at least three months before trying to get pregnant. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: In highly specialised settings, women with diabetes can be helped to achieve similar outcomes to those without the condition, one of the goals of the 1989 St Vincent Declaration. Our study shows that in the general population – of the North of England, at least – this goal appears no closer to becoming reality. The next step, therefore, is to try and understand and address whatever barriers are preventing women with diabetes from achieving an ideal preparation for pregnancy. Citation: Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study Peter W. G. Tennant, Svetlana V. Glinianaia, Rudy W. Bilous, Judith Rankin, Ruth Bell Diabetologia November 2013 10.1007/s00125-013-3108-5 Read the rest of the interview on MedicalResearch.com
  • 23. Multiple Births and Fertility Treatments MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women’s Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Kulkarni: Our study estimates the contribution of fertility treatments and natural conception to multiple births. Fertility treatments include IVF and non-IVF treatments. Non-IVF treatments primarily include ovulation induction and ovarian stimulation coupled with timed intercourse or intrauterine insemination (IUI). All estimated proportions were adjusted for maternal age which makes this study unique. The incidence of twin births nearly doubled and the incidence of triplet and higher-order births quadrupled over the last 4 decades. Our study estimates that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments, after adjusting for maternal age. After initial increase, the incidence of triplet and higher order births decreased by 29% from 1998 to 2011. The decrease in triplet and higher order births has coincided with a 70% reduction in the transfer of 3 or more embryos during IVF and a 33% decrease in the proportion of triplet and higher order births attributable to IVF. The decline in the number of embryos transferred during IVF became possible due to monitoring of ART treatments and outcomes and the work of professional societies, which have repeatedly revised practice guidelines to include recommendations for lowering the number of embryos transferred. In contrast, non-IVF fertility treatments of ovulation induction and ovarian stimulation are estimated to contribute the increasing number of multiple births. Hence there is a need for surveillance of births from non-IVF fertility treatments. MedicalResearch.com: Were any of the findings unexpected? Dr. Kulkarni: This study shows trends over the last 15 years of the effect of fertility treatments on multiple births. The findings show that a lot of progress has been made by reducing the number of embryos transferred during IVF treatments although there is a room for improvement by increasing single embryo transfers. Non-IVF treatments have been previously shown to be significant contributors to multiple births and this study reinforces those findings along with giving maternal age adjusted estimates. Read the rest of the interview on MedicalResearch.com
  • 24. Multiple Births and Fertility Treatments MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women’s Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kulkarni: If considering fertility treatment, understand the potential risk of multiple births. The risk of multiples due to IVF can be greatly minimized by transferring just one embryo. It is much more difficult to prevent multiple births resulting from ovulation induction and ovarian stimulation because of unpredictable ovarian follicular growth dynamics. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kulkarni: We need better understanding of the use of non-IVF fertility treatments in the United States (types of treatments, their effectiveness and safety). Consideration should be given to establishing a national registry collecting data on non-IVF fertility treatments. It would be useful to estimate the contribution of fertility treatments and natural conception to multiple births by state. Citation: Fertility Treatments and Multiple Births in the United States Aniket D. Kulkarni, M.B., B.S., M.P.H., Denise J. Jamieson, M.D., M.P.H., Howard W. Jones, Jr., M.D., Dmitry M. Kissin, M.D., M.P.H., Maria F. Gallo, Ph.D., Maurizio Macaluso, M.D., Dr.P.H., and Eli Y. Adashi, M.D. N Engl J Med 2013; 369:2218-2225 December 5, 2013 DOI: 10.1056/NEJMoa1301467 Read the rest of the interview on MedicalResearch.com
  • 25. Sexual function problems are common but distress about them much less so MedicalResearch.com Interview with: Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mitchell: We explored the distribution of sexual function in the British population using a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years. We measured sexual function using the Natsal-SF, a novel validated measure, which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life. Men and women in the oldest age groups surveyed (55 – 74) were more likely to have low overall sexual function than those in the youngest age group (16 – 24). After taking account of age differences, low sexual function was associated in both men and women with being unemployed, with current depression, and with poor general health. It was also associated with higher numbers of lifetime partners (women only), paying for sex (men only), and reporting same-sex partners, as well as with other aspects of sexual health, such as being diagnosed with an STI and experiencing sex against their will. Low sexual function was associated with relationship breakdown, and with people not being happy with their relationship. Within relationships, the most common problem was an imbalance in level of interest in sex between partners, which affected around a quarter of both men and women. Just under one in five men and women said their partner had experienced sexual difficulties in the last year, and this proportion increased with age, particularly among women. Lack of interest in sex was one of the most commonly reported problems for both men and women, affecting three in every twenty (15%) men, and with women twice as likely as men to say that this had been an issue in the last year. Difficulty reaching climax (16%) and vaginal dryness (13%) were among common problems for women; and reaching a climax more quickly than desired (15%), and difficulty getting or keeping an erection (13%) among men. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Mitchell: Sexual dissatisfaction and avoidance of sex were higher among those who did not have sex in the past year than among those who did, but we were surprised to find that the majority of individuals who had not had sex in the past year reported no distress or dissatisfaction and had not avoided sex because of sexual difficulties. This cautions against assuming that sexual inactivity is necessarily problematic. Read the rest of the interview on MedicalResearch.com
  • 26. Sexual function problems are common but distress about them much less so MedicalResearch.com Interview with: Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report?
 Dr. Mitchell: Sexual function is closely linked with other aspects of sexual health and with aspects of life stage and life events. It deserves to be given greater priority in sexual health policy. Sexual function problems are common but distress about them is much less so. Although 42% of men and 51% of women report one or more problem with sexual function lasting three months or more in the last year, only about 10% report being distressed about their sex life. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mitchell: In public health research and policy, sexual function tends to be overlooked as a component of sexual health. In future, we recommend greater efforts to include sexual function as an explanatory or outcome variable in epidemiological research. Sexual function could be included in quality of life measures or as an endpoint in studies assessing the success of sexual health interventions. Our data highlight the fact that we need to take account of the personal significance of sexual problems for men and women, and their partners. We hope that this study will encourage a move away from ways of measuring sexual function that over-medicalise sexual problems, towards one that takes into account the relationship in which they occur, and the level of personal dissatisfaction and distress they cause. Citation: Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Dr Kirstin R Mitchell PhD,Catherine H Mercer PhD,George B Ploubidis PhD,Kyle G Jones MSc,Jessica Datta MSc,Nigel Field MBPhD,Andrew J Copas PhD,Clare Tanton PhD,Bob Erens MA,Pam Sonnenberg PhD,Soazig Clifton BSc,Wendy Macdowall MSc,Andrew Phelps BA,Prof Anne M Johnson MD,Prof Kaye Wellings FRCOG The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1817-1829 ) DOI: 10.1016/S0140-6736(13)62366-1 Read the rest of the interview on MedicalResearch.com
  • 27. Medical Residents and Nurse Practitioners: Effects of Communication Skills Training MedicalResearch.com Interview with: J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104 • • MedicalResearch.com: What are the main findings of the study? Dr. Curtis: We examined the effect of a communication-skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes. The study was funded by the National Institutes of Nursing Research of the National Institutes of Heatlh. We conducted a randomized trial with 391 internal medicine and 81 nurse practitioner trainees at two universities. Participants were randomized to either an 8-session simulation-based, communication-skills intervention or to usual education. We collected outcome data from a large number of patients with life-limiting illness and their families, including 1866 patient ratings and 936 family ratings. The primary outcome was patient-reported quality of communication and, overall, this outcome did not change with the intervention. However, when we restricted our analyses to only patients who reported their own health status as poor, the intervention was associated with increased communication ratings. Much to our surprise, the intervention was associated with a small but significant increase in depression scores among post-intervention patients. Overall, this study demonstrates that among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education improved communication skills acquisition, but did not improve quality of communication about end-of-life care for all patients. However, the intervention was associated with improved patient ratings of communication for the sickest patients. Furthermore, the intervention was associated with a small increase in patients’ depressive symptoms, and this appeared most marked among patients of the first-year residents. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Curtis: Yes, the finding of increased depressive symptoms among patients of trainees who had received the intervention was a surprise. Although statistically significant, it is important to point out that this change was small and is less than the “minimal clinically important difference” on this scale. Nonetheless, it is possible that patients could experience depressive symptoms or feelings of sadness as a result of discussion about end-of-life care. Our finding that the increase in patients’ depressive symptoms was significantly greater for first-year residents suggests this increase might be associated with the skill level of the clinician having the discussion. Future studies should explore the effect of discussing end-of-life care on patients’ psychological symptoms and satisfaction with care and consider ways to mitigate negative effects while achieving the positive effects of these discussions. Read the rest of the interview on MedicalResearch.com
  • 28. Medical Residents and Nurse Practitioners: Effects of Communication Skills Training MedicalResearch.com Interview with: J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104 • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Curtis: We showed that simulation training improves communication skills, but we were not able to convincingly show the benefits with patient-reported outcomes. Our study suggests that patients and their families may not be sensitive raters of clinician communication because they don’t know what to expect from clinicians and suggests that some prompting or training may be necessary if patients and family members are to be able to identify improved communication. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Curtis: In an editorial about this article Drs. Jeffrey Chi and Abraham Verghese from Stanford University comment that this study “provides an important lesson in the nature of pedagogy in medicine: new and innovative ways are needed to teach skills, and continued measurement, reassessment, and validation are needed to determine if those teaching methods have been successful.” I agree with this assessment and believe this is an important area for future research. Citation: Curtis J, Back AL, Ford DW, et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients With Serious Illness: A Randomized Trial. JAMA. 2013;310(21):2271-2281. doi:10.1001/jama.2013.282081. Read the rest of the interview on MedicalResearch.com
  • 29. Medical School Minority Faculty Not Markedly Increased by Development Programs MedicalResearch.com Interview with: James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children’s Hospital of Philadelphia,Philadelphia, PA 19104 • • • MedicalResearch.com: What did the study attempt to address? Dr. Guevara: Medical schools have sought to build more diverse faculty in their institutions through faculty development programs targeted to underrepresented minority faculty members. This study was conduct by THE CHILDREN’S HOSPITAL OF PHILADELPHIA’S POLICYLAB and The University of Pennsylvania and sought to determine if there was an association between minority faculty development programs and the representation, recruitment, and promotion of underrepresented minority faculty. MedicalResearch.com: What are the main findings from the study? Dr. Guevara: The study was a secondary analysis of faculty-level data from the Association of American Medical Colleges linked to a national survey of medical schools. Findings indicated that there was only a modest increase from 6.8% to 8.0% in faculty from underrepresented minority backgrounds from 2000 to 2010. Schools with faculty development programs targeted to minority faculty members did not see an increase that was different from schools without such programs. However, schools with more intensive minority faculty development programs outperformed schools with less intensive programs. Read the rest of the interview on MedicalResearch.com
  • 30. Medical School Minority Faculty Not Markedly Increased by Development Programs MedicalResearch.com Interview with: James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children’s Hospital of Philadelphia,Philadelphia, PA 19104 • • • • • • • MedicalResearch.com: What are the implications of these findings for medical school administrators? Dr. Guevara: Building a diverse medical school faculty is no easy task and likely will require intensive faculty development programs targeted to minority faculty. Findings from this study suggest programs may need five or more years to mature and provide multiple components including mentoring, career development, social climate, and research support. MedicalResearch.com: What recommendations would you make for future research? Dr. Guevara: Since the findings are primarily observational, future research should examine the effect of minority faculty development programs using experimental designs with standardized measures of success such as publication and grant numbers. Citation: Minority Faculty Development Programs and Underrepresented Minority Faculty Representation at US Medical Schools Guevara JP, Adanga E, Avakame E, Carthon M. Minority Faculty Development Programs and Underrepresented Minority Faculty Representation at US Medical Schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116. Read the rest of the interview on MedicalResearch.com
  • 31. Antiretroviral Therapy: Survival Benefits in South Africa MedicalResearch.com Interview with: Michael D. April, MD, DPhil San Antonio Uniformed Services Health Education Consortium.Department Harvard Medical School The Medical Practice Evaluation Center • • • • MedicalResearch.com: What are the main findings of this study? Dr. April: Using a mathematical model, this study quantified the survival benefits associated with antiretroviral therapy to HIV-infected people in South Africa since 2004. Our results highlight the astounding benefits of treatment. In short, antiretroviral therapy has saved 2.8 million years of life in South Africa to date and is projected to save an additional 15.1 million years of life by 2030. MedicalResearch.com: What are the most important points or takeaway messages from these findings? Dr. April: The return on global investment in antiretroviral therapy has been impressive, but gains already achieved are merely the tip of the iceberg. Using very conservative estimates, our study projects that gains as of December 2011 comprise only 15.6% of the 17.9 million years of life to be saved by 2030 or 12.7% of the 21.7 million years of life projected to be saved over the lifetime of those patients currently receiving ART. What these estimates exclude is those who might benefit from ART in the future. As such, policy-makers have the power to magnify the future trajectory of survival gains further still by pursuing more aggressive HIV testing and treatment strategies. Increased case identification, early ART initiation and expanded treatment options might catapult our conservative survival projections even further. It is our hope that this study reminds stake-holders of the astounding efficacy of the global ART rollout while simultaneously invigorating efforts to redouble commitments toward expanding the availability of ART. Read the rest of the interview on MedicalResearch.com
  • 32. Antiretroviral Therapy: Survival Benefits in South Africa MedicalResearch.com Interview with: Michael D. April, MD, DPhil San Antonio Uniformed Services Health Education Consortium.Department Harvard Medical School The Medical Practice Evaluation Center • • • • • • • • MedicalResearch.com: What should clinicians, patients, and decision makers take away from your report? Dr. April: Significant capital and manpower have already been invested into the impressive ART rollout in South Africa and throughout the globe spanning from early 2004 to the present day. Our results are a testament to the return already realized on that investment. However, the real story here is less the years of life already saved but rather the hard-won establishment of an effective ART delivery system responsible for treatment of 1.4 million HIV-infected persons according to recent WHO estimates. Having already expended significant resources to meet the start-up costs to establish this system, these results highlight the devastating opportunity cost of cutting international commitments to ART in the name of fiscal austerity to avoid current upkeep costs. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. April: Our results suggest that rather than a debate over continuation of current funding commitments, policy-makers and resources should be examining strategies to expand testing and treatment efforts, so increasing future potential survival gains. We are not advocating a blanket approach as we realize these investments need to be made efficiently. Future studies need to best understand where these investments can produce the largest survival yield. Moreover, future survival gains will rise significantly if increasing numbers of patients continue to initiate ART each year, leading to further financing needs. Approaches to reduce these cost may include expansion of access to second-line ART through, negotiations with pharmaceutical companies, competitive price reductions, infrastructure improvement, and examining alternatives to promote economies scale. Our study also highlights where current defaults in the system might have attenuated survival to date and where more work needs to be done. Patients are often limited in their benefits realized because they are diagnosed too late; expanding case detection through more aggressive HIV testing by using rapid tests, mobile testing centers, or home-based testing models are areas meriting further research. Furthermore, mechanisms for effectively tracking monitoring HIV-infected patients not yet eligible for ART must be improved to minimize loss-to-follow-up of potential future ART recipients. Finally, research should continue to examine clinical utility and costeffectiveness of liberalizing ART eligibility criteria to maximize the number of HIV-infected persons benefiting from ART. Citation: The Survival Benefits of Antiretroviral Therapy in South Africa Michael D. April, Robin Wood, Bethany K. Berkowitz, A. David Paltiel, Xavier Anglaret, Elena Losina, Kenneth A. Freedberg, and Rochelle P. Walensky J Infect Dis. first published online December 3, 2013 doi:10.1093/infdis/jit584 Read the rest of the interview on MedicalResearch.com
