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MedicalResearch.com:  Medical Research Interviews
 

MedicalResearch.com: Medical Research Interviews

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MedicalResearch.com: Groundbreaking medical research interviews with scientists from major and specialty medical research journals.

MedicalResearch.com: Groundbreaking medical research interviews with scientists from major and specialty medical research journals.

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    MedicalResearch.com:  Medical Research Interviews MedicalResearch.com: Medical Research Interviews Presentation Transcript

    • MedicalResearch.com Interviews on contemporary Medical Research with medical researchers from major and specialty medical journals. Editor: Marie Benz, MD info@medicalresearch.com October 23, 2013 For Informational Purposes Only: Not for Specific Medical Advice.
    • Medical Disclaimer | Terms and Conditions • • • The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the MedicalResearch.comm 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 MedicalResearch.com Site! If you think you may have a medical emergency, call your doctor or 911 immediately. MedicalResearch.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 MedicalResearch.comm or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.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
    • Stroke in Type I Diabetes with Nephropathy, Retinopathy MedicalResearch.com Interview with: Stefanie Hägg, MB Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland • • • • MedicalResearch.com: What are the main findings of the study? Answer: We studied the incidence of stroke in a large cohort of patients with type 1 diabetes in Finland. During 36,680 person-years of follow-up, we found that the incidence of total stroke, and the subtypes cerebral infarction and cerebral hemorrhage was 406, 286, and 120 per 100,000 person-years, respectively, which is higher than in the Finnish general population, for whom the incidence of stroke varies between 135 and 236 per 100,000 person years. Furthermore, we studied the impact of two diabetic microvascular complications, diabetic nephropathy and severe diabetic retinopathy, on the risk of stroke, as well as for the subtypes of stroke. The incidence of stroke, cerebral infarction, and cerebral hemorrhage increased with both the presence of severe diabetic retinopathy and with advancing diabetic nephropathy. Furthermore, we found that both diabetic nephropathy and severe diabetic retinopathy increased the risk for all subtypes of stroke, independently of traditional risk factors. A novel finding was that already incipient diabetic nephropathy (microalbuminuria) increased the risk of stroke, cerebral infarction, and cerebral hemorrhage more than 3-fold, compared with patients free of renal disease. The highest risk of stroke was seen in patients with end-stage renal disease. MedicalResearch.com: Were any of the findings unexpected? Answer: One of our hypotheses were that the microvascular diabetic complications, diabetic nephropathy and severe diabetic retinopathy, would be associated with especially lacunar infarctions, which are thought to be of microvascular origin.. To our surprise, we could not observe an overrepresentation of lacunar infarctions among patients with diabetic nephropathy and severe diabetic retinopathy. This could possibly be explained by the fact that asymptomatic microvascular lesions are common also in patients with nonlacunar infarctions. Unfortunately, due to our methodology we were not able to address this issue in further detail. Read the rest of the interview on MedicalResearch.com
    • Stroke in Type I Diabetes with Nephropathy, Retinopathy MedicalResearch.com Interview with: Stefanie Hägg, MB Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: A novel finding was that severe diabetic retinopathy, independently from diabetic nephropathy, increased the risk of stroke. Furthermore, already when early signs of diabetic nephropathy (microalbuminuria) were present, the risk of suffering a stroke was increased. Therefore, early detection and treatment of both diabetic retinopathy and diabetic nephropathy is of great importance to possibly decrease the incidence of stroke in patients with type 1 diabetes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Although stroke is a devastating complication of diabetes, studies on stroke in type 1 diabetes are very limited. In this study we demonstrated that the two diabetic microvascular complications diabetic retinopathy and diabetic nephropathy increased the risk of stroke. Other independent risk factors are, however, largely unexplored. Therefore, in future research, we aim to study these risk factors in further detail. Citation: Incidence of Stroke According to Presence of Diabetic Nephropathy and Severe Diabetic Retinopathy in Patients With Type 1 Diabetes. Hägg S, Thorn LM, Putaala J, Liebkind R, Harjutsalo V, Forsblom CM, Gordin D, Tatlisumak T, Groop PH; on behalf of the FinnDiane Study Group. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland. Diabetes Care. 2013 Oct 7. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • Number, Success of Donor Egg Cycles Increase over Decade MedicalResearch.com Interview with: Dr. Jennifer Fay Kawwaas MD Department of Gynecology and Obstetrics Emory University School of Medicine, Atlanta, GA, USA • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Kawwaas: Using CDC National ART Surveillance System (NASS) data, we found an increasing trend from 2000 to 2010 in the number of donor egg cycles performed annually and in the percentage of donor cycles that resulted in a good outcome, defined as delivery of a full term infant weighing more than 5.5lbs. Donor and recipient ages remained relatively stable at 28 and 41, respectively, over the 11-year period. Elective single embryo transfer is recommended when the donor is under 35 years old, regardless of recipient’s age; transfer of a single day 5 embryo was associated with an increased chance of good perinatal outcome. Tubal or uterine factor infertility and non-Hispanic Black race were associated with a lower chance of good perinatal outcome. MedicalResearch.com: Were any of the findings unexpected? Dr. Kawwaas: Donor and recipient ages remained relatively stable at 28 and 41, respectively, over the 11-year period. Additionally, recipient age was not associated with likelihood of good perinatal outcome. In 85% of cycles in which donors were younger than 35 years old, a single embryo transfer was not performed resulting in a high rate, 37%, of twin pregnancies among donor oocyte cycles. Read the rest of the interview on MedicalResearch.com
    • Number, Success of Donor Egg Cycles Increase over Decade MedicalResearch.com Interview with: Dr. Jennifer Fay Kawwaas MD Department of Gynecology and Obstetrics Emory University School of Medicine, Atlanta, GA, USA • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kawwaas: For women with diminished ovarian reserve who cannot use autologous oocytes, egg donation is a good alternative option. Use of oocyte donation and likelihood of a resulting good perinatal outcome have increased over the past eleven years. Elective single embryo transfer is recommended when the donor is under 35 years old, regardless of recipient’s age. Transfer of a single day 5 embryo was associated with an increased chance of good perinatal outcome. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kawwaas: Additional studies evaluating the mechanisms by which race, infertility diagnosis, and day of embryo culture affect perinatal outcomes in both autologous and donor IVF pregnancies are warranted in order to develop preventive measures to increase the likelihood of obtaining a good perinatal outcome among ART users. Further studies are needed to understand the mechanisms underlying the factors associated with unsuccessful outcomes. Given the increasing trend of oocyte donations, the inclusion of more detailed information about donor risks, such as ovarian hyperstimulation syndrome, in the NASS will be useful for monitoring safety of donor cycles. Citation: Trends and Outcomes for Donor Oocyte Cycles in the United States, 2000-2010 Kawwass JF, Monsour M, Crawford S, et al. Trends and Outcomes for Donor Oocyte Cycles in the United States, 2000-2010. JAMA. 2013;():-. doi:10.1001/jama.2013.280924. Read the rest of the interview on MedicalResearch.com
    • Melanoma: Nivolumab with Vaccine in IPI Refractory Melanoma MedicalResearch.com Interview with: Jeffrey Weber, M.D, Ph.D. Senior Researcher, Moffitt Cancer Center Tampa, Florida • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Weber: That the PD-1 blocking antibody nivolumab has a 25% ORR with long duration of response in ipilimumab refractory patients, and that patients with prior grade 3-4 ipilimumab related immune related side effects may be safely treated with nivolumab without reproducing the prior IPI related side effects. MedicalResearch.com: Were any of the findings unexpected? Dr. Weber: The correlative studies done as part of this clinical trial showed that high levels of pre-existing antigen specific tumor specific CD8 T cells were associated with a poor outcome with nivolumab. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Weber: That nivolumab is a very active drug in unresectable melanoma in patients that have failed other therapies and are ipilimumab naïve or –refractory. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Weber: Sequential and concurrent nivolumab and ipilimumab are worth studying, and that important findings will be obtained by studying the phenotype and function of existing circulating and tumor infiltrating immune T cells prior to treatment with PD-1 antibody to develop possible predictive markers for the drug. Citation; Safety, Efficacy, and Biomarkers of Nivolumab With Vaccine in Ipilimumab-Refractory or -Naive Melanoma Jeffrey S. Weber, Ragini Reiney Kudchadkar, Bin Yu, Donna Gallenstein, Christine E. Horak, H. David Inzunza, Xiuhua Zhao, Alberto J. Martinez, Wenshi Wang, Geoffrey Gibney, Jodi Kroeger, Cabell Eysmans, Amod A. Sarnaik, and Y. Ann Chen JCO published online on October 21, 2013; DOI:10.1200/JCO.2013.51.4802. Read the rest of the interview on MedicalResearch.com