  • 33. Alzheimer’s Disease: Connection with Rare Childhood Disorder MedicalResearch.com Interview with: Alessandra d’Azzo PhD Department of Genetics, St Jude Children’s Research Hospital 262 Danny Thomas Place, Memphis, Tennessee 38105 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. d’Azzo: We have discovered a connection between a rare childhood disorder and Alzheimer’s disease that usually affects older people. The culprit is a metabolic enzyme called NEU1 that normally controls the recycling or disposal of proteins in a specific cell compartment, the lysosome. When NEU1 is defective, children develop the severe metabolic disease, sialidosis. Our study suggests that NEU1 also plays an important role in the development of Alzheimer’s disease. Based on this discovery, we decided to increase NEU1 enzyme activity in the brain of an Alzheimer’s disease mouse model that shows features characteristic of the human disease, namely the accumulation of toxic protein aggregates or plaques. Remarkably, we could significantly diminish the number of plaques in the brain of these mice by increasing NEU1 enzyme activity. MedicalResearch.com: Were any of the findings unexpected? Dr. d’Azzo: These findings were totally unexpected because we were studying a pediatric disease that, as it turns out, presents signs of premature aging, mimicking a severe and widespread condition in older people like Alzheimer’s disease. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. d’Azzo: This is the first time the NEU1 enzyme has been linked to Alzheimer’s disease. We hope that these findings can generate better tools to diagnose the disease and maybe slow down or even reverse disease progression. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. d’Azzo: We hope that these findings will propel Alzheimer’s disease research into areas that were not explored before, opening new avenues for the prevention or treatment of this devastating disease. Citation: Lysosomal NEU1 deficiency affects amyloid precursor protein levels and amyloid-β secretion via deregulated lysosomal exocytosis Ida Annunziata, Annette Patterson, Danielle Helton, Huimin Hu, Simon Moshiach, Elida Gomero, Ralph Nixon, Alessandra d’Azzo Nature Communications 4, doi:10.1038/ncomms3734 November 14 2013 Read the rest of the interview on MedicalResearch.com
  • 34. Biphasic Allergic Reactions in ER Patients MedicalResearch.com Interview with: Brian Grunau MD Emergency Physician, St. Paul’s Hospital Clinical Assistant Professor, UBC Department of Emergency Medicine • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Grunau: Among 2819 consecutive Emergency Department visits of patients with allergic reactions or anaphylaxis, five clinically important biphasic reactions were identified (0.18%; 95% confidence interval [CI] 0.07% to 0.44%), with two occurring during the ED visit and three post-discharge. There were no fatalities. When examining patients who satisfied the definition for anaphylaxis and those who did not separately, clinically important biphasic reactions occurred in 2 patients (0.40%; 95% CI 0.07% to 1.6%) and 3 patients (0.13%; 95% CI 0.03% to 0.41%), respectively. MedicalResearch.com: Were any of the findings unexpected? Dr. Grunau: We expected to identify biphasic reactions in the anaphylaxis group and that the incidence would be low. We did not, however, expect to identify biphasic reactions in the patients who did not satisfy the definition for anaphylaxis on the index visit. We also did not expect to identify biphasic reactions which occurred many days after the index visit (the longest duration was 143 hours). MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Grunau: Biphasic reactions are rare, however do occur and may take place many hours or days after the index visit. Patients in our cohort who had a biphasic reaction after ED discharge appropriately presented back to the ED for treatment and there were no deaths. Extended monitoring (for example, over four hours) after ED treatment appears to be unnecessary for the majority of patients whose symptoms have resolved. A careful discussion on when to return to the ED and the importance of an epinephrine autoinjector, however, is essential before discharge. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Grunau: A prospective blinded randomized study examining the efficacy of various ED treatments in preventing biphasic reactions would be ideal, however with such a low incidence of reactions an extremely large sample size would be required. Citation: Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients With Allergic Reactions or Anaphylaxis Brian E. Grunau, Jennifer Li, Tae Won Yi, Robert Stenstrom, Eric Grafstein, Matthew O. Wiens, R. Robert Schellenberg, Frank Xavier Scheuermeyer Annals of Emergency Medicine – 18 November 2013 (10.1016/j.annemergmed.2013.10.017) Read the rest of the interview on MedicalResearch.com
  • 35. Fentanyl for Pain: Intranasal Use in the Out-of-Hospital Setting MedicalResearch.com Interview with: Dr. Morten Sejer Hansen Department of Anaesthesia 4231 Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Out-of-hospital administration of intranasal fentanyl in doses of 50 and 100 microgram appears to be safe and well tolerated, with a low incidence of side effects Secondly, intranasal fentanyl appeared effective in a wide range of patients, although no firm conclusions on analgesic efficacy can be provided due to the lack of a placebo control. MedicalResearch.com: Were any of the findings unexpected? Answer: The low frequency of side effects, with no serious adverse events, was an uplifting result, considering the ambiguous safety profile provided by earlier studies where the frequency of adverse events varied from 3.3% to 39%. Likewise the applicability of intranasal fentanyl in the pediatric (age > 8 years and/or weight >30 kg) out-of-hospital population MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Intranasal fentanyl appears to be a safe and well-tolerated out-of-hospital analgesic in a wide range of patients. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future studies are needed in order to establish a safety profile for rare adverse events. Furthermore, in order to validate the analgesic efficacy of intranasal fentanyl as an out-of-hospital analgesic, future placebo controlled randomized trials are needed. Citation: Safety of Intranasal Fentanyl in the Out-of-Hospital Setting: A Prospective Observational Study Anders P.H. Karlsen, Danny M.B. Pedersen, Sven Trautner, Jørgen B. Dahl, Morten S. Hansen Annals of Emergency Medicine – 25 November 2013 (10.1016/j.annemergmed.2013.10.025) Read the rest of the interview on MedicalResearch.com
  • 36. PTSD and Medication Non-Adherence MedicalResearch.com Interview with: Ian Kronish, MD, MPH Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Division of General Medicine Columbia University Medical Center • • • MedicalResearch.com: What are the main findings of the study? Dr. Kronish: Among primary care patients with persistently uncontrolled blood pressure despite medication treatment, we found that medication non-adherence was more than twice as common in patients with PTSD (68%) as compared to patients without PTSD (26%). The association between PTSD and medication non-adherence remained present after adjustment for key covariates including regimen complexity and depression. Recent research shows that PTSD not only contributes to psychological distress, but is also associated with increased risk for incident and recurrent cardiovascular disease. The data from our study suggest that medication non-adherence may be an important mechanism by which PTSD increases risk for cardiovascular disease. MedicalResearch.com: Were any of the findings unexpected? Dr. Kronish: While the overall prevalence of non-adherence to blood pressure medications in our sample (41% were non-adherent defined as taking <80% of their antihypertensive doses as prescribed) was typical of other studies, we were surprised that non-adherence to blood pressure medications was so prevalent among patients with PTSD. We were also surprised that the association between PTSD and non-adherence did not appear to be weakened by including depression in the multivariable model. Read the rest of the interview on MedicalResearch.com
  • 37. PTSD and Medication Non-Adherence MedicalResearch.com Interview with: Ian Kronish, MD, MPH Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Division of General Medicine Columbia University Medical Center • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kronish: PTSD is common in medical settings, and unfortunately, often goes unrecognized. Clinicians who are aware of significant PTSD symptoms in their patients should carefully assess medication adherence, particularly if their patients are not reaching goals for risk factor control. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kronish: This study was conducted in a single primary care clinic that serves an inner-city, economically vulnerable community. Future research should confirm the association between PTSD and medication non-adherence in other study populations. Future research should also seek to understand which aspects of PTSD lead to non-adherence. We hypothesize that patients with PTSD may be avoidant of stimuli that remind them of their own mortality and this avoidance may lead them to miss important life-preserving cardiovascular medications such as antihypertensives. Future studies should also examine whether nonadherence is an important mediator of the association between PTSD and increased cardiovascular risk. Finally, future research should consider the risks and benefits of screening for PTSD in primary care; if increased awareness of PTSD can help with the identification of patients who will benefit from adherence monitoring and improvement interventions, then there may be an increased benefit to PTSD screening. Citation: Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension Kronish IM, Lin JJ, Cohen BE, Voils CI, Edmondson D. Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.12881. Read the rest of the interview on MedicalResearch.com
  • 38. Beside Nursing Handover: Patients’ Views MedicalResearch.com Interview with: Dr. Lianne Jeffs PhD Nurse and researcher at St. Michael’s Hospital University of Toronto • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Jeffs: The main findings of the study include: 1. Patients described the bedside nursing handover as engaging, personal and informative. The bedside nursing handover created a a space to connect with their nurses in a more personal manner (e.g., provided an introduction between patient and nurse at the beginning of the shift) 2. Patients found the experience increased their engagement in their own care, and kept them informed about their health status and care plan. It also gave the patient an opportunity to identify important needs to the nurse (e.g., daily activities) 3. Not all patients wanted to participate in the bedside nursing handover. This was typically exemplified by long-term-stay patients. MedicalResearch.com: Were any of the findings unexpected? Dr. Jeffs: Our findings were consistent with other studies found in the body of literature on this topic. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Jeffs: Bedside nurse handover is beneficial to both clinicians and patients as they improve and strengthen communication between both parties; reduce errors (e.g., medication) and strengthen the concept of patient centred care. It is important to note that some patients may not want to participate in this type of handover and their preference should be acknowledged and accepted. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Jeffs: Future research would look at pre and post implementation of the intervention in regards to patient satisfaction and medication errors. Citation: Patients’ Views on Bedside Nursing Handover: Creating a Space to Connect J Nurs Care Qual. 2013 Nov 18. [Epub ahead of print] Jeffs L, Beswick S, Acott A, Simpson E, Cardoso R, Campbell H, Irwin T. St. Michael’s Hospital (Drs Jeffs and Cardoso and Mss Beswick, Acott, Simpson, Campbell, and Irwin) Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation, University of Toronto (Dr Jeffs), Toronto, Ontario, Canada. Read the rest of the interview on MedicalResearch.com
  • 39. Stem Cells: Generating Lung Cells from PluriPotent Stem Cells MedicalResearch.com Interview with: Hans-Willem Snoeck MD, PhD Columbia University Medical Center • • • MedicalResearch.com: What are the main findings of the study? Dr. Snoeck: We were, for the first time, able to differentiate human embryonic stem cells and induced pluripotent stem cells into at least 6 different types of lung and airway epithelial cells. Furthermore, we could demonstrate function of surfactant-producing type II alveolar epithelial cells, and the lung progenitors we generated could generate airway after transplantation under the kidney capsule of immunodeficient mice. MedicalResearch.com: Were any of the findings unexpected? Dr. Snoeck: Differentiation of ES and iPS cells into various cell types of other organs has been relatively successful. Differentiation into lung and airway has been very challenging. We used paradigms from mouse lung development as a guide to differentiation of human stem cells. We also found however that certain signaling pathways required for lung development in the mouse appear redundant in the human system. On the other hand, manipulation of other signaling pathways was essential for human differentiation, while studies in mouse development have not shown evidence for this requirement. Read the rest of the interview on MedicalResearch.com
  • 40. Stem Cells: Generating Lung Cells from PluriPotent Stem Cells MedicalResearch.com Interview with: Hans-Willem Snoeck MD, PhD Columbia University Medical Center • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Snoeck: It will now be possible to model at least some human lung diseases in the laboratory. This will then hopefully lead to strategies to screen for drugs that might treat these diseases. One example is idiopathic lung fibrosis, a disease where the aforementioned type II alveolar epithelial cells are believed to play a major role, but of which the pathogenesis or disease mechanism is not understood. This disease yearly kills 40,000 people in the US, and there is no curative treatment, except for lung transplantation, which carries a high mortality from transplant-related complications. In addition, this work may allow the development of autologous (the patient’s own) lungs for transplantation. This approach involves harvesting lungs from donors, removing all of the donor’s cells, and replacing those with stem cells derived from the patient. This would alleviate rejection problems. This application is still far away, but this work is a first and critical step in this direction. Finally, this work will shed light on human lung development, and on a number of congenital diseases affecting lung and airways. Examples are tracheo-esophagal fistulas and tracheal atresia. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Snoeck: Future research should focus on disease modeling and drug discovery, and on strategies to seed lung scaffolds with iPS-derived lung and airway epithelial cells. Questions that will arise in this area are, for example: how do we generate the adult stem cells that endow a lung with regenerative capacity after damage, how will cells home to their correct location in the lung, and how will we ensure that cilia will coordinately beat in the correct direction to allow removal of mucus and debris from the lung, and how can we scale up this system to generate sufficient numbers of cells for a human lung. Furthermore, we also need to determine to what extent the cells we generated are fully mature (in an adult as opposed to a late fetal stage of development), and how we can mature these further if needed. Citation: Efficient generation of airway and lung epithelial cells from human pluripotent stem cells Sarah X L Huang, Mohammad Naimul Islam, John O’Neill, Zheng Hu, Yong-Guang Yang, Ya-Wen Chen,Melanie Mumau,Michael D Green, Gordana Vunjak-Novakovic, Jahar Bhattacharya & Hans-Willem Snoeck Nature Biotechnology (2013)doi:10.1038/nbt.2754 Received 14 August 2013 Accepted 30 October 2013 Published online 01 December 2013 Read the rest of the interview on MedicalResearch.com
  • 41. Health Effects on Sex Life MedicalResearch.com Interview with: Dr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UK • • • • • MedicalResearch.com: What are the main findings of the study?
 Dr. Field: This study, published in The Lancet on Tuesday 26 November, reports data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal), interviewing over 15,000 participants aged 16-74 years, to systematically assess the association between people’s health and their sexual lifestyles in Britain. The key findings from the study are that close to one in six (17%) of men and women feel that their health had affected their sex life in the past year. This rises to three fifths (60%) among men and women who say that they are in bad health. However, only a quarter of men (24%) and under a fifth of women (18%) who say that ill-health affects their sex life had sought help from a health profession, usually a family doctor. The also study shows that the proportion of people who had recently had sex (within the past four weeks) declined with age, and was lower among those who reported being in bad health, compared to those who reported being in very good health. The association remained after adjustment to account for age and whether participants were in a relationship. We also found that lower levels of satisfaction were associated with poorer health, with the association again remaining after adjustment for age and relationship status. Even though the overall results show a clear association between ill-health and individual’s sex lives, we note that many people in bad health reported being sexually active and/or satisfied. About one third of participants reported recent sexual activity and just under half of the same group were satisfied with their sex lives. MedicalResearch.com: Were any of the findings unexpected? Dr. Field: For the first time, we asked people whether they feel that their health affects their sex lives, and our findings indicate that many patients in chronic ill-health are well aware of an effect on their sex lives. Yet few of these people had sought help from health professionals about sexual problems.
 Read the rest of the interview on MedicalResearch.com
  • 42. Health Effects on Sex Life MedicalResearch.com Interview with: Dr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UK • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Field: Our study suggests that sexual lifestyles are strongly linked to overall health and wellbeing. However, most people reporting a health condition affecting their sex life had not sought clinical advice. There may be barriers on both sides, with patients sometimes unwilling to discuss problems, and health professionals sometimes lacking sufficient awareness and training about advising and communication with patients about sexual problems. For clinicians, this study suggests that assessments of sexual health should form part of a holistic approach to care of patients at all ages with chronic ill health. For patients, while the study shows that many people in bad health report being sexually active and/or satisfied with their sex life, it also suggests that concerns about the effect of people’s health on their sex lives are common. Patients might benefit from discussing these concerns with their doctor. Citation: Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Dr Nigel Field MBPhD,Catherine H Mercer PhD,Pam Sonnenberg PhD,Clare Tanton PhD,Soazig Clifton BSc,Kirstin R Mitchell PhD,Bob Erens MA,Wendy Macdowall MSc,Prof Frederick Wu FRCP,Jessica Datta MSc,Kyle G Jones MSc,Amy Stevens BSc,Philip Prah MSc,Andrew J Copas PhD,Andrew Phelps BA,Prof Kaye Wellings FRCOG,Prof Anne M Johnson MD The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1830-1844 ) DOI: 10.1016/S0140-6736(13)62222-9 Read the rest of the interview on MedicalResearch.com
  • 43. Autism Risk: Antidepressant Exposure in Pregnancy? MedicalResearch.com Interview with: Jakob Christensen Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Merete Juul Sørensen Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Denmark • • MedicalResearch.com: What are the main findings of the study? Answer: We found that the risk of autism spectrum disorder was increased by 50% in children of mothers who took antidepressants during pregnancy. However, when we controlled for other factors related to the medication, by comparing with children of mothers with a diagnosis of depression or with un-exposed siblings, the risk was smaller and not significantly increased. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Previous studies have found increased risk of autism spectrum disorder in children of women who took antidepressant medication during pregnancy. We could not find that, when we took into account the disorder in the mother. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Even though there may be risks associated with use of antidepressant medication during pregnancy, the specific risk of autism spectrum disorder may be partly or completely explained by factors other than the medication itself. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future research should aim to study possible risks in individaul antidepressant drugs in order to inform decision making in treating pregnant women with depression. Citation: Antidepressant exposure in pregnancy and risk of autism spectrum disorders Merete Juul Sørensen,Therese Koops Grønborg,Jakob Christensen, Erik Thorlund Parner, Mogens Vestergaard,Diana Schendel, Lars Henning Pedersen • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 44. High Fat Diet: Pubertal Effect on Breast Cancer Development MedicalResearch.com Interview with: Richard Schwartz, Ph.D. Professor, Associate Dean for Graduate Academic and Student Affairs College of Natural Science Michigan State University Department of Microbiology and Molecular Genetics Michigan State University East Lansing, MI 48824-4320 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Schwartz: The main finding is that exposure to a high fat diet from the age of puberty onwards hastened the development of chemical carcinogen-induced breast cancer in absence of weight gain. We also found that prior to the appearance of any tumors, we could detect changes in the mammary gland that included increased cellular proliferation, increased vascularity, and changes in immune function. MedicalResearch.com: Were any of the findings unexpected? Dr. Schwartz: The biggest surprise was the magnitude of the effect. The median time of occurrence of tumors was reduced by about 3 months in the mice tested. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schwartz: We already know that an extreme high fat diet and consequent obesity (in our experiments we used lard, saturated animal fat) has negative consequences for heart disease and diabetes. This adds another potential negative consequence of such a diet, even perhaps for those who do not gain weight. These studies give another reason to avoid excessive fat in our diets. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Schwartz: The directions for future research are many. 1. What are the consequences of exposure to a high fat diet at various life stages? We have preliminary data that puberty is a critical period. 2. What are the effects of various kinds of fats? And how do they interact with various carcinogenic agents? 3. Are the early occurring proliferative, vascular, and immune function perturbations observed in our experimental system causally linked to the development of breast cancer? Citation: Pubertal high fat diet: effects on mammary cancer development. Zhao Y, Tan YS, Aupperlee MD, Langohr IM, Kirk EL, Troester MA, Schwartz RC, Haslam SZ. Breast Cancer Res. 2013 Oct 25;15(5):R100. [Epub ahead of print] PMID: 24156623 PubMed – as supplied by publisher] Read the rest of the interview on MedicalResearch.com
  • 45. Menopause: Effects of Sex Hormones on Cognition and Mood MedicalResearch.com Interview with: Dr. Victor W. Henderson MD Professor of Health Research and Policy and of Neurology and Neurological Sciences Stanford University, Stanford, CA 94305 • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Henderson: Estrogen or hormone therapy effects on some health outcomes differ by age, harmful at one age and beneficial at another. This difference is sometimes referred to as the “critical window” or “timing” theory. It is controversial whether the so-called critical-window applies to memory or other cognitive skills. In assessing the critical window hypothesis, we found that the relation between blood levels of estrogen and memory or reasoning skills is the same in younger postmenopausal women as in older postmenopausal women. Essentially, there is no association at either age. MedicalResearch.com: Were any of the findings unexpected? Dr. Henderson: Our findings for estradiol were different from what we had predicted from the critical window hypothesis, and from other studies that suggest there should be a relation between blood levels of estradiol and memory. Read the rest of the interview on MedicalResearch.com
  • 46. Menopause: Effects of Sex Hormones on Cognition and Mood MedicalResearch.com Interview with: Dr. Victor W. Henderson MD Professor of Health Research and Policy and of Neurology and Neurological Sciences Stanford University, Stanford, CA 94305 • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Henderson: Our research did not look directly at effects of hormone therapy, but the findings seem to imply that there is no reason for younger postmenopausal women to rush into hormone therapy with the goal of improving memory or enhancing reasoning abilities. Conversely, the these results imply there is no reason to avoid hormone therapy solely because of concerns about impairing memory or reasoning. Clearer answers will be available when results of two large, recently completed hormone therapy trials are analyzed and published. One of these, the KEEPS trial, looked only at younger postmenopausal women. The other, the ELITE trial, compared effects of hormone therapy in younger and older postmenopausal women. KEEPS data have been analyzed but not yet published. ELITE data are in the process of being analyzed. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Henderson: The most important recommendation is to see what KEEPS and ELITE trials reveal about hormone therapy effects in younger postmenopausal women. Also, in younger postmenopausal women, our analyses suggested a positive relation between blood levels of progesterone, a different sex steroid hormone, and memory and global cognition. However, we did not predict the progesterone association ahead of time, so I am a bit more concerned that this might still be a chance finding. Very few human studies have considered progesterone effects on cognition in this age group. I think results should first be replicated before perhaps moving on to consider potential clinical implications. Citation: Victor W. Henderson, Jan A. St. John, Howard N. Hodis, Carol A. McCleary, Frank Z. Stanczyk, Roksana Karim, Donna Shoupe, Naoko Kono, Laurie Dustin, Hooman Allayee, and Wendy J. Mack Cognition, mood, and physiological concentrations of sex hormones in the early and late postmenopause PNAS 2013 ; published ahead of print November 25, 2013, doi:10.1073/pnas.1312353110 Read the rest of the interview on MedicalResearch.com
  • 47. Crohn’s Disease: Thalidomide in Refractory Pediatric Disease MedicalResearch.com Interview with Marzia Lazzerini, PhD Institute for Maternal and Child Health IRCCS “Burlo Garofolo,” Trieste, Italy • • MedicalResearch.com: What are the main findings of the study? Answer: In children and adolescent with Crohn’s disease refractory to first and second line treatment, thalidomide was effective in inducing and maintaining clinical remission. About 60% of children achieved clinical remission, and clinical remission was maintained for a mean time of 180 weeks. The main reason to stop thalidomide was peripheral neuropathy. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Thalidomide was effective in inducing remission also in children with previous failure to infliximab. • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: The take home message for clinicians is that thalidomide may be considered as a therapeutic option for cases of Crohn’s diseases resistant or intolerant to first and second line treatments. • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: More studies are needed to investigate safety of thalidomide in children. Other interesting questions include: genetic factors involved in thalidomide effects ( both positive and negative effects); dose comparison studies to explore the ideal treatment scheme; the safety and effectiveness of thalidomide in comparison to other existing treatment; treatment in combination with other therapies, and others. Citation: Effect of Thalidomide on Clinical Remission in Children and Adolescents With Refractory Crohn Disease Lazzerini M, Martelossi S, Magazzù G, et al. Effect of Thalidomide on Clinical Remission in Children and Adolescents With Refractory Crohn Disease: A Randomized Clinical Trial. JAMA. 2013;310(20):2164-2173. doi:10.1001/jama.2013.280777. • • • Read the rest of the interview on MedicalResearch.com
  • 48. Total Hip Replacement Surgery: Exercise May Postpone Need MedicalResearch.com Interview with: Ida C. Svege
 PhD student / Physical Therapist Norwegian research centre for Active Rehabilitation
Department of Orthopaedics, Oslo University Hospital / NIMI / Norwegian School of Sports Sciences • • MedicalResearch.com: What are the main findings of the study? Answer: The main finding of the study was that exercise therapy in addition to patient education resulted in significantly higher 6-year cumulative survival of the native hip to total hip replacement compared with patient education only. Over the 6 year follow-up period the need for total hip replacement was reduced by 44% in the group who received both exercise therpay and patient education. Also, better self-reported physical function was demonstrated in the group who received exercise therapy and patient education, suggesting that the lower surgery rate in this group were due to better hip function, with or without the presence of pain. • • MedicalResearch.com: Were any of the findings unexpected? Answer: In a previous publication which reported the results of self-reported pain and function, a beneficial effect of exercise therapy and patient education was demonstrated in self-reported physical function, but no difference in self-reported pain was found. Thus, it was somewhat unexpected that the beneficial effect in time to total hip replacement seem to be associated with better physical function rather than perceived pain, as pain often is presented as the patients’ main reason for undergoing surgery. Furthermore, the demonstrated long-term effect of the 12-week exercise programme is noteworthy, and may be associated with an adaptation of the content of the patient education programme and the exercise programme in the long term. Read the rest of the interview on MedicalResearch.com
  • 49. Total Hip Replacement Surgery: Exercise May Postpone Need MedicalResearch.com Interview with: Ida C. Svege
 PhD student / Physical Therapist Norwegian research centre for Active Rehabilitation
Department of Orthopaedics, Oslo University Hospital / NIMI / Norwegian School of Sports Sciences • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Patients with hip osteoarthritis presenting with mild to moderate symptoms should be offered a targeted exercise therapy programme in addition to patient education to improve physical function and postpone the need for total hip replacement. Postponing or avoiding surgery is important for healthcare consumptions, and for the patients who may avoid total hip replacement surgery and later revision surgery and its potential complications. Total hip replacement surgery is a good treatment options in cases of advanced disease with severe pain and symptoms, where other treatment modalities have failed. However, in patients with tolerable pain who are able to maintain their desired activity level postponing surgery is appropriate. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: This study is the first to evaluate effect of exercise therapy and patient education by time to total hip replacement, and there is need for future trials to confirm our findings. Furthermore, more studies should be conducted in patients with hip osteoarthritis to evaluate the effect of different exercise therapy interventions, to identify potential mechanisms for the effect of exercise therapy, and to evaluate which patients who are most likely to benefit from exercise therapy. Citation: Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial Ida Svege, Lars Nordsletten, Linda Fernandes, May Arna Risberg Ann Rheum Dis annrheumdis-2013-203628Published Online First: 19 November 2013 doi:10.1136/annrheumdis-2013-203628 Read the rest of the interview on MedicalResearch.com
  • 50. Electronic Medical Records: Tool to Identify Readmission Risk MedicalResearch.com Interview with: Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiologyl Director, Center for Evidence-based Practice Medical Director, Clinical Decision Supportl Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104 • • MedicalResearch.com: What are the main findings of the study? Dr. Umscheid: We developed and successfully deployed into the electronic health record of the University of Pennsylvania Health System an automated prediction tool which identifies newly admitted patients who are at risk for readmission within 30 days of discharge. Using local data, we found that having been admitted to the hospital two or more times in the 12 months prior to admission was the best way to predict which patients are at risk for being readmitted in the 30 days after discharge. Using this finding, our automated tool identifies patients who are “high risk” for readmission and creates a “flag” in their electronic health record (EHR). The flag appears next to the patient’s name in a column titled “readmission risk.” The flag can be double-clicked to display detailed information relevant to discharge planning. In a one year prospective validation of the tool, we found that patients who triggered the readmission alert were subsequently readmitted 31 percent of the time. When an alert was not triggered, patients were readmitted only 11 percent of the time. There was no evidence for an effect of the intervention on 30-day all-cause readmission rates in the 12-month period after implementation. • This is the first study in a general population of hospitalized patients to describe the development, validation and impact of an automated readmission risk assessment tool on readmission rates. The simplicity of the prediction rule and the integration of it into a commonly used commercial electronic health record make these findings generalizable to other EHRs and healthcare populations. MedicalResearch.com: Were any of the findings unexpected? Dr. Umscheid: A distinctive characteristic of our prediction model is its simplicity. We were cognizant of the realities of running a prediction model in a high-volume production environment and the diminishing returns of adding more variables. We were not particularly surprised that readmission rates did not change significantly during the study period. This likely reflects the reality that providing readmission risk assessment alone is not sufficient to influence readmission rates. Interventions and organizational changes targeting those at high risk for readmission need to be implemented and routinely performed to reduce readmissions. Thus, as the readmission risk flag becomes more routinely used, and those interventions necessary to impact readmission rates of those defined as high risk are implemented and performed, we believe readmission rates will decrease. • • • Read the rest of the interview on MedicalResearch.com
  • 51. Electronic Medical Records: Tool to Identify Readmission Risk MedicalResearch.com Interview with: Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiologyl Director, Center for Evidence-based Practice Medical Director, Clinical Decision Supportl Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104 • • • • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Umscheid: An automated prediction model can be effectively integrated into an existing EHR and identify patients on admission who are at risk for readmission within 30 days of discharge. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Umscheid: Future work will aim to further examine the impact of the flag on readmission rates, further refine the prediction model, and gather data on how providers and care teams use the information provided by the flag. A link to a press release is below: http://www.uphs.upenn.edu/news/News_Releases/2013/11/baillie/?utm_source=feedburner&utm_medi um=feed&utm_campaign=Feed%3A+penn-medicine-news+%28Penn+Medicine+News%29 Citation: The readmission risk flag: Using the electronic health record to automatically identify patients at risk for 30-day readmission J Hosp Med. 2013 Nov 13. doi: 10.1002/jhm.2106. [Epub ahead of print] The readmission risk flag: Using the electronic health record to automatically identify patients at risk for 30-day readmission. Baillie CA, Vanzandbergen C, Tait G, Hanish A, Leas B, French B, William Hanson C, Behta M, Umscheid CA. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Read the rest of the interview on MedicalResearch.com