    • Cryopreserved Fat Cells Can Be Stored for Future Stem Cell Use Medicalresearch.com Interview with: David T Harris, Phd Department of Immunobiology University of Arizona PO Box 245221, Tucson, AZ 85724. • • • • MedicalResearch.com: What are the main findings of the study? Dr. Harris: The primary finding of the study was that it was routinely possible to harvest leftover adipose tissue and stem cells from both liposuction and cosmetic procedures, cryopreserve it for prolonged periods of time, and then thaw the tissue later when needed. Frozen and thawed adipose tissue was routinely viable and able to be differentiated into additional fat, as well as bone, cartilage and neuron-like cells. Thus, one can bank adipose tissue and stem cells without first isolating the stem cells allowing one to use the frozen and thawed tissue at later times for both cosmetic applications as well as for regenerative medicine. MedicalResearch.com: Were any of the findings unexpected? Dr. Harris: Previous reports in the literature had been mixed with regard to the success of freezing and thawing adipose tissue, but the methodology had been quite primitive. However, utilizing the methodology we devised one can successfully and routinely cryopreserve adipose tissue in liquid nitrogen dewers and later thaw the tissue and stem cells for clinical use. Read the rest of the interview on MedicalResearch.com
    • Cryopreserved Fat Cells Can Be Stored for Future Stem Cell Use Medicalresearch.com Interview with: David T Harris, Phd Department of Immunobiology University of Arizona PO Box 245221, Tucson, AZ 85724. • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Harris: If a patient is undergoing a liposuction or other cosmetic procedure where adipose tissue (fat) will be harvested; then rather than throwing it away it can now be banked for future use. Adipose tissue is the richest source of stem cells in the body. These stem cells (termed mesenchymal stem cells or msc) are being used in more than 100 clinical trials for orthopedic, cardiac and neural applications. One now has the opportunity to save some of these stem cells when young and healthy for later use in regenerative medicine and tissue engineering. In addition, one can use the whole, frozen tissue for cosmetic applications such as scar reductions, wrinkle treatments, breast or buttocks augmentations, and for wound healing. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Harris: We have currently frozen and thawed a variety of adipose tissue samples and used these samples clinically for a variety of cosmetic applications. We are currently investigating the use of the thawed samples for tissue engineering, with initial success. More work on using the samples for various regenerative medicine applications is needed. However, there does not seem to be any difference between cryopreservation of adipose tissue and cord blood (commonly performed more than one million times each year). What seems to be most important is that younger and healthier stem cells work better than older and/or unhealthy stem cells. Thus, one needs to take the opportunity to bank the tissue and stem cells when one can. Citation: Cryopreservation Of Whole Adipose Tissue For Future Use In Regenerative Medicine Mahmood S. Choudhery, Michael Badowski, Angela Muise, John Pierce, David T. Harris Journal of Surgical Research – 10 October 2013 (10.1016/j.jss.2013.09.027) Read the rest of the interview on MedicalResearch.com
    • Sleep in Hospitalized Patients: Non-Pharmacologic Interventions MedicalResearch.com Interview with: Ruth Tamrat, Minh-Phuong Huynh-Le, and Madhav Goyal Johns Hopkins University School of Medicine, MSIV • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among inpatients. Behavioral interventions are recommended as first line therapy prior to using pharmacologic therapy due to the adverse side effects of sedative hypnotics. This systematic review sought to identify the efficacy of non-pharmacologic interventions that have been used to improve the sleep of general inpatients. The results of this review demonstrate a lack of high quality evidence regarding the efficacy of these non-pharmacologic interventions in improving the sleep quality or quantity of patients in the hospital. MedicalResearch.com: Were any of the findings unexpected? Answer: The dearth of high quality studies was surprising. Only two out of the thirteen studies included in this review were rated as low risk of bias. The other eleven studies had shortcomings, including lack of blinding, high attrition rates, and controls that were not matched for time and attention, that reduced our confidence in their results. The lack of efficacy of the interventions to reduce insomnia was another unexpected finding. One would think that if we didn’t disturb patients as much at night then they would sleep better. That may be the case, but only two poor-quality studies looked at this and it was hard to draw conclusions from them. Most studies tried to get patients to relax in some form, and there was overall some evidence that relaxation techniques may help, but much more work needs to be done in this area. Read the rest of the interview on MedicalResearch.com
    • Sleep in Hospitalized Patients: Non-Pharmacologic Interventions MedicalResearch.com Interview with: Ruth Tamrat, Minh-Phuong Huynh-Le, and Madhav Goyal Johns Hopkins University School of Medicine, MSIV • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Current guidelines recommend non-pharmacologic interventions for hospitalized patients with insomnia prior to instituting pharmacologic therapy. Unfortunately, the studies that have been conducted examining the effectiveness of various non-pharmacologic interventions have been of poor quality, providing us with little evidence that any of these interventions are of use. Until further high quality studies have been performed to provide more definitive evidence identifying the best non-pharmacologic interventions, clinicians can take several simple, common sense steps to try to improve the sleep of their patients prior to prescribing them sedative hypnotics. These include: decreasing nighttime vital sign frequency to a safe minimum, ordering medication administration times in a manner that least interrupts patient nighttime sleep, and facilitating normal circadian rhythms by opening patient window blinds/turning on lights during the day and closing window blinds/turning off lights at night. • Read the rest of the interview on MedicalResearch.com
    • Sleep in Hospitalized Patients: Non-Pharmacologic Interventions MedicalResearch.com Interview with: Ruth Tamrat, Minh-Phuong Huynh-Le, and Madhav Goyal Johns Hopkins University School of Medicine, MSIV • • • • • • • • • • • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: future studies should address: 1) The development of computerized order entry protocols that make decreasing interruptions to patient nighttime sleep the default, requiring overrides if interruptions are absolutely necessary. These studies would need to evaluate the effectiveness of this type of order entry system in improving sleep as well as ensure that patient care and safety is not compromised. 2) Various relaxation techniques have been explored individually and/or in combination with others. It is currently still unclear which of these is most helpful, to what degree they are helpful, and which patients they benefit. 3) Does the inpatient setting and its associated alterations in light, noise, and activity levels influence circadian rhythms and homeostatic sleep drives? 4) Studies in this area should limit their risk of bias by using blinding, appropriate randomization, allocation concealment, and objective measures of sleep quality and quantity. 5) In what sub-groups are non-pharmacologic interventions not effective? How can we better define the threshold at which to consider pharmacologic therapies? Citation: Non-Pharmacologic Interventions to Improve the Sleep of Hospitalized Patients: A Systematic Review. Tamrat R, Huynh-Le MP, Goyal M. Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E. Monument St, Suite 1-500W, Baltimore, MD, 21287 J Gen Intern Med. 2013 Oct 10. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • ER Visits, EMS Calls Fell with Paramedics Visits to Senior Centers MedicalResearch.com Interview with: Dr. Gina Agarwal Assistant Professor Department of Family Medicine McMaster Family Practice 690 Main Street West Hamilton , Ontario L8S 1A4 • • • MedicalResearch.com: What are the main findings of the study? Dr. Agarwal: The study findings are just preliminary as of yet, but suggest that the CHAP-EMS program is potentially a feasible and effective health program for seniors housing buildings in urban areas. The program delivered tailored health risk assesments to seniors living in subsidized city housing, also assessing their risk of cardiovascular disease, diabetes and falls using validated tools. Paramedics were trained in how to assess, and deliver risk assessment results and then provide community resource information. Seniors attending the program could drop in any time and were encouraged to come back for follow up sessions. Results of each attendance were forwarded to family doctors to close the loop. At the 5th month of implementation, we have recorded 241 participant visits by 40 unique participants; 37 had 2 or more visits; 70% had elevated BPs initially; 77.8% of those previously diagnosed hypertensive and 55.8% of those undiagnosed hypertensive had elevated BP; 82.5% had moderate to high CANRISK scores. Preliminary data shows a 32% reduction in EMS calls. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Agarwal: We did not expect such a dramatic decrease in EMS calls, but more data has been collected and we have to do a final analysis yet on a full 12 months worth of data – we still expect a decrease to have remained. Read the rest of the interview on MedicalResearch.com