  • 52. Primary Care: The Impact of Cost Displays on Laboratory Test Ordering MedicalResearch.com Interview with: Thomas D. Sequist, MD, MPH, Atrius Health • • • • • • • • • • Dr. Sequist: Our study, the Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering published in the Journal of General Internal Medicine found that when the costs of certain lab tests were displayed electronically in real time, the rate at which physicians ordered tests decreased. It was conducted among 215 primary care physicians working for Atrius Health, an alliance of six non-profit medical groups and a home health and hospice agency in Massachusetts, where an integrated electronic health record system is used. Physicians in the intervention group received real-time information on laboratory costs for 27 individual tests when they placed their electronic orders, while the control group did not. What we found was a significant decrease in the ordering rates of both high and low cost range tests by physicians to whom the costs of the tests were displayed electronically in real-time. This included a decrease in ordering rates for four of the 21 lower cost laboratory tests, and one of six higher cost laboratory tests. In addition, physicians were generally very receptive to the intervention. A majority (81 percent) reported that the exercise increased their knowledge regarding costs of care and requesting real-time cost information on an expanded set of health care services. MedicalResearch.com: Were any of the findings unexpected? Dr. Sequist: We saw a statistically significant decrease in ordering rates for five tests, but what I found very interesting is that we actually saw a directional decrease in ordering rates for the majority of lab tests included in the study. While they were not all statistically significant and therefore, we didn’t include them in the final paper, it shows that the future implications are real. We were also intrigued by the finding that nearly one-half of physicians reported that they did not have a firm understanding of costs of laboratory tests they routinely order. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Sequist: Doctors tell us all the time that they don’t have a sense of what tests cost so our primary goal in showing these costs to providers was to educate them. We were trying to give them as much information as possible to help them practice value-based medicine and educate their patients as well. The study was about more than just costs, but also outcomes and value. With further research and testing, these findings show patients tangible results that you can receive quality care at lower costs. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Sequist: There are two issues we should focus on for future research. First, we need to look at how the reduction in utilization of procedures and tests impacts quality of care. We want to make sure that we are only cutting back on low value services of limited benefit to patients and that high value services continue to be delivered. Second, we should look at whether displaying costs is an effective strategy for more expensive items like operations and imaging. Citation: The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering J Gen Intern Med. 2013 Nov 21. [Epub ahead of print] The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering. Horn DM, Koplan KE, Senese MD, Orav EJ, Sequist TD. Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA Read the rest of the interview on MedicalResearch.com
  • 53. Pap Tests: Why are Older Women Without a Cervix Still Getting Them? MedicalResearch.com Interview with Deanna Kepka, PhD, MPH Assistant Professor College of Nursing & Huntsman Cancer Institute University of Utah • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Kepka: Nearly two-thirds, 64.8% (95% CI: 62.2% – 67.3%) of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy and more than half, 58.4% (95% CI: 55.3% – 61.4%) of women age 65 years and older without a hysterectomy reported a Pap test in the past three years. Together, this represents approximately 14 million in the United States. MedicalResearch.com: Were any of the findings unexpected? Dr. Kepka: The rates of overuse of Pap testing have been slow to decline over the past decade. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kepka: We need to increase familiarity with guidelines and work harder to follow them. This will reduce the unnecessary use of valuable medical resources. Patients should inform their clinicians of their support of these guidelines and state that if they are not at high risk, they do not want these tests anymore. Improvement in medical records will help clinicians decide if a Pap test is necessary or not for an older woman or a woman who has undergone a hysterectomy. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kepka: We need to learn more about why clinicians are not following guidelines for Pap testing among older women and women without a cervix. We would also like to look at the costs associated with overuse of Pap testing in the United States. Lastly, we would like to look at the impact of improved electronic medical records on the assessment of a patient’s medical history and risk for cervical cancer. Citation: Overuse of Papanicolaou Testing Among Older Women and Among Women Without a Cervix Mona Saraiya, MD, MPH; Zahava Berkowitz, MSc, MSPH; K. Robin Yabroff, PhD, MBA; Louise Wideroff, PhD; Sarah Kobrin, PhD, MPH; Vicki Benard, PhD Arch Intern Med. 2010;170(11):977-986. doi:10.1001/archinternmed.2010.134. Read the rest of the interview on MedicalResearch.com
  • 54. Low Testosterone: MI Association MedicalResearch.com Interview with: Bledar Daka MD, PhD-student. University of Gothenburg in Sweden • • • • • • • • • MedicalResearch.com: What are the main findings of your study? Answer: The main finding of our study was that low testosterone levels were associated with MI in both men and women but the association was stronger in men with type 2 diabetes. This finding was in concert with findings that could associate the CVD death with low levels of testosterone especially in elder men. MedicalResearch.com: Were any of the findings surprising? Answer: What we were surprised of was the strong association in men with diabetes which brought us to the conclusion that measurements of testosterone in men with type 2 diabetes will give more information in the assessment of MI risk. MedicalResearch.com: What further research do you recommend as a result of this report? Answer: A limitation of the study was that the sample was not large. Larger prospective studies on the effect of testosterone concentrations in subjects with type 2 diabetes studying cardiovascular outcomes are needed. Citation: European Association for the Study of Diabetes Source reference: Daka B, et al “Low concentrations of testosterone predict acute myocardial infarction in men with type 2 diabetes mellitus” EASD 2013; Abstract 11. Read the rest of the interview on MedicalResearch.com
  • 55. Non-Exercise Physical Activity: Longevity and Heart Health MedicalResearch.com Interview with: Elin Ekblom Bak | Doktorand Institutionen för Medicin, Enheten för klinisk epidemiologi, Karolinska universitetssjukhuset Solna 114 86 Stockholm • • • • • • • • • • • • MedicalResearch.com Interview with: Elin Ekblom Bak | Doktorand Institutionen för Medicin, Enheten för klinisk epidemiologi, Karolinska universitetssjukhuset Solna 114 86 Stockholm MedicalResearch.com: What are the main findings of the study? Answer: That we, in a large sample of 60 y old men and women, found that a generally active day life (compared with an inactive daily life) was significantly associated with a better metabolic health at baseline, and a reduced risk with 27% for a first time cardiovascular event and 30% for allcause mortality during 12.5 years of follow up. This was seen regardless of intentional exercise. Why this is important is because the focus is often of just exercise for health benefits and longevity. Exercise is still important, but, as we saw in this study, the activity that we do during the extended hours of daily living is as important and has a significant effect on cardiovascular health and longevity. These results are in a reversed way in line with the detrimental effects of prolonged sitting (regardless exercise habits) now frequently reported in an increasing amount of research studies. This is because sedentary time mainly replaces time in daily activity, and vice versa (daily activity replace time spent sitting). MedicalResearch.com: Were any of the findings unexpected? Not totally unexpected, but we did not expect that strong independent associations with higher levels of daily activity with such important prospective outcomes as cardiovascular disease and mortality. MedicalResearch.com: What should clinicians and patients take away from your report? Promoting daily life activities is as important as recommending regular exercise for older adults for cardiovascular health and longevity. This is particularly important for older adults as they tend, compared to other age groups, to spend a greater portion of their active day performing NEPA as they often finds it difficult to achieve recommended exercise intensity levels. Though, one should not forget that exercise regularly on higher intensity levels is still important. We saw that those who exercised regularly and that also had a daily physically active life had the lowest risk profile of all. The issue here is that the proportion of time spent doing intentional exercise usually consists of only a fraction of the day (a large part of the general population even lacks daily exercise), which leaves a great deal of time for daily activities or sitting. MedicalResearch.com: What recommendations do you have for future research as a result of this study? When evaluating the importance of physical activity/inactivity, one have to consider all different components of the daily movement pattern; time spent sitting, time in daily activity (non-exercise physical activity), and time in exercise. Citation: The importance of non-exercise physical activity for cardiovascular health and longevity Elin Ekblom-Bak, Björn Ekblom, Max Vikström, Ulf de Faire, Mai-Lis Hellénius Br J Sports Med bjsports-2012-092038Published Online First: 28 October 2013 doi:10.1136/bjsports-2012-092038 Read the rest of the interview on MedicalResearch.com
  • 56. Autism Disorders after NICU Stays MedicalResearch.com Interview Dr. Michael Shevell Chair of the Pediatrics Department at the McGill Faculty of Medicine and Pediatrician-in-Chief at the Montreal Children’s Hospital and the McGill University Health Centre • • MedicalResearch.com: What are the main findings of the study? Dr. Shevell: At risk term infants who have spent some time in a Level III NICU after birth are at substantially increased later risk for an autistic spectrum disorder. Frequently this disorder occurs in conjunction with substantial co-morbidity. • • • • MedicalResearch.com: Were any of the findings unexpected? Dr. Shevell: The degree of increased risk and the occurrence of co-morbidity was unexpected. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Shevell: Term infants discharged from a Level III NICU should be screened for an ASD systematically as part of programmatic follow-up. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Shevell: A multi-centre prospective study with an ASD screening protocol would be an ideal methodology to further address this issue. Citation: Shevell MI, et al “Autism spectrum disorder in a term birth NICU population” CNS 2013; Abstract 56. • • • • Read the rest of the interview on MedicalResearch.com
  • 57. Prostate Biopsy: Psychological Impact MedicalResearch.com Interview with: Dr Julia Wade PhD Research Associate University of Bristol, Clifton, Bristol • • • Dr. Wade: We hope that our study provides men with more information about diagnosing prostate cancer. A diagnosis of prostate cancer can only be confirmed through prostate biopsies after the finding of a raised PSA. This biopsy process requires 10 or so samples to be taken rectally, with a local anaesthetic, and this has some side effects. Most men describe prostate biopsies as uncomfortable, but around 40% report pain and many experience bleeding; a small number, 1%, are admitted to hospital and 10% need to see a doctor because of post-biopsy symptoms. We found that the men who experienced post-biopsy symptoms as ‘problematic’ at 7 days post biopsy also experienced raised anxiety compared to men who experienced symptoms as non-problematic MedicalResearch.com: Were any of the findings unexpected? Dr. Wade: Although most men experienced biopsy symptoms as not a problem or a minor problem, the proportion of men who reported symptoms to be problematic was higher than has been previously reported (11% of those experiencing pain, 22% of those experiencing fever and 26% of those experiencing blood in the ejaculate). Read the rest of the interview on MedicalResearch.com
  • 58. Prostate Biopsy: Psychological Impact MedicalResearch.com Interview with: Dr Julia Wade PhD Research Associate University of Bristol, Clifton, Bristol • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Wade: We think that men should have as much information as possible about the possible consequences of having a PSA test before they decide to take the test. Most men having a PSA test will hope that it is negative, but it is important that they know that if the PSA is raised, they will be advised to have a prostate biopsy. The biopsy process is uncomfortable for most, and for some will be painful and lead to symptoms including bleeding and infection, which may last for 5 weeks and if severe, may lead to them becoming anxious. Having clear information about the possible consequences of biopsy may reduce anxiety MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Wade: Future research is needed to identify ways of reducing the incidence of adverse effects after biopsy and to evaluate whether improved information provision about effects of biopsy may reduce anxiety. Citation: Psychological Impact of Prostate Biopsy: Physical Symptoms, Anxiety, and Depression Wade J, Rosario DJ, Macefield RC, Avery KN, Salter CE, Goodwin ML, Blazeby JM, Lane JA, Metcalfe C, Neal DE, Hamdy FC, Donovan JL. Julia Wade, Rhiannon C. Macefield, Kerry N.L. Avery, C. Elizabeth Salter, Jane M. Blazeby, J. Athene Lane, Chris Metcalfe, and Jenny L. Donovan, University of Bristol, Clifton, Bristol; Derek J. Rosario and M. Louise Goodwin, Royal Hallamshire Hospital, University of Sheffield, Sheffield; David E. Neal, University of Cambridge, Addenbrooke’s Hospital, Cambridge; and Freddie C. Hamdy, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom J Clin Oncol. 2013 Oct 21. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 59. Surgical Outcomes and Income-Related Disparities MedicalResearch.com Interview with: Mehwish Qasim PhD Candidate, Research & Teaching Assistant Department of Health Management and Policy University of Iowa, College of Public Health • • • • • MedicalResearch.com: What are the main findings of the study? Answer: This study focused on two questions: Do patients living in the poorest communities have worse post-surgical outcomes than those in the wealthiest communities? And has the level of these differences in post-surgical outcomes changed over time? We found that although post-surgical outcomes improved in general from 20002009, (significant decreases in nine of twelve mortality and patient safety measures), patients from low-income areas had worse surgical outcomes than those from high-income areas for nine of twelve measures in both 2000 and 2009. The disparities in outcomes between lowand high-income groups did not change significantly for nine of the twelve measures. MedicalResearch.com: Were any of the findings unexpected? Answer: There is a large body of evidence identifying low socioeconomic status as a risk factor for a whole host of diseases and poor outcomes, therefore, we had hypothesized that patients residing in the poorest communities would fare worse on many of the twelve patient safety and mortality measures examined. Perhaps, the lack of any significant change in most of the disparities between low- and high-income groups is unexpected because of widespread quality and safety improvement initiatives at the hospital, state, and national levels. Read the rest of the interview on MedicalResearch.com
  • 60. Surgical Outcomes and Income-Related Disparities MedicalResearch.com Interview with: Mehwish Qasim PhD Candidate, Research & Teaching Assistant Department of Health Management and Policy University of Iowa, College of Public Health • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: This study found encouraging results in two areas. First, nearly all post-surgical outcomes improved for patients from both low- and high-income communities between 2000 and 2009. Second, disparities between patients from low-income areas and those from high-income areas improved for two of the mortality measures. However, patients from low-income areas continued to have worse outcomes for most of the surgical measures. The reasons for the persistence in disparities in outcomes by income should be examined in future research to tease out the specific and unique contributions of patient risk factors and medical care characteristics that contribute to poor surgical outcomes for patient residing in poorer communities. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Understanding why disparities in outcomes remain is important for developing policies and interventions to improve quality of care. Researchers should examine whether and how differences in medical care received and differences at the patient level contribute to the persistence of disparities in surgical outcomes. Future research could employ more detailed clinical information to examine whether unmeasured clinical factors explain the disparities and multivariate analyses could be used to help tease out the unique contribution of low-income status and patient characteristics to post-surgical outcomes. Citation: Despite Overall Improvement In Surgical Outcomes Since 2000, Income-Related Disparities Persist Qasim M, Andrews RM. Health Aff (Millwood). 2013 Oct;32(10):1773-80. doi: 10.1377/hlthaff.2013.0194. Read the rest of the interview on MedicalResearch.com
  • 61. Asthma and COPD: Results of Clinical Trials of dual PDE3 and PDE4 inhibitor MedicalResearch.com Interview with: Professor Clive Page Director, Sackler institute of Pulmonary Pharmacology Joint Head, Institute of Pharmaceutical Science King’s College London 150 Stamford Street Waterloo Campus London SE1 9NH • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Prof. Page: RPL 554 was shown to cause bronchodilation and anti-inflammatory activity at the same dose. The drug showed benefit in both patients with COPD and asthma. MedicalResearch.com: Were any of the findings unexpected? Prof. Page: Our results were compatible with the activity of RPL 554 to act as an inhibitor of PDE3 (to elicit bronchodilation) and PDE4 (to elicit the anti-inflammatory activity). MedicalResearch.com What should clinicians and patients take away from your report? Prof. Page: That we have discovered a new class of bronchodilator that has concomitant antiinflammatory activity which could provide extra clinical benefit to existing drugs used in the treatment of respiratory diseases such as asthma and COPD. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof. Page: Further research in patients with more severe disease and to look at longer term studies to investigate whether the drug could provide an alternative to existing therapy for maintenance treatment Citation: Efficacy and safety of RPL554, a dual PDE3 and PDE4 inhibitor, in healthy volunteers and in patients with asthma or chronic obstructive pulmonary disease: findings from four clinical trials The Lancet Respiratory Medicine, Early Online Publication, 25 October 2013doi:10.1016/S22132600(13)70187-5 Read the rest of the interview on MedicalResearch.com
  • 62. Neurofibromatosis: Simvastatin for Cognitive Deficits MedicalResearch.com Interview with: Prof Ype Elgersma PhD Professor, Neuroscience Neuroscience Institute, Erasmus University Rotterdam Rotterdam, Netherlands • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Research in genetic mouse models suggested that inhibition of HMG-CoA-reductase by statins might ameliorate the cognitive and behavioral phenotype of children with Neurofibromatosis type 1 (NF1), an autosomal dominant disorder. In a 12-month randomized placebo-controlled study including 84 children with NF1, we found that simvastatin, an inhibitor of the HMG-CoA-reductase pathway had no effect on full-scale intelligence, attention problems or internalizing behavioral problems, or on any of the secondary outcome measures. MedicalResearch.com: Were any of the findings unexpected? Answer: A previous, smaller, randomized study with simvastatin was already largely negative, although that study was limited in treatment duration to 12-weeks. One secondary outcome measure was significantly better in the treatment-arm compared to placebo. A 12-week study of lovastatin, a very similar drug, found improvements, but that study had no control group. Hence, our results were disappointing, but not entirely unexpected. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Simvastatin should not be prescribed for treating cognitive or behavioral issues in NF1 at this point. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We advocate further investigations into the pathophysiology of the cognitive deficits in NF1, as new clues may result in developing novel treatments. In particular it is of importance to understand how NF1 selectively affects GABA-ergic neurons. Our trial further emphasizes the need for randomized placebo-controlled trials and the use of outcome measures that are of direct relevance to the patient, when doing cognitive trials. Citation: Simvastatin for cognitive deficits and behavioural problems in patients with neurofibromatosis type 1 (NF1-SIMCODA): a randomised, placebo-controlled trial behavioural problems in patients with neurofibromatosis type 1 (NF1-SIMCODA): a randomised, placebocontrolled trial. van der Vaart T, Plasschaert E, Rietman AB, Renard M, Oostenbrink R, Vogels A, de Wit MC, Descheemaeker MJ, Vergouwe Y, CatsmanBerrevoets CE, Legius E, Elgersma Y, Moll HA. Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, Netherlands; Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, Netherlands; ENCORE Expertise Centre For Neurodevelopmental Disorders, Erasmus University Medical Centre, Rotterdam, Netherlands. Lancet Neurol. 2013 Nov;12(11):1076-83. doi: 10.1016/S1474-4422(13)70227-8. Epub 2013 Oct 1. Read the rest of the interview on MedicalResearch.com
  • 63. Testosterone Therapy and Risk of Heart Attack and Stroke MedicalResearch.com Interview with: Michael Ho, MD, PhD Assistant Professor of Medicine, Division of Cardiology Cardiology 111B 1055 Clermont Street Denver CO 80220 • • MedicalResearch.com: What are the main findings of the study? Dr. Ho: We found that testosterone use was associated with a 29% increased risk of death, MI and stroke over a follow-up period of 27 months. The risk was similar among patients with or without coronary artery disease on coronary angiography. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Ho: We hypothesized that there would be an association between testosterone therapy use and adverse outcomes among patients with coronary artery disease but did not expect that the association would be similar among patients without coronary artery disease following the coronary angiography. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Ho: The study findings provide additional information about the potential risks associated with testosterone therapy and hopefully will inform a better discussion of the benefits and risks of testosterone replacement therapy between patients and their physicians. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Ho: Additional studies including retrospective studies in other patient populations as well as a prospective randomized controlled trial may be needed to assess the safety and effectiveness of testosterone therapy as well as in specific patient populations. Citation: Vigen R, O’Donnell CI, Barón AE, et al. Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels. JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386. • • • • • • Read the rest of the interview on MedicalResearch.com
  • 64. SLE: Poor Medication Adherence MedicalResearch.com Interview with: Dr. Jinoos Yazdany MD, MPH Assistant Professor in Residence UCSF School of Medicine • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: For almost all of the drugs we examined, we found that less than half of patients adhered to treatment. For some drugs, less than one-third of individuals were adherent. The average medication possession ratios were low across all drugs. We found that several factors played an important part in adherence. Younger individuals were less likely to adhere to treatment for several drugs, and we also found racial/ethnic differences, with Black, Hispanic and Native populations having lower adherence. We also found geographic variation in adherence, with individuals in the Northeast being the most likely to adhere to treatment. MedicalResearch.com: Were any of the findings unexpected? Answer: As a physician who spends my professional time taking care of people with lupus, these data are highly concerning. For many individuals with lupus, treatment is very effective and has a proven track record of preventing life-threatening complications and longterm organ damage such as kidney failure. The fact that less than one in three patients are adhering with treatment is surprising and lower than expected. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Physicians may be unaware of their patient’s adherence with medication, and patients’ may not be forthcoming about this issue. Concerns about side effects, inadequate understanding of the benefit and cost may be barriers for patients. Treatment associated side effects may be another important barrier. There is clearly a need for better patient-physician communication around the issue of adherence. And we urgently need interventions that assess and improve adherence. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Moving forward, we need studies that will help us improve adherence in lupus. One exciting study that was just funded by the Patient-Centered Research Outcomes Institute (PCORI) that we are conducting with investigators at the University of Alabama, will develop and test a treatment decision aid for minority patients with lupus nephritis that incorporates their specific concerns as well as perceived barriers to treatment. More studies such as this are needed if we are to begin to address the underlying reasons for poor adherence in individuals with lupus. Citation: Poor Adherence To Medications For Systemic Lupus Erythematosus Among U.S. Medicaid Beneficiaries Abstract: #1588 Presenter: Yazdany, Jinoos MD, MPH Co-Authors: Liu, Jun PhD; Alarcon, Graciela S. MD, MPH; Costenbader, Karen H. MD, MPH; Feldman, Candace H. MD, MPH Read the rest of the interview on MedicalResearch.com
  • 65. Bisphenol A: Lose Dose Effects MedicalResearch.com Interview with: Laura N. Vandenberg, PhD Assistant Professor University of Massachusetts – Amherst School of Public Health, Division of Environmental Health Science Amherst, MA 01003 • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Vandenberg: Back in 2007, a group of 38 researchers wrote the Chapel Hill consensus statement about BPA (vom Saal et al. Reproductive Toxicology 2007). We also wrote 5 separate review articles summarizing what was known at the time about 1) BPA and cancer; 2) BPA and its effects on wildlife animals and in environmental matrices (air, water, soil, etc.); 3) BPA and molecular mechanisms in cultured cells; 4) BPA levels in humans and their exposure sources; 5) BPA’s effects on laboratory animals. Several of these groups analyzed what effects BPA has at “low doses”, i.e. at doses below those tested in traditional toxicology studies. (These are doses that are thought to be “safe” for animals and humans.) For the past few years, our group has been revisiting all of the Chapel Hill statements from 2007 and updating them. The Chapel Hill groups identified low dose effects for a number of study types (for example, they found strong evidence that developmental exposures to BPA affect development of the male reproductive tract; in 2007, multiple studies from independent laboratories had identified that low doses of BPA during early development could affect adult prostate weight, for example.) We set aside the endpoints that the Chapel Hill groups found there was significant evidence for low dose effects. We instead focused on areas that lacked sufficient studies to make a conclusion in 2007. We were able to identify a number of study areas that did not have sufficient data in 2007 for any conclusion. Several of these areas of study revealed reproducible, consistent low dose effects that were found in multiple independent laboratories. These included the effects of developmental exposures on female reproduction, mammary gland development and neoplasias, and mammary gland response to carcinogenic challenges; and the effects of adult exposures on brain morphology and metabolic endpoints. Similar to other recent reviews, we also discussed the results of recent epidemiology studies. In the past six or seven years, the number of epidemiology studies focusing on BPA has increased tremendously. Now, more than 60 human studies suggest relationships between BPA exposures and diseases or other dysfunctions. Looking at all published studies on BPA, we concluded that: (1) Consistent, reproducible low dose effects have been demonstrated for BPA in cell lines, primary cells and tissues, laboratory animals, and in some human populations. (2) Many of these low dose effects should be considered adverse. (3) Doses that reliably produce statistically significant effects in animals are 1–4 magnitudes of order lower than the current lowest observable adverse effect level (LOAEL) of 50 mg/kg/day. (4) Endocrine disruptors, including BPA, often pose a greater threat when exposure occurs during early development, organogenesis, or during critical postnatal periods during which tissues are differentiating. Read the rest of the interview on MedicalResearch.com
  • 66. Bisphenol A: Lose Dose Effects MedicalResearch.com Interview with: Laura N. Vandenberg, PhD Assistant Professor University of Massachusetts – Amherst School of Public Health, Division of Environmental Health Science Amherst, MA 01003 • • • MedicalResearch.com: Were any of the findings unexpected? Dr. Vandenberg: What was done in 2007 with the Chapel Hill group was a one-of-a-kind (or perhaps first-of-a-kind) analysis. It was truly ground breaking, and brought light to the areas of study with convincing results and also helped researchers identify the areas of study that needed additional research. We found that many of these areas that had limited information in 2007 had significantly more information available in 2013, suggesting that those “data gaps” identified in 2007 were helpful in steering scientific studies – and were tackled by numerous laboratories. Thus, what we did in writing this new paper is to “carry the scientific torch” and readdress and reassess the body of evidence, again asking “Do low doses of BPA affect these endpoints?”. The BPA literature continues to grow exponentially and we did our best to assess it all at once – we studied more than 400 new low dose studies published since the Chapel Hill reviews in 2007. We also used a new approach to look at endpoints from an integrative assessment, asking “Do we see similar effects in cultured cells, in laboratory animals, and in humans?” We did this for five endpoints – endpoints that were selected because a relatively large amount of data was available. Not every single study showed an effect of BPA on these endpoints, but overwhelmingly the data suggest that BPA has effects at low doses on cells, animals and human populations. Using this approach, we could clearly see that there were patterns visible across multiple levels of biological organization… what we see in cells could predict what we would see in animals. Or what we see in animals could predict what was observed in human populations. For example, we saw that BPA affects oocytes (eggs) and ovarian cells in culture. It affects ovarian cells and eggs in animals. And it appears to have some relationship with IVF outcomes in women. From a scientific perspective, this is not terribly surprising because we expect that cultured cells are chosen because they accurately predict effects in animals, and that animal models predict the effects of chemicals on humans; this is consistent with evolutionary theory. But in practice, it is actually a lot harder to see these kinds of relationships. Animal studies are tightly controlled, and human exposures are not! Thus, it was somewhat surprising that there are a significant number of endpoints with consistent low dose effects at multiple levels of biological organization. Read the rest of the interview on MedicalResearch.com
  • 67. Bisphenol A: Lose Dose Effects MedicalResearch.com Interview with: Laura N. Vandenberg, PhD Assistant Professor University of Massachusetts – Amherst School of Public Health, Division of Environmental Health Science Amherst, MA 01003 • • • • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Vandenberg: Our group found strong evidence for low dose effects of BPA. A relatively large number of animal studies found effects of BPA at doses that humans typically encounter. Furthermore, the large number of epidemiology studies showing relationships between BPA and human diseases suggest that exposures are not without harm. Thus, all patients should avoid sources of BPA whenever possible. Clinicians should educate themselves on endocrine disruptors in general, as well as BPA. The 2012 “State of Science” document from the World Health Organization and United Nations Environment Programme is a great place to start. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Vandenberg: We made a number of recommendations for the scientific community including: (1) The use of a consistent definition of “low dose” and “low dose effects” in the endocrine disruptor literature. (2) Improved data on the sources of BPA exposure. (3) Incorporation of low doses and additional sensitive endpoints in guideline studies. (4) Evaluation of additive and synergistic effects of BPA with other endocrine disruptors including phytoestrogens. (5) To better define critical windows of vulnerability for various endpoints shown to be sensitive to low doses of BPA. Citation: Low dose e ects of bisphenol A: An integrated review of in vitro, laboratory animal, and epidemiology studies Vandenberg LN, Ehrlich S, Belcher SM, Ben-Jonathan N, Dolinoy DC, Hugo ER, Hunt PA, Newbold RR, Rubin BS, Saili KS, et al. Low dose effects of bisphenol A: An integrated review of in vitro, laboratory animal, and epidemiology studies. Endocrine Disruptors 2013; 1:0 – -1; http://dx.doi.org/10.4161/endo.26490 Read the rest of the interview on MedicalResearch.com
  • 68. Ulcerative Colitis: Black Raspberries May Decrease Progression to Colon Cancer MedicalResearch.com Interview with: Li-Shu Wang, PhD Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin • • MedicalResearch.com: What are the main findings of the study? Answer: Ulcerative colitis (UC) is frequently an intermediate step to colon cancer. The interleukin10 knock-out (KO) mouse is a genetic model of this progression. We have now shown that KO mice fed 5% black raspberries (BRBs) had significantly less colonic ulceration as compared to KO mice that consumed the control diet. Dysfunction of the Wnt signaling pathway is a key event in UCassociated colon carcinogenesis. We investigated the effects of BRBs on the Wnt pathway and found that the BRB-fed KO mice exhibited significantly decreased promoter methylation of Wnt antagonists and a significantly lower level of β-catenin nuclear translocation. Our results suggest that BRBs inhibit colonic ulceration partly through inhibiting aberrant epigenetic events that dysregulate Wnt signaling. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Wnt3a, a Wnt ligand gene, is associated with the regulation of Wnt pathway and repair. Further, wnt3a is one of the most up-regulated genes so far known in inflamed human colon. Our study showed that BRBs decreased promoter methylation of wnt3a and, interestingly they also decreased mRNA expression of wnt3a in colons from the KO mice. This finding suggests that they decrease activation of wnt3a signaling. These results agree with the observation that BRBs decreased  -catenin nuclear localization; BRBs effectively inhibited the translocation of this transcription-regulating co-factor. In addition, our results suggest other mechanisms are involved in regulating the expression of wnt3a. Read the rest of the interview on MedicalResearch.com
  • 69. Ulcerative Colitis: Black Raspberries May Decrease Progression to Colon Cancer MedicalResearch.com Interview with: Li-Shu Wang, PhD Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Mesalamine is a mainstay therapeutic agent in human chronic ulcerative colitis; partly through decreasing  -catenin activation which, in turn, decreases colitis-associated cancer. Our data suggest that part of the mechanism of prevention by BRBs is by antagonizing the development of inappropriate epigenetic events and  -catenin nuclear translocation which then correct dysregulated Wnt signaling at the onset of cancer development. Overall our results lend credence to the supposition that including significant quantities of BRBs in the diet may reduce the risk of UC patients to develop colon cancer. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: The IL-10 KO mouse model is a genetic animal model that recapitulates the genesis of human colon cancer that originates within a UC lesion. Our current study shows that proper governance of the Wnt signaling pathway is maintained by BRBs by sustaining correct methylation patterns and expression of Wnt pathway negative regulatory genes. Cancer chemoprevention by affecting histone modification and/or DNA methylation and DNMT1, DNMT3b, HDAC1, HDAC2, and MBD2 is a common observation. We have now shown that ingestion of BRBs prevent the onset of their aberrant actions in the KO mice. One question that remains, however, is whether BRBs prevent up regulation of DNMT1, DNMT3b, HDAC1, HDAC2, and MBD2, or cause their down regulation, or both. Another question is whether they affect expression of these enzymes/proteins directly or indirectly. We are currently searching for the answers to these questions. Citation: Black Raspberries Protectively Regulate Methylation of Wnt Pathway Genes in Precancerous Colon Tissue Li-Shu Wang, Chieh-Ti Kuo, Tim H. M. Huang, Martha Yearsley, Kiyoko Oshima, Gary D. Stoner, Jianhua Yu, John F. Lechner, and Yi-Wen Huang Cancer Prev Res canprevres.0077.2013; Published OnlineFirst October 15, 2013; doi:10.1158/1940-6207.CAPR-13-0077 Read the rest of the interview on MedicalResearch.com
  • 70. Rhinovirus Infections and Probiotics Supplementation in Preterm Infants MedicalResearch.com Interview with: Raakel Luoto, MD Department of Paediatrics and Adolescent Medicine Turku University Hospital, Turku, Finland • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Luoto: Firstly, we found a significantly lower incidence of respiratory tract infections (RTIs) in infants receiving specific prebiotics or probiotics compared to those receiving placebo. Also, the incidence of rhinovirus –induced episodes, comprising 80% of all RTI episodes, was found to be significantly lower both in the prebiotic and in the probiotic group compared to the placebo group. Secondly, neither of interventions was found to have an impact on the duration or severity of RTIs. MedicalResearch.com: Were any of the findings unexpected? Dr. Luoto: Actually the impact of both prebiotic and probiotic supplementation in the incidence of RTIs was better than our study team did expect. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Luoto: Based on our results, gut microbiota modulation with specific pre- and/or probiotics could offer a cost-effective tool in the fight against RTIs, which are a major cause of mortality and morbidity particularly during the first years of life. Preterm infants carry a heightened risk of infectious ailments, of both bacterial and viral causes. Although strict hygienic measures have been shown to reduce viral transmission and thus to diminish the incidence of RTIs, no definitive preventive measures have thus far been discovered for the effective control of this entity. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Luoto: Most importantly, more investigations and clinical studies are needed to evaluate the impact of gut microbiota modulation on nonintestinal infections. Further studies should also repeat our results with larger study population. Additionally, the exact mechanisms behind such an effect need to be elucidated in the future. Citation: Prebiotic and probiotic supplementation prevents rhinovirus infections in preterm infants: A randomized, placebo-controlled trial. Luoto R, Ruuskanen O, Waris M, Kalliomäki M, Salminen S, Isolauri E. Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland. J Allergy Clin Immunol. 2013 Oct 13. pii: S0091-6749(13)01307-9. doi: 10.1016/j.jaci.2013.08.020. [Epub ahead of print Read the rest of the interview on MedicalResearch.com
  • 71. Depression Second Leading Cause of Disability Worldwide MedicalResearch.com Interview with: Alize J. Ferrari University of Queensland School of Population Health Herston, Queensland, Australia • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: In our paper recently published in PloS Medicine, we report findings from the Global Burden of Disease Study 2010 for depression. We found that depression (defined as major depressive disorder and dysthymia) accounted fr 8% of the non fatal burden in 2010, making it the second leading cause of disability worldwide. Burden due to depression increased by 35% between 1990 and 2010, although this increase was entirely driven by population growth and ageing. Burden occurred across the entire lifespan, was higher in females compared to males, and there were differences between world regions.When depression was considered a risk factor for other health outcomes it explained 46% of the burden allocated to suicide and 3% of the burden allocated ischemic heart disease. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Depression is a global health priority. It is important to understand the variations in burden between age, sex, place and time as it will help us set health objectives for the disorder. MedicalResearch.com: What recommendations do you have for future research as a result of this study? 