    • ER Visits, EMS Calls Fell with Paramedics Visits to Senior Centers MedicalResearch.com Interview with: Dr. Gina Agarwal Assistant Professor Department of Family Medicine McMaster Family Practice 690 Main Street West Hamilton , Ontario L8S 1A4 • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Agarwal: Paramedics can deliver in house community risk assessment and education and this service can be a useful expansion to any primary care service when done in conjunction with family doctors. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Agarwal: We will be looking to ascertain if these results are robust by performing a randomised controlled trial using several subsidized housing buildings. We are currently seeking funding for this expansion. Citation: Paramedics’ visits with seniors result in less EMS calls and saves on emergency room trips Abstract Presented at: Canadian Cardiovascular Congress October 2013 Read the rest of the interview on MedicalResearch.com
    • Fewer Infant Hospitalizations for Whooping Cough after Tdap Universal Recommendation MedicalResearch.com Interview with Katherine Auger, MD, MSc Assistant Professor of Pediatrics Division of Hospital Medicine Cincinnati Children’s Hospital Medical Center • • MedicalResearch.com: What are the main findings of the study? Dr. Auger: We examined hospitalization rates in infants for pertussis before versus after the recommendation to universally vaccinate all adolescents with Tdap. We used mathematical modeling to predict the number of infant hospitalizations that would be expected without the Tdap vaccine policy. We then compared these predicted numbers to the actual observed numbers of infant hospitalizations. In 3 of the 4 years after Tdap vaccine policy, there were significantly fewer infant hospitalizations for pertussis than expected base on the predictions. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Auger: Pertussis incidence in the US has been on the rise since the mid 1980s. Our findings are among the first to suggest that the vaccination efforts may be protecting infants, who are most prone to lifethreatening pertussis, from severe disease requiring hospitalization. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Auger: Vaccinating adolescents and caregivers may help reduce the number of hospitalizations for pertussis in infants. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Auger: Vaccine policy has been expanded further since the 2006 adolescent recommendation. In 2012, the CDC recommended women to be vaccinated during each pregnancy. Future studies are warranted to determine if this policy may further impact infant pertussis hospitalization rates. Citation: Infant Hospitalizations for Pertussis Before and After Tdap Recommendations for Adolescents Katherine A. Auger, Stephen W. Patrick, and Matthew M. Davis Pediatrics peds.2013-1747; published ahead of print October 21, 2013, doi:10.1542/peds.2013-1747 • • • • • • • • Read the rest of the interview on MedicalResearch.com
    • Hearing Loss in Women: BMI, Waist Circumference, Physical Activity MedicalResearch.com Interview with: Sharon Curhan, MD, ScM Channing Division of Network Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115 • • • • MedicalResearch.com: What are the main findings of the study? Dr. Curhan: The main findings of our study are that higher body mass index and larger waist circumference are associated with an increased risk of acquired hearing loss, and higher level of physical activity is associated with a decreased risk of acquired hearing loss in women. Specifically, after adjusting for potential confounders, compared with women with BMI <25 kg/m2, the relative risk for hearing loss was 25% higher for women with BMI >40. Compared with women with waist circumference <71 cm, the relative risk for hearing loss was 27% higher for women with waist circumference >88 cm. Higher physical activity was inversely related to risk; compared with women in the lowest quintile of physical activity, women in the highest quintile of physical activity had a 17% lower risk of hearing loss. Walking, the most common form of physical activity among these women, was associated with a lower risk; women who walked 2 hours per week or more had a 15% lower risk of hearing loss than women who walked less than one hour per week. These findings provide evidence that maintaining healthy weight and staying physically active, potentially modifiable lifestyle factors, may help reduce the risk of hearing loss. MedicalResearch.com: Were any of the findings unexpected? Dr. Curhan: A common perception is that hearing loss is an inevitable part of the aging process. However, these findings illustrate that there may be potentially modifiable risk factors—that is, things that we can change in our diet and/or lifestyle in order to prevent hearing loss or delay its progression. Read the rest of the interview on MedicalResearch.com
    • Hearing Loss in Women: BMI, Waist Circumference, Physical Activity MedicalResearch.com Interview with: Sharon Curhan, MD, ScM Channing Division of Network Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115 • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Curhan: Acquired hearing loss is a very common and often disabling chronic condition. Although hearing loss is often considered to be an unavoidable companion to aging, there may be dietary and lifestyle factors that can be modified that may reduce the risk of agerelated hearing loss. For example, maintaining healthy weight and staying physically active, potentially modifiable lifestyle factors, may help reduce the risk of hearing loss. Hearing loss is often subtle in onset, yet can have a substantial adverse influence on communication, social connectivity, work productivity and health. If an individual notices a change in hearing or has concerns, it may be helpful to consult with a health care provider to consider an evaluation by a hearing specialist. Citation: Body Mass Index, Waist Circumference, Physical Activity, and Risk of Hearing Loss in Women Sharon G. Curhan, Roland Eavey, Molin Wang, Meir J. Stampfer, Gary C. Curhan The American Journal of Medicine – 14 October 2013 (10.1016/j.amjmed.2013.04.026) Read the rest of the interview on MedicalResearch.com
    • Omega-3 Fatty Acids: MI Risk in Diabetic, Non-Diabetic Patients with CAD MedicalResearch.com Interview wit: Elin Strand Researcher, Department of Clinical Science University of Bergen, Norway • • • • MedicalResearch.com: What are the main findings of this study? Answer: The main findings in this prospective observational cohort study among patients with established coronary artery disease were that a very high intake of omega-3 fatty acids was associated with a reduced risk of acute myocardial infarction in patients with diabetes, but with an increased risk of fatal acute myocardial infarction and with lower glycosylated hemoglobin in those without impaired glucose metabolism. MedicalResearch.com: Were any of the findings unexpected? Answer: A beneficial effect among patients with diabetes was in accordance with our research hypothesis. However, the association between a very high omega-3 intake and increased risk of fatal acute myocardial infarction in patients without diabetes with normal glucose metabolism was somewhat surprising, although this was in accordance with a more speculative hypothesis. This hypothesis was based on results from prior studies showing that subjects with particular low glycosylated hemoglobin may have higher mortality. We thus speculate that this could be due to excess mortality from myocardial infarction and promoted by excess omega-3 intake. We did not expect to observe an effect of this extent on glucose metabolism, such as the adverse effect of the very high omega-3 associated with significantly lower levels of glycosylated hemoglobin. Read the rest of the interview on MedicalResearch.com
    • Omega-3 Fatty Acids: MI Risk in Diabetic, Non-Diabetic Patients with CAD MedicalResearch.com Interview wit: Elin Strand Researcher, Department of Clinical Science University of Bergen, Norway • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: This and previous studies on omega-3 effects altogether suggests that there is no simple answer to what recommendations should be made in relation to omega-3 intake in a large heterogeneous population. A good lifestyle with a well-balanced diet that includes a few fish meals per week, will probably meet the need for omega-3 in most people. In such cases, additional use of omega-3 supplements is probably in general not necessary. However, a high intake may be beneficial for certain sub-groups, but may have adverse effects in other sub-groups. Read the rest of the interview on MedicalResearch.com