 Answer: More work is required to implement cost-effective interventions for depression in order to reduce its ubiquitous burden. Citation: Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010 Citation: Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010 Alize J. Ferrari, Fiona J. Charlson, Rosana E. Norman, Scott B. Patten, Greg Freedman, Christopher J.L. Murray, Theo Vos, Harvey A. Whiteford Published: Nov 05, 2013 DOI: 10.1371/journal.pmed.1001547 Read the rest of the interview on MedicalResearch.com
  • 72. Obesity: Protein Kinase II and Hepatic Insulin Signaling MedicalResearch.com Interview with: Ira Tabas, M.D., Ph.D. Richard J. Stock Professor and Vice-Chair of Research Department of Medicine Professor of Anatomy & Cell Biology (in Physiology and Cellular Biophysics) Columbia University New York, NY 10032 • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Tabas: We discovered a new pathway in the liver, relevant to humans, that controls the two hallmarks of type 2 diabetes (T2D), namely, excessive glucose production and defective insulin signaling. Thus, if drugs could be developed to inhibit this pathway, they could be very effective at treating or preventing T2D. MedicalResearch.com: Were any of the findings unexpected? Dr. Tabas: Yes—the downstream processes that control glucose production and those that regulate insulin signaling in the liver are completely different, and so the finding that one common upstream pathway controls 2 disparate downstream pathways, which together encompass the two major features of T2D, is quite remarkable. The other unexpected finding was that the common upstream pathway is activated in livers of obese humans before they get diabetes, i.e., in subjects with so-called “prediabetes.” This suggest that the pathway is fundamentally important in the initiation of the disease and could be targeted for prevention. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Tabas: There is hope that a new type of drug could safely and effectively treat T2D and prevent T2D in subjects with prediabetes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Tabas: Inhibitors for the upstream pathway, particularly a target called MK2, need to be optimized in animal studies for potency and safety and then tried in early clinical trials to validate efficacy and safety. Citation: Activation of Calcium/Calmodulin-Dependent Protein Kinase II in Obesity Mediates Suppression of Hepatic Insulin Signaling Lale Ozcan, Jane Cristina de Souza, Alp Avi Harari, Johannes Backs, Eric N. Olson, Ira Tabas Read the rest of the interview on MedicalResearch.com
  • 73. Hepatitis C: Sofosbuvir/Ledipasvir Combination Treatment MedicalResearch.com Interview with: Prof Eric Lawitz MD Vice President of Scientific and Research Development at The Texas Liver Institute Clinical professor of Medicine San Antonio University of Texas Health Science Center. • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Lawitz: Currently available treatments for HCV involve weekly injections of pegylated interferon and daily doses of oral antivirals that must be taken for up to a year. These regimens are not only burdensome for patients, but are not always effective and can cause serious and debilitating side effects, including anemia. So there is a significant need for new tablet-based treatment regimens for HCV that eliminate interferon and ribavirin, are more effective, better tolerated and easier for patients to take. The Phase 2 LONESTAR study evaluated an 8- or 12-week course of therapy with a fixed-dose combination tablet containing two investigational agents, sofosbuvir and ledipasvir. The combination tablet was given to patients either with or without ribavirin. The medicines were tested among HCV patients with genotype 1 HCV infection – the most difficult strain of the virus to treat. Some of these patients had cirrhosis of the liver, or had failed prior therapy with protease inhibitors, and are considered among the most challenging patients to cure of HCV. In LONESTAR, 95 percent of patients new to HCV therapy who received 8 weeks of treatment with the sofosbuvir/ledipasvir tablet were HCV undetectable 12 weeks after the therapy ended. This means they are considered cured of HCV. Similarly, 95 percent of patients who had failed prior therapy and who received 12 weeks of the combination tablet became HCV undetectable. The combination pill was well tolerated by patients, and no one discontinued therapy due to side effects. MedicalResearch.com: Were any of the findings unexpected? Dr. Lawitz: To our knowledge, this trial is the first to report data for cirrhotic genotype 1 hepatitis C patients who did not respond to prior treatment with a protease inhibitor-based regimen – patients that currently have no approved treatment options for their HCV. In LONESTAR, 95 percent of these difficult-totreat patients were cured with the sofosbuvir/ledipasvir combination tablet – which is a very impressive result. Read the rest of the interview on MedicalResearch.com
  • 74. Hepatitis C: Sofosbuvir/Ledipasvir Combination Treatment MedicalResearch.com Interview with: Prof Eric Lawitz MD Vice President of Scientific and Research Development at The Texas Liver Institute Clinical professor of Medicine San Antonio University of Texas Health Science Center. • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Lawitz: The results of LONESTAR suggest that the sofosbuvir/ledipasvir combination tablet has the potential to offer HCV patients a significantly improved treatment regimen, irrespective of their treatment history or whether they have cirrhosis. The combination tablet also has the potential to cure HCV much more rapidly than the current standard of care, and in a far more convenient form – just one pill taken once a day for as a little as 8 weeks. So these are potentially highly significant results for the treatment of hepatitis C. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Lawitz: While the results of LONESTAR are very promising, as a Phase 2 study it only included 100 patients, which is a relatively small number. Large-scale, Phase 3 studies are needed to confirm these findings. Three clinical trials of this size are now testing the sofosbuvir/ledipasvir combination tablet, and we should have results from all of these studies by early 2014. Citation: Sofosbuvir and ledipasvir fixed-dose combination with and without ribavirin in treatment-naive and previously treated patients with genotype 1 hepatitis C virus infection (LONESTAR): an openlabel, randomised, phase 2 trial Prof Eric Lawitz MD,Prof Fred F Poordad MD,Phillip S Pang MD,Robert H Hyland DPhil,Xiao Ding PhD,Hongmei Mo PhD,William T Symonds PharmD,John G McHutchison MD,Fernando E Membreno MD The Lancet – 5 November 2013 DOI: 10.1016/S0140-6736(13)62121-2 Read the rest of the interview on MedicalResearch.com
  • 75. Dabigatran: Comparison Mini-Sentinel Clinical Trials and GI Bleeding MedicalResearch.com Interview with: Ilke Sipahi, MD Department of Cardiology Acibadem University Medical School, Istanbul, Turkey Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio • • • • • • • • MedicalResearch.com: Were you surprised at the extreme difference between these 2 analyses? Answer: I was surprised. However, it is not unusual to find completely contradictory results in medical studies. I was more surprised at the fact that FDA paid more attention to it administrative observational dataset rather than the huge large randomized clinical trials, all showing excess GI bleeds with dabigatran (Pradaxa). Anyone who is even slightly familiar with the medical literature knows that randomized trials are the gold standard in medical studies. MedicalResearch.com: How should clinicians react to these findings? What do we tell patients? Answer: Clinicans should know the Pradaxa leads to more GI bleeds compared to the old anticoagulant. Pradaxa is commonly market as a drug that leads to both fewer bleeding events, as well as fewer events due to blood clots. This does not hold true for GI bleeds. Indeed Pradaxa leads to more GI bleeds. Physicians should be very cautious to use these drugs in patients with history of GI problems. Perhaps even more importantly, one of our previous study shows that Pradaxa also leads to an increased risk of heart attacks. So this is a drug with extremely important side effects and patients should know these important facts. MedicalResearch.com: What main message would you hope for physicians to take away from this research? Answer: Once again we see that the side effect profile of a new drug is not known well at the time of approval of the drug. The last few years’ research shed light on to the adverse effects of Pradaxa. While the introduction of these new anticoagulants is an important step forward in medicine, we should know that in medicine newer is not necessarily better in every aspect. Citation: A Comparison of Results of the US Food and Drug Administration’s Mini-Sentinel Program With Randomized Clinical Trials The Case of Gastrointestinal Tract Bleeding With Dabigatran Sipahi I, Celik S, Tozun N. A Comparison of Results of the US Food and Drug Administration’s Mini-Sentinel Program With Randomized Clinical Trials: The Case of Gastrointestinal Tract Bleeding With Dabigatran. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.12217. Read the rest of the interview on MedicalResearch.com
  • 76. Venous Thrombosis: Decreased Kidney Function Raises Risk MedicalResearch.com Interview with: Frits R. Rosendaal PhD Department of Clinical Epidemiology Leiden University Medical Center, Leiden, The Netherlands • • MedicalResearch.com: What are the main findings of the study? Answer: In our study, we found that moderately to severely decreased kidney function was associated with a 2.6-fold (95%CI 2.0-3.5) increased risk of venous thrombosis as compared with normal kidney function. Several hemostatic factors showed a procoagulant shift with decreasing kidney function, most notably factor VIII and von Willebrand factor. We showed that the increased risk of venous thrombosis in chronic kidney disease could not be explained by confounding factors such as body mass index, diabetes, hospitalization, or corticosteroid use. However, we found that factor VIII and von Willebrand factor fully explained the increased risk of venous thrombosis associated with impaired kidney function. • • MedicalResearch.com: Were any of the findings unexpected? Answer: To our knowledge, this is the first study that investigated increased levels of hemostatic factors as an explanation for the risk of venous thrombosis in individuals with a decreased kidney function. The increased risk of venous thrombosis in individuals with moderately to severely decreased kidney function was not unexpected. However, the finding that factor VIII and von Willebrand factor fully explained the association between kidney function and venous thrombosis is, as far as we know, a novel finding. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: A 2.6-fold increased risk of venous thrombosis for moderately to severely decreased kidney function probably does not justify thromboprophylaxis in all patients with decreased kidney function (since such a strategy is unlikely to outweigh the bleeding risk). However, our data imply that chronic kidney disease is a procoagulant state, for which patients may receive thromboprophylaxis when encountering a high venous thrombosis risk situation. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: First, findings from our study reinforce that that future studies should aim to identify high risk groups within patients with chronic kidney disease that may benefit from thromboprophylaxis. Second, studies that investigate whether a procoagulant state (and hence venous thrombosis risk) can be downsized in patients with chronic kidney disease by means of cardiovascular drugs that are often given to patients with chronic kidney disease may be of interest (e.g. statins). Third, it would be of interest to further clarify the underlying mechanism, i.e. explain how kidney disease leads to high levels of factor VIII and von Willebrand factor. Citation: Role of Hemostatic Factors on the Risk of Venous Thrombosis in Persons with Impaired Kidney Function Gürbey Ocak, Carla Y. Vossen, Willem M. Lijfering, Marion Verduijn, Friedo W. Dekker, Frits R. Rosendaal, and Suzanne C. Cannegieter Circulation. 2013;CIRCULATIONAHA.113.002385published online before print November 8 2013, doi:10.1161/CIRCULATIONAHA.113.002385 • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 77. HER2-positive Breast Cancer and Adjuvant Chemotherapy MedicalResearch.com Interview with: Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TX • • MedicalResearch.com: What are the main findings of the study? Dr. Hunt: The primary endpoint of the Z1041 trial was the proportion of patients who had pathological complete response in the breast, defined as the percentage of women who started the neoadjuvant treatment with no histological evidence of disease in the breast at surgery. We found that high pathologic response rates were observed in both treatment groups with similar cardiac safety profiles in both arms of the trial. Specifically, 56.5% of patients in the sequential group (fluorouracil, epirubicin and cyclophosphamide on day one of a 21-day cycle for four cycles followed by paclitaxel plus trastuzumab weekly for 12 weeks) had a complete pathological response versus 54.2% of the patients who received the concurrent regimen (paclitaxel and trastuzumab weekly for 12 weeks followed by fluorouracil, epirubicin and cyclophosphamide on day one of a 21day cycle with trastuzumab on days one, eight and 15 of the 21-day cycle for four cycles). The difference in pathologic complete response rates between the treatment arms was not statistically significant. Cardiac safety was a secondary endpoint of the trial and we found that both regimens had acceptable cardiac safety profiles. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Hunt: Based on results of previous trials, including a study performed at MD Anderson Cancer Center which was the basis for the current trial, we expected that the pathologic complete response rates would be higher in those patients who received the concurrent regimen where they received trastuzumab concurrently with both anthracyclines and taxanes in the neoadjuvant setting. In fact we found that similar high pathologic response rates were achieved whether the trastuzumab was delivered concurrently or sequentially with the anthracycline regimen. Read the rest of the interview on MedicalResearch.com
  • 78. HER2-positive Breast Cancer and Adjuvant Chemotherapy MedicalResearch.com Interview with: Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TX • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Hunt: The take-home message is that concurrent administration of trastuzumab with anthracyclines does not provide additional benefit in terms of pathologic complete response rates in the neoadjuvant setting and therefore is not warranted. Therefore clinicians can avoid this concurrent regimen and alleviate some of the concerns about cardiac toxicity. The standard chemotherapy agents utilized in this trial provided significant response in HER-2-positive breast cancer and the rates of pathologic complete response are similar to those seen with newer agents being evaluated in the neoadjuvant setting. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Hunt: Future trials will be focused on which patients can be treated with a standard regimen like that utilized in the Z1041 trial and avoid the cost and toxicity of additional agents. We are currently utilizing genomic studies to evaluate which tumors are most likely to respond to this regimen and which will be resistant. In addition, future studies will focus on which patients may benefit from the newer biologic therapies without the need for chemotherapy. Citation: Fluorouracil, epirubicin, and cyclophosphamide (FEC-75) followed by paclitaxel plus trastuzumab versus paclitaxel plus trastuzumab followed by FEC-75 plus trastuzumab as neoadjuvant treatment for patients with HER2-positive breast cancer (Z1041): a randomised, controlled, phase 3 trial Prof Aman U Buzdar MD,Prof Vera J Suman PhD,Prof Funda Meric-Bernstam MD,Prof A Marilyn Leitch MD,Prof Matthew J Ellis FRCP,Judy C Boughey MD,Gary Unzeitig MD,Prof Melanie Royce MD,Linda M McCall MS,Prof Michael S Ewer MD,Prof Kelly K Hunt MD,on behalf of the American College of Surgeons Oncology Group investigators The Lancet Oncology – 13 November 2013 DOI: 10.1016/S1470-2045(13)70502-3 Read the rest of the interview on MedicalResearch.com
  • 79. Venous Thromboembolism: Risk of First Blood Clots in Hospitalized Pregancy Women MedicalResearch.com Interview with: Alyshah Abdul Sultan, doctorate student Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2 City Hospital, Nottingham NG5 1PB, UK • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Overall, we found that hospitalisation during pregnancy was associated with an excess risk of 16.6 cases per 1,000 person-years compared with time outside hospital (17.5-fold increase in risk). There was also an excess risk of 5.8 cases per 1,000 person years in the 28 days after discharge with VTE events more likely to occur in the third trimester of pregnancy and in women aged 35 years and over. MedicalResearch.com: Were any of the findings unexpected? Answer: These results are not that surprising as higher risk of VTE during hospital admission has already been demonstrated in non-pregnant general non-pregnant population. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: In the light of our findings pregnant hospitalized women should receive careful considerations in terms of VTE risk assessment especially those in their third trimester or age>35 years. The should also receive careful consideration the in the post-discharge period. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: An even bigger study which can look into the reasons for each hospitalistion Citation: Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England Abdul Sultan A ,West J ,Tata LJ ,Fleming KM ,Nelson-Piercy C ,Grainge MJ. Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England. BMJ 2013;347:f6099 Read the rest of the interview on MedicalResearch.com
  • 80. Dementia: Mini-Screen Tool MedicalResearch.com Interview with: Dr. Soo Borson, M.D. Professor Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Borson: We developed a new short screen to help clinicians and health care systems identify dementia patients and their caregivers who have unmet needs for dementia care services – extra help from primary care providers or clinical specialists skilled in understanding and managing problems related to dementia, working with caregivers to alleviate stress and burden, and locating community-based support services. MedicalResearch.com: Were any of the findings unexpected? Dr. Borson: Yes. We were surprised by the power of a simple stress question and a short problem behavior list to predict needs and gaps in dementia-related services, and by how little other clinical and psychosocial factors added to those two elements. In addition, we didn’t expect that needs would as great in early stages of dementia as we actually observed. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Borson: Medical and psychosocial services for dementia related problems are needed by both patients and caregivers, even in the milder stages of Alzheimer’s disease that are encountered most often in primary care settings. We believe our study could help reduce barriers to delivering high quality dementia care services by improving recognition of dyads who need them most. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Borson: The Dementia Services Mini-Screen – the tool we developed in this study – is ready for testing in clinical practices and health care systems striving to become members of a ‘dementia-capable’ health care community. Citation: The Dementia Services Mini-Screen: A Simple Method to Identify Patients and Caregivers Needing Enhanced Dementia Care Services Soo Borson, James M. Scanlan, Tatiana Sadak, Mary Lessig, Peter Vitaliano The American Journal of Geriatric Psychiatry – 14 November 2013 (10.1016/j.jagp.2013.11.001) Read the rest of the interview on MedicalResearch.com