    • Omega-3 Fatty Acids: MI Risk in Diabetic, Non-Diabetic Patients with CAD MedicalResearch.com Interview wit: Elin Strand Researcher, Department of Clinical Science University of Bergen, Norway • • • • • • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: These findings need confirmation, and we hope that prior conducted studies could be reanalysed to investigate whether patients with normal glucose tolerance are particular vulnerable to a very high intake of these fatty acids. Future randomized studies should investigate whether patients with diabetes may benefit from having a high intake of omega-3. Since a high intake of omega-3 may be disadvantageous in certain patients as indicated here, we believe it would not be ethical to perform a randomized clinical study targeting this specific sub-group. Instead, it would be very interesting to study if the current results could be reproduced by dividing previous larger prospective cohorts or randomized trials into similar sub-groups and by investigating the effects using animal models. A randomized trial in diabetes patients would be appropriate, although the recent Origin study in dysglycemic patients did not reveal an effect. In our opinion, the population represented by the Origin study clearly differed from our diabetes patients as thoroughly discussed in the manuscript. Thus, it would be interesting to study the effects through a randomized trial in a diabetic population more similar to the diabetes group in our study, not so aggressively treated by diabetic medication. Citation: Dietary intake of n-3 long-chain polyunsaturated fatty acids and risk of myocardial infarction in coronary artery disease patients with or without diabetes mellitus: a prospective cohort study. Strand E, Pedersen ER, Svingen GF, Schartum-Hansen H, Rebnord EW, Bjørndal B, Seifert R, Bohov P, Meyer K, Hiltunen JK, Nordrehaug JE, Nilsen DW, Berge RK, Nygård O. BMC Med. 2013 Oct 8;11(1):216. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • Children’s Health Insurance Program: Expansion did not reduce ER Use MedicalResearch.com Interview with: Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI 48109-5303 • • • • MedicalResearch.com: What are the main findings of the study? Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered). Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time. MedicalResearch.com: Were any of the findings unexpected? Dr. Haggins: We hypothesized that improved access to primary and specialty care would decrease reliance on ED services over time. However, our analysis over the course of the years 1992-2009 demonstrated a persistent and steady trend in ED use. Read the rest of the interview on MedicalResearch.com
    • Children’s Health Insurance Program: Expansion did not reduce ER Use MedicalResearch.com Interview with: Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI 48109-5303 • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Haggins: Outpatient clinicians work within a system of finite resources where barriers to accessing primary care and specialty care can influence ED use. Examining trends in both the outpatient clinics and EDs demonstrated the increasing demand for health care services in both settings. Therefore, as the nation prepares for the next major expansion of coverage, additional interventions informed by patients’ usage patterns, along with their expectations and preferences for care will likely be needed to optimize access to ambulatory health care services. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Haggins: In examining the effect of the Affordable Care Act and the capacity of ambulatory care to accommodate the newly insured, it will be important to assess both ED and outpatient use. It will also be important to understand the factors patients find most important in deciding when and where to seek care as health care systems attempt to align health care resources with patient preferences and health care needs. Citation: Academic Emergency Medicine 2013; 20:1026–1032 © 2013 by the Society for Academic Emergency Medicine Presented at The Robert Wood Johnson Foundation Clinical Scholars National Meeting, November 2011; the Society for Academic Emergency Medicine Annual Meeting, May 2012; and the Academy Health Annual Academic Research Meeting, June 2012. Funded through the Robert Wood Johnson Foundation Clinical Scholars Program. Dr. Patrick has been a consultant with Vermont Oxford Network. The other authors have no disclosures or conflicts of interest to report. Read the rest of the interview on MedicalResearch.com
    • CMS Health Care Spending Projections 2012-22 MedicalResearch.com Interview with: Gigi Cuckler Economist National Health Statistics Group Office of the Actuary, CMS • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Below we provide the major findings, but it’s important to note that these estimates incorporate two substantial changes from prior projections. First, the estimates incorporate the June 2012 US Supreme Court ruling that made the Medicaid eligibility expansion under health reform optional for states. Second, unless otherwise stated, the estimates focus on an outlook for spending in which the scheduled Medicare physician payment rate updates under the Sustainable Growth Rate formula do not occur. The following are highlights from our most recent report: Over the projection period, 2012-22, national health spending is projected to grow at an average rate of 5.8 percent, which is 1.0 percentage point faster than expected average annual growth in the economy over the period. Consequently, the health share of GDP is projected to increase from 17.9 percent in 2011 to 19.9 percent of the economy by 2022. In the near term of the projection, through 2013, national health spending growth is expected to remain just under 4.0 percent due to the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and low growth for Medicare and Medicaid. However, in 2014, national health spending growth is projected to accelerate to 6.1 percent, reflecting the expanded insurance coverage that will become available through the Affordable Care Act. After 2014 through the remainder of the projection period, national health spending is projected to grow 6.2 percent per year on average, largely as a result of the continued implementation of the coverage expansions under reform, faster projected economic growth, the aging of the population, and the end of the sequester. While projected health spending growth is faster compared to recent experience, it is still slower than the growth experienced over the longer-term history. Read the rest of the interview on MedicalResearch.com
    • CMS Health Care Spending Projections 2012-22 MedicalResearch.com Interview with: Gigi Cuckler Economist National Health Statistics Group Office of the Actuary, CMS • • MedicalResearch.com: Were any of the findings unexpected? Answer: Though our projections this year are similar to the projections that we have published in the past, our projection for national health spending growth in 2014 this year is lower than in past projections. While this may not necessarily be unexpected given the June 2012 Supreme Court decision regarding the Affordable Care Act, this lower rate of growth for 2014 is a particularly notable finding. Last year, we projected national health spending growth of 7.4 percent for 2014, compared to 6.1 percent in this year’s projection. This lower projected growth is mostly explained by the assumption last year that every state would expand their Medicaid program in 2014, whereas in this year’s projections, the Medicaid expansion is treated as optional for states (based on the June 2012 Supreme Court decision regarding the Affordable Care Act). Last year we were expecting 22 million to gain coverage in 2014, while this year we are projecting 11 million to gain coverage in 2014 (more information on this is provided in the next question). Read the rest of the interview on MedicalResearch.com
    • CMS Health Care Spending Projections 2012-22 MedicalResearch.com Interview with: Gigi Cuckler Economist National Health Statistics Group Office of the Actuary, CMS • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Some notable takeaways from the report are the health care sectors most impacted by health reform as well as the anticipated health insurance enrollment gains as a result of reform. In 2014, 11 million Americans are projected to gain health insurance coverage under the Affordable Care Act, predominantly through either Medicaid or the Health Insurance Marketplaces, with an additional eight million Americans expected to gain coverage during 2015. These expansions of health insurance coverage are projected to increase the demand for health care, particularly for prescription drugs and physician and clinical services. By 2022, the health insurance coverage expansions under reform are projected to reduce the number of uninsured people by 30 million. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: These projections remain subject to substantial uncertainty, given the variable nature of future economic trends and a lack of historical experience with many forthcoming health system reforms. In particular, the supply-side effects of the Affordable Care Act, such as changes in providers’ behavior in reaction to an influx of newly insured patients, remain highly speculative and are not included in these estimates. Thus, the supply-side response to the major coverage expansions under the Affordable Care Act, in terms of quantity of providers available (for example, the number of physicians, nurses, and other healthcare practitioners to provide primary care services) and the costs of services provided after an influx of newly insured patients in 2014 is an important area for future research. Citation: National Health Expenditure Projections, 2012–22: Slow Growth Until Coverage Expands And Economy Improves Cuckler GA, Sisko AM, Keehan SP, Smith SD, Madison AJ, Poisal JA, Wolfe CJ, Lizonitz JM, Stone DA. Health Aff (Millwood). 2013 Oct;32(10):1820-31. doi: 10.1377/hlthaff.2013.0721. Epub 2013 Sep 18. Read the rest of the interview on MedicalResearch.com
    • Antipsychotics: Financial Incentives to Improve Medication Adherence MedicalResearch.com Interview with Professor Stefan Priebe, Dipl.-Psych., Dr. med. habil., FRCPsych Unit for Social and Community Psychiatry WHO Collaborating Centre for Mental Health Services Development Queen Mary, University of London • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Offering modest financial incentives can help patients to achieve better adherence to antipsychotic maintenance medication. MedicalResearch.com: Were any of the findings unexpected? Answer: We did hypothesise that offering incentives may be effective, but did not necessarily expect the extent of the effect and some of the very positive feed back of patients about how the incentives initiated a much better therapeutic relationship. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: That offering modest financial incentives is an effective option for improving adherence to anti-psychotic maintenance medication. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We need to study the long term effects of offering financial incentives in this patient group. Further research should be done on how to use incentives – financial or otherwise – to achieve adherence to important treatments across medicine in general and mental health in particular. Priebe S ,Yeeles K ,Bremner S ,Lauber C ,Eldridge S ,Ashby D ,et al. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013;347:f5847 Read the rest of the interview on MedicalResearch.com
    • Atrial Fibrillation: Risks of Renal, Stroke,Thrombotic Events after Ablation MedicalResearch.com Interview with: Dr. med. Jelena Kornej Department of Electrophysiology, Heart Center, University of Leipzig , Leipzig, Germany & University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom • • MedicalResearch.com: What are the main findings of the study? Answer: The main finding of our analysis was that thromboembolic events after atrial fibrillation (AF) catheter ablation are rare, but all three stroke risk stratification scores, i.e. CHADS2, CHA2DS2-VASc, and R2CHADS2 were associated with thromboembolic risk in anticoagulated population. Furthermore, patients with AF recurrences had increased risk for thromboembolic complications. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Great part of our findings is in accordance with previously published studies. However, our study is the largest one assessing the incidence and risk factors for thromboembolic complications after AF catheter ablation during mid-term follow-up with a special focus on renal dysfunction and stroke risk stratification scores. Also, for the first time we show that the CHA2DS2-VASc had the best predictive value for thromboembolic events in the subgroup with AF recurrences. Read the rest of the interview on MedicalResearch.com
    • Atrial Fibrillation: Risks of Renal, Stroke,Thrombotic Events after Ablation MedicalResearch.com Interview with: Dr. med. Jelena Kornej Department of Electrophysiology, Heart Center, University of Leipzig , Leipzig, Germany & University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: The results of our study demonstrate that all scores are useful in predicting future thromboembolic events after AF catheter ablation. However, we would encourage the GPs and medical personal to use the CHA2DS2-VASc since in our large study cohort this score can differentiate those patients in ‘truly-low’ risk strata (CHA2DS2-VASc = 0-1). Our results demonstrated a 4.2-fold risk for thromboembolic events in patients with AF recurrence during follow-up. This data should sensitize cardiologists and GP’s for the proper rhythm outcome control after invasive AF procedure. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Although we had careful follow up data in a large consecutive series, our study is limited by its registry design. Prospective randomized trials are required to confirm whether the incidence of thromboembolic events is reduced in the catheter ablation-treated patients. Of note, since the rhythm outcomes follow-up were available only in 75% of our study cohort, the proper rhythm outcome control would be necessary to prove our findings regarding association between thromboembolic events incidence in patients with AF recurrences. Citation: Renal Dysfunction, Stroke Risk Scores (CHADS2, CHA2DS2-VASc and R2CHADS2) and the Risk of Thromboembolic Events after Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry Citation: Circ Arrhythm Electrophysiol. 2013 Oct 1;6(5):868-874. Epub 2013 Sep 18. Kornej J, Hindricks G, Kosiuk J, Arya A, Sommer P, Husser D, Rolf S, Richter S, Piorkowski C, Gaspar T, Lip GY, Bollmann A. Read the rest of the interview on MedicalResearch.com
    • Intelligence and Cognitive Abilities: Heritable and Cultural Influences MedicalResearch.com Interview with Dr. Kees-Jan Kan PhD Department of Biological Psychology, VU University Department of Psychological Methods, University of Amsterdam • • • • MedicalResearch.com: What are the main findings of the study? Answer: We asked ourselves how well theories of intelligence actually predict empirical results. To this end, we reviewed and scrutinized the predictions from intelligence theories and collected relevant results that have been published in the scientific literature over the last decades. The results pertained to intelligence test scores from thousands of subjects across the world. We found that on essential aspects the empirical results were opposite of the predictions from the mainstream theories of intelligence, in which intelligence is interpreted as a biological trait. MedicalResearch.com: Were any of the findings unexpected? Answer: As a number of empirical results were in contrast to mainstream theories, these results were indeed unexpected. The most surprising finding was that the larger the genetic influences on completing an intelligence tests are, the larger is also the dependency on educational and cultural factors: Heritability estimates of clearly culture-depended knowledge and skills, such as vocabulary, spelling, and general knowledge, are the highest among all abilities that are measured by intelligence test batteries. Hence they are higher than heritability estimates of less culture-depended abilities such as working memory, spatial ability, reasoning, and processing speed. This pattern does not follow from mainstream theories of intelligence, in which intelligence is interpreted as a biological, largely genetically fixed trait. Read the rest of the interview on MedicalResearch.com
    • Intelligence and Cognitive Abilities: Heritable and Cultural Influences MedicalResearch.com Interview with Dr. Kees-Jan Kan PhD Department of Biological Psychology, VU University Department of Psychological Methods, University of Amsterdam • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: There is no evidence at all that – although intelligence is highly heritable in adulthood – intelligence is largely fixed by the genes. Intelligence in childhood is also not that predictive of intelligence in adulthood. Intelligence changes, and these changes are normal. A child patient who has an IQ below average may develop as a normally intelligent adult. Also the other way around. Parents and teachers of children who’s IQ is exceptionally high should not be surprised when their children lose their advantage or do not meet high expectations. We really need to get rid of the reasoning that because intelligence is highly heritable, it is hardly malleable by environmental factors. To draw a parallel: Differences in vocabulary are the most heritable, but does this imply vocabulary is hardly malleable by environment? No. Simply educate people in a different language or raise them in a different culture and their vocabulary turns out radically different from our vocabulary. Yet, if you raise children in the same culture, individual differences in genetic makeup will eventually become clearly visible. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Heritability estimates have been based on a model in which genetic and environmental influences are independent from another. There lies a problem, because those influences go together. We stress that relations between genetic and environmental influences on intelligence deserve more attention from the scientific community. We advance the development of models in which genetic and environmental influences depend on another. This allows researchers to study dynamical interactions between environment and genetic influences throughout the course of development and to study their effects on the maturation of intelligence. Citation: On the Nature and Nurture of Intelligence and Specific Cognitive Abilities: The More Heritable, the More Culture Dependent Kan KJ, Wicherts JM, Dolan CV, van der Maas HL. 1Department of Biological Psychology, VU University. Psychol Sci. 2013 Oct 8. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • Heart Failure Care in Patients Admitted for Other Diagnoses MedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine Department of Medicine, NYU School of Medicine, New York, NY • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Blecker: Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code. However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments. We found that in our sample, as compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a non–heart failure diagnosis had lower rates of guideline-concordant care, including assessment of left ventricular function and prescription for an ACE inhibitor or ARB, at time of discharge. This is important as our study suggests that these therapies were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization. MedicalResearch.com: Where any of the findings unexpected? Dr. Blecker: The number of patients prescribed an ACE inhibitors or ARB at time of discharge was surprisingly low for hospitalized patients with systolic heart failure; only 64% of patients with a principal diagnosis of heart failure and 56% of patients with another principal diagnosis received one of these medications. Our study was limited in its ability to account for physician exception for these medications, but these numbers were still much lower than we expected. Read the rest of the interview on MedicalResearch.com