  • 81. Thyroid Cancer: Increase in BRAF, RAS Mutations MedicalResearch.com Interview Yuri E. Nikiforov, M.D., Ph.D. Professor of Pathology, Vice Chair for Molecular Pathology Director, Division of Molecular & Genomic Pathology Department of Pathology, University of Pittsburgh Pittsburgh, PA • • • MedicalResearch.com: What are the main findings of the study? Dr. Nikiforov: This is examined temporal changes in mutational profiles and standardized histopathologic features of thyroid cancer in the U.S. over the last four decades. It showed a significant change in molecular profiles of thyroid cancer during the past 40 years as it determined two major trends in changing the mutational make-up of thyroid cancer: a rapid increase in the prevalence of RAS mutations, particularly for the last 10 years, and continuous decrease in frequency of RET/PTC rearrangement. The rising incidence of RAS mutations points to new and more recent etiologic factors, probably of a chemical or dietary nature. The decreasing incidence of RET/PTC rearrangements, a known marker of high-dose environmental and medical radiation, suggest that the impact of ionizing radiation, at least as related to high-dose environmental exposures and historical patterns of radiation treatment for benign conditions, is diminishing. MedicalResearch.com: Were any of the findings unexpected? Dr. Nikiforov: One of the unexpected finding was a stable and high incidence of BRAF mutations. These mutations are known to occur in progressive and clinically relevant cancers, and this finding suggests that the continuous increase in the incidence of thyroid cancer observed in the U.S. and many other countries is unlikely to be only due to better surveillance leading to the detection of small, non-progressing, and clinically irrelevant cancers. Read the rest of the interview on MedicalResearch.com
  • 82. Thyroid Cancer: Increase in BRAF, RAS Mutations MedicalResearch.com Interview Yuri E. Nikiforov, M.D., Ph.D. Professor of Pathology, Vice Chair for Molecular Pathology Director, Division of Molecular & Genomic Pathology Department of Pathology, University of Pittsburgh Pittsburgh, PA • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Nikiforov: That the increasing incidence of thyroid cancer is likely to be real and is not simply due to overdiagnosing thyroid cancer. The study we report does not imply that all or most thyroid cancers are aggressive and have to be treated extensively, but it suggests that this disease requires attention and that early diagnosis and appropriate treatment is important. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Nikiforov: The study shows, for the first time in any cancer type, a significant change in molecular profiles of thyroid cancer during the past 40 years. The obtained data suggest that the molecular landscape of thyroid cancer, and likely of other cancer types, is not static and changes over time, probably reflecting the constant change in environmental factors and behavioral patterns of humans. It means that the data on mutational profiles being obtained for multiple cancer types, reflect the situation at the time of the study and may not be extrapolated longitudinally. Additional studies are needed to answer the question if the molecular profiles of all major cancer types evolve over time. Citation: The increase in thyroid cancer incidence during the last four decades is accompanied by a high frequency of BRAF mutations and a sharp increase in RAS mutations J Clin Endocrinol Metab. 2013 Nov 18. [Epub ahead of print] Jung CK, Little MP, Lubin JH, Brenner AV, Wells SA Jr, Sigurdson AJ, Nikiforov YE. Department of Pathology (C.K.J., Y.E.N.), University of Pittsburgh, Pittsburgh, PA, 15261, USA; Department of Hospital Pathology (C.K.J.), The Catholic University of Korea, Seoul 137-701, Republic of Korea; Radiation Epidemiology and Biostatistics Branches (J.H.L., A.V.B., M.P.L. A.J.S.), Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA; Cancer Genetics Branch, National Cancer Institute, (S.A.W.) National Institutes of Health, Bethesda, MD, 20892, USA Read the rest of the interview on MedicalResearch.com
  • 83. Testosterone Levels: Middle Range Better for Older Men MedicalResearch.com Interview with: Dr Bu Beng Yeap MBBS, FRACP, PhD Professor, School of Medicine and Pharmacology, University of Western Australia Endocrinologist, Department of Endocrinology and Diabetes, Fremantle Hospital. • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: We found that older men with testosterone levels in the middle of the range had the lowest mortality risk. Having a low testosterone level predicted higher mortality, and there was no benefit of having a high-normal testosterone level. Men with optimal rather than high testosterone levels lived longest. The other important finding was that men with higher dihydrotestosterone levels had lower mortality from ischaemic heart disease, suggesting that androgens may protect against heart disease in older men. MedicalResearch.com: Were any of the findings unexpected? Answer: The U shaped association of testosterone levels with mortality risk was unexpected, as was the finding that dihydrotestosterone rather than testosterone was a robust biomarker for ischaemic heart disease deaths. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Having the right level of testosterone might be better than having a high level. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We need further studies including randomised controlled trials to determine whether testosterone would preserve health in ageing men. Citation: In Older Men an Optimal Plasma Testosterone Is Associated With Reduced All-Cause Mortality and Higher Dihydrotestosterone With Reduced Ischemic Heart Disease Mortality, While Estradiol Levels Do Not Predict Mortality Bu B. Yeap, Helman Alfonso, S. A. Paul Chubb, David J. Handelsman, Graeme J. Hankey, Osvaldo P. Almeida, Jonathan Golledge, Paul E. Norman, and Leon Flicker JCEM jc.2013-3272; doi:10.1210/jc.2013-3272 Read the rest of the interview on MedicalResearch.com
  • 84. Benign Prostatic Hyperplasia BPH: Tamsulosin and Hypotension MedicalResearch.com Interview with: Mahyar Etminan Assistant Professor University of British Columbia Therapeutic Evaluation Unit, Provincial Health Services Authority University of British Columbia, Vancouver • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Tamsulosin resulted in a roughly doubled risk for hypotension needing hospital admission during the first eight weeks after tamsulosin initiation and first eight weeks after restarting tamsulosin treatment. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Physicians should focus on improving counseling strategies to warn patients regarding the first dose phenomenon. Optimal drug adherence should be promoted, given these drugs increase risk for hypotension immediately after gaps in drug therapy. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future work is needed to determine whether genetic characteristics or other nonmeasured risk factors may modify susceptibility to hypotension with tamsulosin. Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. Citation: Bird ST ,Delaney JAC ,Brophy JM ,Etminan M ,Skeldon SC ,Hartzema AG. Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. BMJ 2013;347:f6320 Read the rest of the interview on MedicalResearch.com
  • 85. Stroke: Using CLOTBUST-ER Ultrasound Device MedicalResearch.com Interview with: Andrew D. Barreto, M.D. Assistant Professor of Neurology University of Texas, Houston • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Barreto: Applying a novel, operator-independent device used to produce ultrasound energy through the skull of stroke patients receiving IV-tPA (intravenous clot-busting medication that is the standard treatment for stroke patients) was safe – no signal of increased risk of symptomatic intracerebral hemorrhage (brain bleeding). Rates of recanalization (clot dissolution) were consistent with prior work that suggest aiming transcranial Doppler ultrasound energy at the clot amplifies the clot-busting effect of tPA alone. MedicalResearch.com: What should clinicians and patients take away from your report? 
 Dr. Barreto: Although more data is necessary, our results suggest that this new device might be substituted for an ultrasound expert at the bedside to provide skill in aiming the ultrasound energy at the clot causing strokes. Thus, if sonothrombolysis (term used to describe the clot-dissolving effect of ultrasound) is proven effective, this new device could be placed on the head of any stroke patient anywhere since it does not require a skilled technician or physician. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Barreto: The device needs more study and I am happy to report that the necessary (and pivotal) study is actually on-going. See the CLOTBUST-ER study (www.clinicaltrials.gov NCT01098981). This study is a large, double-blinded international study of 830 stroke patients randomized to receive tPA + 2-hours of ultrasound vs. tPA alone (sham ultrasound). Results of CLOTBUST-ER will hopefully confirm that not only does sonothrombolysis recanalize more brain arteries, but patients have improved outcomes (less disability) at 3months. Citation: CLOTBUST-Hands Free: Pilot Safety Study of a Novel Operator-Independent Ultrasound Device in Patients With Acute Ischemic Stroke. Barreto AD, Alexandrov AV, Shen L, Sisson A, Bursaw AW, Sahota P, Peng H, Ardjomand-Hessabi M, Pandurengan R, Rahbar MH, Barlinn K, Indupuru H, Gonzales NR, Savitz SI, Grotta JC. From the Department of Neurology, Stroke Program (A.D.B., L.S., A.W.B., P.S., H.I., N.R.G., S.I.S., J.C.G.) and Center for Clinical and Translational Sciences (H.P., M.A.-H., R.P., M.H.R.), University of Texas Health Science Center at Houston, TX; Comprehensive Stroke Center, Department of Neurology, The University of Alabama at Birmingham (A.V.A., A.S.); and Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany (K.B.) Stroke. 2013 Oct 24. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 86. Alzheimer’s Disease and High Blood Pressure MedicalResearch.com Interview with: Dan Nation Assistant Professor, Department of Psychology at University of Southern California Veterans Affairs San Diego Healthcare System • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: The main study findings indicate that high blood pressure, specifically pulse pressure (systolic – diastolic pressure), is associated with increased markers of Alzheimer’s disease in the cerebral spinal fluid of healthy middle-aged adults. These results suggest a connection between blood pressure and Alzheimer’s disease prior to the onset of any symptoms of the disease. MedicalResearch.com: Were any of the findings unexpected? Answer: The findings suggest a connection between blood pressure and Alzheimer‘s disease during the earliest stages of the disease. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: The findings are only correlational, so causation cannot be inferred, but if the correlation is due to a causal effect of blood pressure on Alzheimer‘s disease then control of blood pressure in midlife could help prevent Alzheimer’s disease. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future studies should determine whether controlling blood pressure, including pulse pressure specifically, at the earliest stage of the disease slows the progressive increase in Alzheimer’s biomarkers or delays the onset of symptoms. Citation: Pulse pressure is associated with Alzheimer biomarkers in cognitively normal older adults Daniel A. Nation, PhD, D. Edland, PhD, Mark W. Bondi, PhD, David P. Salmon, PhD, Lisa DelanoWood, PhD, Elaine R. Peskind, MD, Joseph F. Quinn, MD and Douglas R. Galasko, MD Published online before print November 13, 2013, doi: 10.1212/01.wnl.0000436935.47657.78 Neurology Read the rest of the interview on MedicalResearch.com
  • 87. Pancreatic Cancer: Frequent Nut Consumption May Reduce Risk MedicalResearch.com Interview with: Ying Bao, MD, ScD Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School Boston, MA. • • MedicalResearch.com: What are the main findings of the study? Dr. Bao: Frequent nut consumption is inversely associated with risk of pancreatic cancer in women, independent of other potential risk factors for pancreatic cancer. • • • • • • • MedicalResearch.com: Were any of the findings unexpected? Dr. Bao: No. Nuts are a rich source of bioactive components that may confer antioxidant, anti-inflammatory, or anticancer properties. For example, previous studies reported that nut consumption was associated with decreased insulin levels, a lower prevalence of abdominal obesity and metabolic syndrome, and a lower risk of type 2 diabetes; and insulin resistance, obesity, and diabetes are all risk factors for pancreatic cancer. Moreover, nuts are rich in vitamins; and high serum alpha-tocopherol, the biologically active form of vitamin E, was associated with a reduced risk of pancreatic cancer in a large prospective cohort study. This evidence also supports a role of nuts in pancreatic cancer prevention. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Bao: Increased nut consumption was associated with a reduced risk of pancreatic cancer in this large prospective cohort study of women. But additional confirmatory studies are warranted. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Bao: Although well-conducted randomized clinical trials would be ideal, more data from large prospective cohort studies are needed to confirm our findings. In addition, the association between nut intake and survival among pancreatic cancer patients is also an intriguing area of research. Citation: Nut consumption and risk of pancreatic cancer in women Y Bao, F B Hu, E L Giovannucci, B M Wolpin, M J Stampfer, W C Willett and C S Fuchs British Journal of Cancer , (22 October 2013) | doi:10.1038/bjc.2013.665 Read the rest of the interview on MedicalResearch.com
  • 88. Concussion: Gray Matter Abnormalities vs Self-Reported Symptoms MedicalResearch.com Interview with: Dr. Andrew R. Mayer, PhD The Mind Research Network Lovelace Biomedical and Environmental Research Institute • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mayer: a) Just because mTBI patients self-report reduced and/or no post-concussive symptoms does not mean that they have completed the healing process. b) Current gold-standards in the clinical world (CT scans and self-report) may not be accurately capturing brain health after injury. c) Diffusion imaging shows promise for being a more sensitive biomarker for measuring recovery than currently used techniques. MedicalResearch.com Were any of the findings unexpected? Dr. Mayer: No. We have observed similar findings previously in both adult and pediatric patients. MedicalResearch.com What should clinicians and patients take away from your report? Dr. Mayer: The field only has a preliminary understanding of the pathophysiological effects of mTBI/concussion and the subsequent recovery from these injuries. More work is needed to develop objective bio-markers about when it is truly safe to return to physical activities. MedicalResearch.com What recommendations do you have for future research as a result of this study? Dr. Mayer: The current results are based on small sample (50 mTBI patients) and need to be replicated in an independent study. Objective characterization of concussion is a must for the field to move forward. Citation: A prospective study of gray matter abnormalities in mild traumatic brain injury Josef M. Ling, BA, Stefan Klimaj, BA, Trent Toulouse, PhD and Andrew R. Mayer, PhD Published online before print November 20, 2013, doi: 10.1212/01.wnl.0000437302.36064.b1 Neurology Read the rest of the interview on MedicalResearch.com
  • 89. Bullying: Sexual Risk Taking Among Adolescents MedicalResearch.com Melissa K. Holt, PhD School of Education, Boston University Boston, Massachusetts • • • • • • • • • • • MedicalResearch.com: What are the main findings? Dr. Holt: Results from this study indicated that among the sample of adolescents surveyed, bullies and bully-victims (i.e., youth who are both perpetrators and targets of bullying) engaged in more sexual risk taking behaviors than their peers. Specifically, they were more likely to report casual sex and sex under the influence of alcohol or drugs. For instance, 33.8% of bullies and 23% of bully-victims reported sex under the influence of alcohol or drugs in contrast to 14% of youth not involved in bullying. Notably, findings suggested that bullying involvement might be a more salient predictor of sexual risk taking for heterosexual than GLBTQ adolescents. MedicalResearch.com: Were any of the findings unexpected? Dr. Holt: One somewhat surprising finding was that bullying experiences significantly predicted sexual risk taking, over and above other adverse childhood experiences (e.g., child maltreatment, dating violence). This suggests that bullying experiences might have a particularly strong influence on sexual risk taking. MedicalResearch.com What are the take away messages? Dr. Holt: One recommendation based on study findings is that bullying prevention programs should consider addressing the potential link between bullying and sexual risk taking. This could be accomplished by taking a broader stress and coping perspective to better address the potential ways in which bullying involvement influences other areas of functioning. MedicalResearch.com: What are your recommendations for future research? Dr. Holt: Given that findings suggested that bullying involvement might be a more salient predictor of sexual risk taking for heterosexual than GLBTQ adolescents, additional research could address how coping responses to bullying involvement might differ for GLBTQ youth. Citation: Sexual Risk Taking and Bullying Among Adolescents Melissa K. Holt, Jennifer L. Matjasko, Dorothy Espelage, Gerald Reid, and Brian Koenig Pediatrics peds.2013-0401; published ahead of print November 11, 2013, doi:10.1542/peds.2013-0401 Read the rest of the interview on MedicalResearch.com
  • 90. Burkitt’s Lymphoma: Effectivenss of Low-Intensity Therapy MedicalResearch.com Interview with Kieron M. Dunleavy, M.D. Metabolism Branch Lymphoma Therapeutics Section Center for Cancer Research National Cancer Institute, Bethesda, MD 20892 • • MedicalResearch.com: What are the main findings of the study? Dr. Dunleavy: We found that low-intensity therapy was highly effective in Burkitt’s lymphoma and cured over 95% of patients with the disease. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Dunleavy: Burkitt’s lymphoma is typically treated with very intensive chemotherapy regimens so the fact that it can be successfully treated with low-intensity therapy represents a paradigm shift. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Dunleavy: Low-intensity therapy (EPOCH-R based treatment) is highly effective in Burkitt’s lymphoma and associated with low toxicity compared to standard Burkitt’s lymphoma regimens. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Dunleavy: To validate these results, we are currently studying this approach in a multi center study of Burkitt’s lymphoma and the approach is also being tested in a pediatric study. Citation: Low-Intensity Therapy in Adults with Burkitt’s Lymphoma Kieron Dunleavy, M.D., Stefania Pittaluga, M.D., Ph.D., Margaret Shovlin, R.N., Seth M. Steinberg, Ph.D., Diane Cole, M.S., Cliona Grant, M.D., Brigitte Widemann, M.D., Louis M. Staudt, M.D., Ph.D., Elaine S. Jaffe, M.D., Richard F. Little, M.D., and Wyndham H. Wilson, M.D., Ph.D. N Engl J Med 2013; 369:1915-1925November 14, 2013DOI: 10.1056/NEJMoa1308392 • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 91. Coffee: Caffeine Improves Microvascular Endothelial Function MedicalResearch.com Interview with: Masato Tsutsui, MD, PhD, FAHA Professor and Chairman Department of Pharmacology Graduate School of Medicine University of the Ryukyus Okinawa 903-0215, Japan • • MedicalResearch.com: What are the main findings of the study? Dr. Tsutsui: A recent large prospective study reported that coffee consumption is associated with reduced mortality for cardiovascular disease (NEJM 2012). However, its precise mechanisms remain to be clarified. Our double-blind, placebo-controlled, crossover study demonstrated, for the first time, that caffeine contained in a cup of coffee ameliorates microvascular endothelial function in healthy individuals. These findings may explain, at least in part, the association of coffee consumption with reduced mortality for cardiovascular disease. • • MedicalResearch.com: Were any of the findings unexpected?