    • Heart Failure Care in Patients Admitted for Other Diagnoses MedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine Department of Medicine, NYU School of Medicine, New York, NY • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Blecker: Hospitalizations of heart failure patients represent an opportunity for physicians to ensure that patients are receiving guideline recommended care that has been associated with improved outcomes. Our findings suggest that providers need to be aware of the quality of care delivered to hospitalized patients with heart failure regardless of the reason for hospitalization. Citation: Quality of care for heart failure patients hospitalized for any cause. Blecker S, Agarwal SK, Chang PP, Rosamond WD, Casey DE, Kucharska-Newton A, Radford MJ, Coresh J, Katz S. Department of Population Health, NYU School of Medicine, New York, NY; Department of Medicine, NYU School of Medicine, New York, NY. Am Coll Cardiol. 2013 Sep 25. pii: S0735-1097(13)05349-7. doi: 10.1016/j.jacc.2013.08.1628. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • Metabolically Healthy Obesity – Weight Discordant Twin Study MedicalResearch.com Interview with: Jussi Naukkarinen, M.D., Ph.D Research Scientist Institute for Molecular Medicine Finland (FIMM) Nordic EMBL Partnership for Molecular Medicine Helsinki Finland and National Institute for Health and Welfare (THL) School of Medicine Dept. of Medical Genetics • • • • MedicalResearch.com: What are the main findings of the study? Answer: We found in this sample of relatively young, Finnish twins that there are clearly two different kinds of obesity. While most individuals with BMIs in the “obese” category will go on to develop the usual pathologies associated with obesity (namely diabetes, hypertensio, dyslipidemia), a fraction of the obese population seems to be spared. These “metabolically healthy obese” individuals displayed a number of features that were associated with a healthy metabolic profile despite considerable overweight: a capacity for hyperplasia of the adipose tissue (as opposed to just hypertrophy) seemed to be associated with maintained mitochondrial function, lack of inflammation and liver fat. MedicalResearch.com: Were any of the findings unexpected? Answer: I think the 7-fold difference in the amount of liver fat between the lean and heavier co-twins in the non-healthy obesity group was a surprisingly large difference. Many of the obesity associated features (mitochondrial dysfunction, inflammation etc) had been observed in our earlier studies, but to see the same features here restricted only to the non-healthy obesity group was perhaps also surprising. Realising that all obesity was lumped together as one group in earlier studies makes one wonder how could many studies have been effected by the presence of MHO individuals in the study groups. This probably has a larger effect on studies with more young participants. Read the rest of the interview on MedicalResearch.com
    • Metabolically Healthy Obesity – Weight Discordant Twin Study MedicalResearch.com Interview with: Jussi Naukkarinen, M.D., Ph.D Research Scientist Institute for Molecular Medicine Finland (FIMM) Nordic EMBL Partnership for Molecular Medicine Helsinki Finland and National Institute for Health and Welfare (THL) School of Medicine Dept. of Medical Genetics • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: A general guideline should be that with limited resources (and with the knowledge that many treatments also have their risks), the most aggressive treatments to any condition should be targeted to those groups that can most benefit. Realising that certain obese individuals are clearly more at risk than others should help to focus treatment on those individuals. Being “metabolically healthy obese” should not necessarily be seen as an excuse to continue with unhealthy eating/exercise habits, as we do not currently know whether the MHO phenomenon persists with increased exposure (the length of time one carries excess weight), not to mention the other negative effects associated with obesity (ex. joint problems). MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: It would be important to know whether the MHO phenomenon persists throughout an individual’s lifetime. Also, as our research points that remaining free of adipose tissue inflammation and the maintenance of mitochondrial function seem to be hallmarks of MHO, testing whether the usual complications of obesity could be avoided by targeting these processes with medication would be important. Citation: Characterising metabolically healthy obesity in weight-discordant monozygotic twins. Naukkarinen J, Heinonen S, Hakkarainen A, Lundbom J, Vuolteenaho K, Saarinen L, Hautaniemi S, Rodriguez A, Frühbeck G, Pajunen P, Hyötyläinen T, Orešič M, Moilanen E, Suomalainen A, Lundbom N, Kaprio J, Rissanen A, Pietiläinen KH. Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, C424b, PO Box 63, Helsinki, Finland, 00014. Diabetologia. 2013 Oct 8. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
    • Anorexia Nervosa: Optimized Psychodynamic, Cognitive Behavior Therapy MedicalResearch.com Interview with Stephan Zipfel MD Professor of Medicine & Dean of Medical Education Head Department of Internal Medicine VI University Medical Hospital Tuebingen President of the German College of Psychosomatic Medicine (DKPM) 72076 Tuebingen / Germany • • MedicalResearch.com: What are the main findings of the study? Prof. Zipfel: Outpatient treatment of adults with anorexia nervosa by either enhanced cognitive-behaviour therapy, focal psychodynamic therapy, or optimised treatment as usual led to relevant weight gains and a decrease in general and eating disorder-specific psychopathology during the course of treatment. These positive effects continued beyond treatment until 12-month follow-up. Most patients completed treatment and the acceptance of both specific therapy approaches was high among both patients and therapists. • • MedicalResearch.com: Were any of the findings unexpected? Prof. Zipfel: It was unexpected that the control condition, i.e. optimised treatment as usual, which included a combination of outpatient psychotherapy in combination with regular monitoring by GPs linked to specialised eating disorder centres, was not inferior in terms of weight gain. Overall, the specific therapy approaches had clear advantages, however: At the end of the study period, focal psychodynamic therapy was most successful, whereas enhanced cognitive-behaviour therapy resulted in a faster weight gain. Further, patients in the psychodynamic arm needed less additional hospitalisation. Read the rest of the interview on MedicalResearch.com
    • Anorexia Nervosa: Optimized Psychodynamic, Cognitive Behavior Therapy MedicalResearch.com Interview with Stephan Zipfel MD Professor of Medicine & Dean of Medical Education Head Department of Internal Medicine VI University Medical Hospital Tuebingen President of the German College of Psychosomatic Medicine (DKPM) 72076 Tuebingen / Germany • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Prof. Zipfel: Adult patients with anorexia nervosa have a realistic chance to surmount the illness when treated by specific therapies at specialised eating disorder centres. Major challenges for prevention and early treatment of anorexia nervosa remain, however. Psychotherapy is the treatment of choice for patients with anorexia nervosa. New more specific forms of psychotherapy for the treatment of anorexia nervosa have advantages particularly in terms of long-term results. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof. Zipfel: Additional measurements beyond the 1-year follow-up are neccessary in order to secure the success of the treatments involved. Currently, the 5-year follow-up measurements are taking place at the 10 ANTOP centres. Future research should focus on improving strategies of prevention and early intervention as well as optimising existing treatment approaches. To include the perspective of patients and their relatives seems to be an important aspect. Further refinements of psychotherapy is necessary as well as aspects of patient preferences and treatment experiences. Citation: Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial Prof Stephan Zipfel MD,Beate Wild PhD,Gaby Groß PhD,Hans-Christoph Friederich MD,Martin Teufel MD,Dieter Schellberg PhD,Katrin E Giel PhD,Prof Martina de Zwaan MD,Andreas Dinkel PhD,Prof Stephan Herpertz MD,Prof Markus Burgmer MD,Prof Bernd Löwe MD,Sefik Tagay PhD,Prof Jörn von Wietersheim PhD,Prof Almut Zeeck MD,Carmen Schade-Brittinger MA,Prof Henning Schauenburg MD,Prof Wolfgang Herzog MD,on behalf of the ANTOP study group The Lancet – 14 October 2013 DOI: 10.1016/S0140-6736(13)61746-8 Read the rest of the interview on MedicalResearch.com
    • Assessing Internal Medicine Resident Performance: Feedback on Reporting Milestones MedicalResearch.com Interview with: Eva Aagaard, MD Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of Colorado • • • MedicalResearch.com: What are the main findings of the study? Dr. Aagaard: We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and SystemsBased Practice used a mixed methods study involving competency committee members in Internal Medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice. MedicalResearch.com: Were any of the findings unexpected?
Dr. Aagaard: This has been a tough transition toward competency-based education for almost all IM residency programs. I was gratified to see such strong belief that these milestones would be considered a useful aid. Read the rest of the interview on MedicalResearch.com
    • Assessing Internal Medicine Resident Performance: Feedback on Reporting Milestones MedicalResearch.com Interview with: Eva Aagaard, MD Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of Colorado • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report?

 Dr. Aagaard: The reporting milestones in Internal Medicine are an important step forward in competency—based residency education. However, as with all new tools, their successful implementation will require significant faculty development both of program directors and faculty. Moreover, they will need refinement after widespread review. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Aagaard: Additional research is necessary to validate the milestones; more importantly, assessment tools that are developed as a result of these milestones will require further evaluation to assess reliability and validity. Finally, future research should assess whether these new frameworks actually improve assessment of competence and ultimately patient care. Citation: Early Feedback on the Use of the Internal Medicine Reporting Milestones in Assessment of Resident Performance Eva Aagaard, Gregory C. Kane, Lisa Conforti, Sarah Hood, Kelly J. Caverzagie, Cynthia Smith, Davoren A. Chick, Eric S. Holmboe, and William F. Iobst (2013) Early Feedback on the Use of the Internal Medicine Reporting Milestones in Assessment of Resident Performance. Journal of Graduate Medical Education: September 2013, Vol. 5, No. 3, pp. 433-438. doi: http://dx.doi.org/10.4300/JGME-D-13-00001.1 Read the rest of the interview on MedicalResearch.com
    • Diabetes: Type I Diabetics Still Make Small Amounts of Insulin MedicalResearch.com Interview with: Richard A. Oram, BMBCh, BA(hons), MRCP NIHR Exeter Clinical Research Facility University of Exeter Medical School, Barrack Road, Exeter, UK • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Historically people with Type 1 diabetes were thought to progress to make absolutely none of their own insulin. Modern assays allow us to measure very low levels of insulin, and using these we can find very tiny amounts of insulin production in most people with Type 1 diabetes even if they have had the disease for many years. MedicalResearch.com: Were any of the findings unexpected? Answer: The above finding fits with autopsy data that show a large proportion of people with Type 1 Diabetes have occasional beta cells visible within their pancreases, but it was still a surprise to find quite so many people, so far from diagnosis were still making these tiny amounts of insulin. We wanted to demonstrate that the low levels were not “background noise” from the assay so were very happy and surprised that the results of the stimulation test were so clear: When comparing fasting and post-meal samples, we felt the fact that C-peptide either went up (80% of the time) or stayed the same but never went down, proved that the C-peptide levels detected truly represented functional beta cells. Read the rest of the interview on MedicalResearch.com
    • Diabetes: Type I Diabetics Still Make Small Amounts of Insulin MedicalResearch.com Interview with: Richard A. Oram, BMBCh, BA(hons), MRCP NIHR Exeter Clinical Research Facility University of Exeter Medical School, Barrack Road, Exeter, UK • • • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: This is an exciting result that improves our knowledge of the biology of Type 1 diabetes, it also raises questions about whether very low levels of insulin can be of any clinical benefit (to complications and hypoglyaemia). Being able to compare who keeps endogenous insulin to the people who do not will enable us to further study the biology of Type 1 diabetes. This is very important for the long-term goal of developing a way to prevent Type 1 diabetes, halt beta cell destruction or ultimately find a cure. It is important to remember this is a “proof of concept” study with a modest sample size. It should not change day-to-day management of people with Type 1 diabetes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: It would be great to replicate these findings in a larger group – this is something we are currently working on. (We used a urine C-peptide measurement as well as a blood in this study specifically because the urine method for assessing Cpeptide can be posted from home and may therefore be logistically easier to use for large population based studies. We have a follow up study of ~1000 people and we are currently doing the data analysis and hope to present this work soon…..) A key question is whether the very tiny levels that we detected could affect the risk of complications or hypoglycaemia, this would be of clinical importance and would also impact on the work of groups trying to restore beta cell function or prevent destruction using immunotherapy. We do not know for sure whether the cells that remain are cells that have regenerated of are just resistant to immune attack, it would be really nice to be able to answer this… Citation: The majority of patients with long-duration type 1 diabetes are insulin microsecretors and have functioning beta cells Richard A. Oram, Angus G. Jones, Rachel E. J. Besser, Bridget A. Knight, Beverley M. Shields, Richard J. Brown, Andrew T. Hattersley, Timothy J. McDonald DOI 10.1007/s00125-013-3067-x Diabetologia Received: 6 August 2013 /Accepted: 9 September 2013 Read the rest of the interview on MedicalResearch.com
    • Gulf Oil Spill and Adverse Effects in Clean-Up Workers MedicalResearch.com interview with: Kesava Reddy, PhD, MHA University Cancer and Diagnostic Centers, Houston, Tex • • • • MedicalResearch.com: What are the main findings of the study? Dr. Reddy: Crude oil spills affect the human health through their exposure to the inherent hazardous chemicals such as para-phenols and volatile benzene. Evidence show that oil spill exposure is associated with multiple adverse health effects and increased cancer risk. In this study, we assessed the adverse health effects of the Gulf oil spill exposure in subjects participating in the clean-up operation along the coast of Louisiana. The findings were compared with those not exposed to the oil spill. We found that platelet counts were notably decreased in the oil spill exposed group. In addition, creatinine and blood urea nitrogen levels were substantially lower in the exposed group, while hemoglobin and hematocrit levels were increased compared to the unexposed subjects. Furthermore, considered indicators of hepatic damage, the serum alkaline phosphatase (ALP), aspartate amino transferase (AST), alanine amino transferase (ALT), levels in the exposed subjects were also elevated. Participants in the oil spill cleanup activity also reported somatic symptoms, with headache reported most frequently, followed by shortness of breath, skin rash, cough, dizzy spells, fatigue, painful joints, night sweats, and chest pain. MedicalResearch.com: Were any of the findings unexpected? Dr. Reddy: To our knowledge, no previous study has explored the adverse health effects of the oil spill exposure specifically assessing the hematological and hepatic functions in oil spill clean-up workers. For the first time, we reported altered blood profiles and hepatic function in subjects participating in the clean-up operation of the Gulf oil spill. Read the rest of the interview on MedicalResearch.com
    • Gulf Oil Spill and Adverse Effects in Clean-Up Workers MedicalResearch.com interview with: Kesava Reddy, PhD, MHA University Cancer and Diagnostic Centers, Houston, Tex • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Reddy: The results of this study indicate that clean-up workers exposed to the oil spill experienced significantly altered blood profiles, liver enzymes and somatic symptoms. Thus, exposure to oil spills has potential risks for developing health problems, specifically, hepatic or hematological abnormalities. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Reddy: Studies evaluating the changes in hematologic, cardiac, hepatic, renal, and other vital organ functions in oil spill exposed populations are sparse. We have yet to learn and understand the extent of the adverse health effects from these oil spills. The lack of available clinical information on the subject was the motivation for future investigation on the effect of oil spill exposure on vital organs function such as changes in cardiac, renal, and pulmonary functions. Citation: D’Andrea MA, Reddy GK: Health consequences among subjects involved in gulf oil spill cleanup activities. Am J Med 2013 Aug 31 [Epub ahead of print]. Read the rest of the interview on MedicalResearch.com