 Dr. Tsutsui: Coffee might adversely affect cardiovascular health. However, our study suggests that caffeinated coffee improves microvascular endothelial function. What this beneficial effect was observed by only a cup of caffeinated coffee is also an interesting finding. MedicalResearch.com: What should clinicians and patients take away from this study? Dr. Tsutsui: Our study subjects were healthy persons. Whether or not caffeine contained in a cup of coffee is beneficial to patients with cardiovascular disease remains to be examined in future studies. MedicalResearch.com: What further research do you recommend as a result of your study? Dr. Tsutsui: We examined only a small number of subjects (n=27). Our findings should be confirmed by large-scale clinical studies. Furthermore, whether or not caffeine contained in a cup of coffee is beneficial to patients with cardiovascular disease also should be studied. Addendum: Dr. Tsutsui: Although the AHA News Release says that caffeine contained in a cup of coffee improves finger blood flow, it is not correct. Correctly, it improved reactive hyperemia of finger blood flow. Let me explain reactive hyperemia of finger blood flow. Reactive hyperemia is a marker of vascular endothelial function, and reactive hyperemia of finger blood flow is a marker of microvascular endothelial function. Reactive hyperemia of finger blood flow was measured by laser Doppler flowmetry. A flow-probe of laser Doppler flowmetry was placed at the tip of the left index finger or thumb, and a manchette was placed on the left upper arm. Reactive hyperemia of finger blood flow was induced by inflating a manchette for 1 minute in order to interrupt finger arterial blood flow, and then deflating the manchette. Reactive hyperemia was evaluated by the extent of an increase in finger blood flow after deflating a manchette. Caffeine contained in a cup of coffee improved reactive hyperemia of finger blood flow, but not finger blood flow. Citation: Presented at the 2013 American Heart Association American Heart Association Meeting Report: Abstract 12428 (Hall F, Core 7, Poster Board: 7062) Co-authors are Katsuhiko Noguchi, Ph.D.; Toshihiro Matsuzaki, M.D., Ph.D.; Mayuko Sakanashi, Ph.D.; Naobumi Hamadate, Ph.D.; Taro Uchida; B.Sc.; Mika Kina-Tanada, D.D.S.; Haruaki Kubota, M.D.; Junko Nakasone, Ph.D.; Matao Sakanashi, M.D., Ph.D.; Fumihiko Kamezaki, M.D., Ph.D.; Akihide Tanimoto, M.D., Ph.D.; Nobuyuki Yanagihara, Ph.D.; Yusuke Ohya, M.D., Ph.D.; Hiroaki Masuzaki, M.D., Ph.D.; and Shogo Ishiuchi, M.D., Ph.D. • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • 92. Ischemic Stroke after Synthetic Marijuana Use MedicalResearch.com Interview with: W. Scott Burgin, MD Professor and Chief, Cerebrovascular Division Director, Comprehensive Stroke Center Department of Neurology USF College of Medicine Tampa General Hospital Stroke Center. • • • • • • • • • • • MedicalResearch.com What are the main findings of the study? Dr. Burgin: Two cases of stroke, of embolic appearance, shortly after smoking synthetic marijuana. MedicalResearch.com Were any of the findings unexpected? Dr. Burgin: This is a relatively new recreational drug class, and not much is known about its toxicity. MedicalResearch.com What should clinicians and patients take away from your report? Dr. Burgin: Synthetic marijuana constitutes a wide range of potential chemicals, and there can be any number of organic materials that it is sprayed on to allow it to be smoked. The toxicities of these agents are unclear, the purities and sources of the drugs are unknown, and the potential interactions are uncertain. This should not be regarded as a safer alternative to organic marijuana. Physicians should be alert for newer designer drugs, such as synthetic marijuana, particularly when presenting with neurological symptoms. These are not detected on most common drug screens, and require special testing. MedicalResearch.com What recommendations do you have for future research as a result of this study? Dr. Burgin: This is only an observational report. More study will be required. Citation: Ischemic stroke after use of the synthetic marijuana “spice” Freeman MJ, Rose DZ, Myers MA, Gooch CL, Bozeman AC, Burgin WS. From the Department of Neurology, University of South Florida, Tampa. Neurology. 2013 Nov 8. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 93. Cognitive Decline: Dietary Patterns Associations MedicalResearch.com: Samantha Gardener PhD Student Senior Research Assistant for DIAN and AIBL Studies McCusker Alzheimer’s Research Foundation NEDLANDS Western Australia • • • • • • • MedicalResearch.com: What are the main findings of your study? Answer: Our research indicates that consuming larger quantities of foods included in a western dietary pattern is associated with greater cognitive decline in visuospatial functioning after 36 months. Foods included in the western dietary pattern are red and processed meats, high fat dairy products, chips, refined grains, potatoes, sweets and condiments. Visuospatial functioning is an area which includes distance and depth perception, reproducing drawings and using components to construct objects or shapes. In contrast, adherence to the Mediterranean diet, a healthy eating pattern is associated with less decline in executive function. Foods included in the Mediterranean diet are vegetables, fruits and fish. Examples of executive function include planning and organising, problem solving and time management. We saw no effect on other areas of cognition, including verbal and visual memory, language and attention and any of the three dietary patterns. These associations were seen after controlling for the effect of known Alzheimer’s disease risk factors including age, cardiovascular risk factors and presence of an Apolipoprotein ɛ4 allele which is the most common genetic risk factor for Alzheimer’s disease. The world’s population is growing older due to improved healthcare and nutrition. As a result, Alzheimer’s disease prevalence is rapidly increasing. Cognitive decline is the progressive loss of cognitive functions, including memory, and may lead to dementia, of which Alzheimer’s disease is the most common type. The focus of the current research climate is shifting from understanding Alzheimer’s disease pathology and diagnosis to primary prevention and intervention strategies. Diet represents one potential intervention strategy accessible to all. There is increasing evidence that components in the foods we consume interact with each other to impart disease protection and a higher level of health. The evidence for health benefit appears stronger when foods are inserted into synergistic dietary patterns, rather than considered as individual foods or food constituents. Our findings are in agreement with previously published work on dietary patterns and cognitive decline. In American populations, it has been shown that higher Mediterranean diet adherence is associated with lower Alzheimer’s disease risk and slower cognitive decline. Higher consumption of a ‘whole foods’ pattern (similar to our prudent pattern) has been associated with less risk of cognitive deficits, and consumption of a ‘processed foods’ pattern (similar to our western pattern) has been associated with higher risk of cognitive deficits. Our results further highlight the importance of eating a healthy diet with respect to reducing risk for cognitive decline and Alzheimer’s disease. To our knowledge, this is the first study extensively comparing Mediterranean diet, western diet and prudent diet scores to cognitive decline in an elderly, Australian cohort, to assess protective and detrimental effects of these diets. Read the rest of the interview on MedicalResearch.com
  • 94. Cognitive Decline: Dietary Patterns Associations MedicalResearch.com: Samantha Gardener PhD Student Senior Research Assistant for DIAN and AIBL Studies McCusker Alzheimer’s Research Foundation NEDLANDS Western Australia • • • • The aim of our study was to investigate the association of three dietary patterns — Mediterranean diet, western diet and prudent diet — with cognitive change over three years, assessed using a comprehensive memory test. Dietary data was collected using food frequency questionnaires. Our results report on data from 527 men and women from a wellcharacterized, Australian elderly cohort, drawn from the larger Australian Imaging, Biomarkers and Lifestyle study of ageing. Dietary patterns have not been tested extensively for their association with maintaining cognition or reducing cognitive decline. The number of published studies in this area is fairly limited, and consequently there is a need for further investigation in well-characterized ageing cohorts. It is hoped that the information generated can be used in the development of preventative strategies against cognitive decline and Alzheimer’s disease. Citation: Gardener SL, et al “Dietary patterns and their association with cognitive decline: data from the Australian imaging, biomarkers, and lifestyle study of ageing” SFN 2013; Abstract 89.01/FFF12. Read the rest of the interview on MedicalResearch.com
  • 95. Type 2 Diabetes: Ambulatory Treatment in US MedicalResearch.com Interview with: Caleb Alexander, MD, MS Department of Epidemiology, Bloomberg School of Public Health Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Alexander: There have been large shifts in the types of treatments used to treat Type 2 diabetes during the past decade in the United States. We document large declines in the use of glitazones and sulfonylureas and important increases in the use of the newer DPP-4 inhibitors and GLP-1 agonists. We also found large shifts in the types of insulins used, with substantial reductions in the use of regular and intermediate insulins, and large increases in the use of long-acting and ultra short-acting therapies. Costs have increased significantly over the past 5 years, driven primarily by insulin and DPP-4 inhibitors All of these changes notwithstanding, biguanides continue to remain a mainstay of therapy. MedicalResearch.com: Were any of the findings unexpected? Dr. Alexander: Although the first GLP-1 agonist was approved a year prior to any DPP-4 inhibitor, and evidence suggests that GLP-1 agonists may be more efficacious with respect to glycemic endpoints, there has been low uptake of GLP-1 agonists, particularly compared with DPP-4 inhibitors. There have been larger than expected changes in the types of insulins used. There has been no substantial market recovery by glitazones following their rapid decline associated with emerging evidence of rosiglitazone’s cardiovascular risks, despite the fact that those risks continue to be debated. Read the rest of the interview on MedicalResearch.com
  • 96. Type 2 Diabetes: Ambulatory Treatment in US MedicalResearch.com Interview with: Caleb Alexander, MD, MS Department of Epidemiology, Bloomberg School of Public Health Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Alexander: There have been many important changes in the treatment of Type 2 diabetes in the United States during the past decade. – – • • • • • • • • Drugs and therapeutic areas such as diabetes exist in a dynamic landscape, and there are many drivers of the changes that we describe. Our study was not a study of quality of care, but patients and physicians alike should consider the degree to which their diabetes treatments reflects best practices. Caution and clinical prudence is particularly important to exercise with the use of newer therapies such as DPP-4 inhibitors and GLP-1 agonists whose long-term safety and comparative effectiveness has not been well characterized. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Alexander: Our study shows increases in treatment complexity, which begs for more studies determining the safety and effectiveness of combination products and multiple medications. As use of newer therapies grows, the long-term safety and effectiveness of these agents must be monitored Continued investigations of the benefits of long-acting insulin are important, particularly on its impact on glycemic control, morbidity and mortality. Citation: Ambulatory Treatment of Type 2 Diabetes Mellitus in The United States, 1997-2012 Diabetes Care. 2013 Nov 12. [Epub ahead of print] Turner LW, Nartey D, Stafford RS, Singh S, Alexander GC. Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland. Read the rest of the interview on MedicalResearch.com
  • 97. Metabolically healthy obese still at increased risk of diabetes, heart disease MedicalResearch.com Interview with: Carlos Lorenzo, MD Department of Medicine, University of Texas Health Science Center 7703 Floyd Curl Drive San Antonio, Texas 78229 • • • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Lorenzo: Metabolically healthy obese individuals are at increased risk of developing of diabetes and cardiovascular disease. These findings were demonstrated in men and women and in Mexican Americans and non-Hispanic whites. Management of excess weight and any metabolic abnormality appears to be important for all individuals. Our study is also in agreement with previous studies that indicate that metabolically unhealthy normal weight individuals are at increased risk of developing of diabetes and cardiovascular disease. MedicalResearch.com: Were any of the findings unexpected? Dr. Lorenzo: There is conflicting evidence regarding the risk of cardiovascular disease and mortality associated with the metabolically healthy obese phenotype. Our results suggest that the metabolically healthy obese phenotype is not a benign condition (at least not always). Our study also adds information of the risk of diabetes in these individuals. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Lorenzo: Physicians must not be overly complacent in assessing future cardiometabolic risk in metabolically healthy obese individuals. Normal weight individuals are also at increased risk if they are metabolically unhealthy (if they have multiple metabolic risk factors). MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Lorenzo: An expert consensus is needed to characterize both phenotypes: metabolically healthy obese and metabolically unhealthy normal weight. To determine how to detect non-obese individuals who will develop the metabolically healthy obese phenotype vs. the metabolically unhealthy obese phenotype To examine the metabolic stability over time of the metabolically healthy obese phenotype. Citation: Risk of Developing Diabetes and Cardiovascular Disease in Metabolically Unhealthy Normal-Weight and Metabolically Healthy Obese Individuals Department of Medicine, University of Texas Health Science Center KoKo Aung, Carlos Lorenzo, Marco A. Hinojosa, and Steven M. Haffner JCEM jc.2013-2832; doi:10.1210/jc.2013-2832 Read the rest of the interview on MedicalResearch.com
  • 98. Hospital Readmissions: Best US Hospitals Reduce Globally MedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical Center • • • • • • MedicalResearch.com: What were the main findings of the study Dr. Dharmarajan: In the United States, 1 in 5 older patients is readmitted to the hospital within 30 days of hospital discharge. However, there is great variation in rates of 30-day readmission across hospitals, and we do not know why some hospitals are able to achieve much lower readmission rates than others. We therefore wondered whether top performing hospitals with low 30-day readmission rates are systematically better at preventing readmissions from particular conditions or time periods after discharge. For example, are hospitals with low 30-day readmission rates after hospitalization for heart failure especially good at preventing readmissions due to recurrent heart failure or possible complications of treatment? Similarly, are top performing hospitals especially good at preventing readmissions that occur very soon after discharge, which may signify poor transitional care as the patient moves form the hospital back home? We found that hospitals with very different 30-day readmission rates after hospitalization for heart failure, heart attacks, and pneumonia had a similar spectrum of readmissions with regard to their diagnoses and timing. In other words, high performing hospitals had a lower absolute number of readmissions while maintaining a similar pattern of readmission diagnoses and timing as lower performing institutions. MedicalResearch.com: Were any of the findings unexpected? Dr. Dharmarajan: We actually hypothesized that top performing hospitals would show generalized excellence in reducing readmissions across all readmission diagnoses and time periods after discharge, as previous studies have linked high hospital performance with organizational and cultural characteristics that would be expected to apply broadly to a range of conditions and times after hospital discharge. Read the rest of the interview on MedicalResearch.com
  • 99. Hospital Readmissions: Best US Hospitals Reduce Globally MedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical Center • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Dharmarajan: Our study suggests that hospitals may best reduce readmissions with strategies that lower readmission risk globally rather than for specific diagnoses or time periods after admission. The best performing hospitals in the United States have empirically reduced across the board. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Dharmarajan: We need to perform further studies of top performing hospitals to better understand the specific strategies they have used to reduce readmissions. This may call for predominantly qualitative methodologies, which are relatively infrequently used in health services research. Citation: HOSPITAL READMISSION PERFORMANCE AND PATTERNS OF READMISSION: RETROSPECTIVE COHORT STUDY OF MEDICARE ADMISSIONS Dharmarajan K ,Hsieh AF ,Lin Z ,Bueno H ,Ross JS ,Horwitz LI ,et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ 2013;347:f6571 Read the rest of the interview on MedicalResearch.com

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