    • Cancer Risk from Imaging Radiation in Ischemic Heart Disease MedicalResearch.com: Prof. Dr. Gunnar Brix Division of Medical and Occupational Radiation Protection Federal Office for Radiation Protection Institut für Med. Strahlenhygiene 85764 Neuherberg • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: We investigated the cumulative radiation exposure and cancer risk of more than 1200 patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging procedures performed 3 month before and 12 month after the date of diagnosis. The major findings were: - 87% of patient exposure resulted from heart catheter procedures. - The average cumulative effective dose was 13.3 mSv in males and 10.3 mSv in females. The highest dose was nearly 100 mSv. - The estimated average attributable life-time risk of male and female patients to develop a radiation-induced cancer in their remaining life was 0.09 % and 0.07 %, respectively. This correspond to 1 excess cancer in about 1100 male and 1400 female IHD patients. The highest risk was 0.9 %. - The effective dose is inadequate to characterize individual radiation risks, since neither the age nor the sex of the patient is taken into account. According to our results, cancer risks can vary by a factor of more than 10 for comparable values of the effective dose. MedicalResearch.com: Were any of the findings unexpected? Answer: Although IHD patients were partially exposed to considerable amounts of radiation, the estimated radiation risks were small – primarily due to the higher age of the patients. Read the rest of the interview on MedicalResearch.com
    • Cancer Risk from Imaging Radiation in Ischemic Heart Disease MedicalResearch.com: Prof. Dr. Gunnar Brix Division of Medical and Occupational Radiation Protection Federal Office for Radiation Protection Institut für Med. Strahlenhygiene 85764 Neuherberg • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from this study? Answer: The cancer risk related to IHD-specific diagnostic and therapeutic imaging procedures are small as compared to the baseline cancer risk as well as to the expected lethality risk from an insufficient, alternative (surgery) or even lacking treatment of the lifethreatening disease. Nevertheless indications for imaging procedures in IHD patients have to be strictly limited to patients who will probably benefit from the procedures, and any effort has to be undertaken to optimize the procedures in order to reduce patient exposure. MedicalResearch.com: What further research do you recommend as a result of your study? Answer: To determine the cumulative radiation exposure and risk of IHD patients over a considerably longer period than one year. Citation: Cumulative radiation exposure and cancer risk of patients with ischemic heart diseases from diagnostic and therapeutic imaging procedures Eur J Radiol. 2013 Nov;82(11):1926-1932. doi: 10.1016/j.ejrad.2013.07.015. Epub 2013 Aug 15. Brix G, Berton M, Nekolla E, Lechel U, Schegerer A, Süselbeck T, Fink C. Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingoldstädter Landstraße 1, D-85764 Oberschleissheim, Germany. Read the rest of the interview on MedicalResearch.com
    • Preterm Infants and Effects of Antenatal Steroids MedicalResearch.com Interview with: Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC Sunnybrook Health Sciences Centre 2075 Bayview Ave., Room M4 230 Toronto, ON M4N 3M5 • • • • • • • • • • MedicalResearch.com What are the main findings of the study? Answer: This study was focused to see if there were differences in the main neurodevelopmental outcomes of children whose mothers had participated in the original MACS trial. We found that there were no differences in the main outcomes of the trial as it related to the aspects of death and/or developmental. MedicalResearch.com: Were any of the findings unexpected? Answer: The main findings were not unexpected since we were not seeing benefits all the way along with our ongoing follow-up throughout the past 10 years since the original MACS trial had started. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Multiple antenatal corticosteroids are often used with the hopes of improving respiratory management for the preterm infant. The original MACS trial showed that even though there was some marginal improvement in respiratory management, it did not translate into a reduction in the major neonatal morbidities often associated with long-term outcome. We saw that in our two-year follow-up. This continued onwards to 5 years of age. Because there is still unknown knowledge about the long-term effects of steroids as it relates to its contribution to long-term health, and knowing that there is no benefit seen, then the current practice of single course of antenatal corticosteroids given when a women is at risk of preterm labor should be encouraged only. Additional courses should only be considered with the patient knowing that it is not seen as reducing the major neonatal morbidities and improving long-term outcome. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: It would be of great interest to be able to continue to follow this study population to see any long-term effects of exposure to antenatal corticosteroids on general health and its potential contribution or not to illness and wellness. Citation: Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study Outcomes in Children at 5 Years of Age (MACS-5) JAMA Pediatr. Published online October 14, 2013. Read the rest of the interview on MedicalResearch.com
    • Vaccines: Delaying Measles Vaccination May Increase Risk of Seizures MedicalResearch.com Interview with: Dr. Ali Rowhani-Rahbar PhD, MD, MPH Kaiser Permanente Vaccine Study Center, Oakland, California University of Washington Department of Epidemiology Health Sciences Seattle, WA 98195 • • • • • • • • • • MedicalResearch.com: What are the main findings of your study? Answer: We found that the magnitude of increased risk of fever and seizures following immunization with the first dose of measles-containing vaccines during the second year of life depends on age. Specifically, the risk of seizures attributable to the vaccine during the 7 to 10 days following vaccination was significantly greater among children 16-23 months of age (9.5 excess cases per 10,000 doses) than among children 12-15 months of age (4.0 excess cases per 10,000 doses). MedicalResearch.com: Were any of the findings unexpected? Answer: I do not consider any of the findings necessarily “unexpected”; however, they were certainly quite interesting to us. This is one of the first studies to document a modifying effect of age on the risk of adverse events following immunization with measles-containing vaccines. It should be emphasized that the excess risk is small: less than 10 additional cases of febrile seizure per 10,000 doses during the 7 to 10 days following vaccination; but, the excess risk is even smaller when children receive this vaccine on a timely basis. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Most important takeaway message: Timely administration of these vaccines according to the recommended schedule is very important. Clinicians and parents should not delay immunizing children with these vaccines with the hope of minimizing the risk of adverse events. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Further research on the potential impact of delaying vaccination on other health outcomes in the context of immunization safety is needed. Citation: Rowhani-Rahbar A, Fireman B, Lewis E, et al. Effect of Age on the Risk of Fever and Seizures Following Immunization With Measles-Containing Vaccines in Children. JAMA Pediatr. 2013;():-. doi:10.1001/jamapediatrics.2013.2745. Read the rest of the interview on MedicalResearch.com
    • Comparison of Bariatric Surgery Procedurues and Glucose Tolerance MedicalResearch.com Interview with: Dr. Mitchell S. Roslin, MD Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery 186 E 76th Street, 1st Floor New York, NY 10021. • • • • • • • • • • • • • MedicalResearch.com Interview with: Dr. Mitchell S. Roslin, MD Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery 186 E 76th Street, 1st Floor New York, NY 10021. MedicalResearch.com: What are the main findings of the study? Dr. Roslin: The cornerstone of medical management for weight loss and to prevent weight gain is to regulate glucose and insulin and prevent wide fluctuation. Yet, Gastric bypass, widely considered the gold standard operation, accentuates these fluctuations. The purpose of our study was to compare glucose tolerance of gastric bypass, sleeve gastrectomy and a modified version of duodenal switch that preserves adequate intestine. We found that all operations improve insulin resistance, but that duodenal switch normalizes the curve, whereas gastric bypass causes wide spikes in insulin and glucose. MedicalResearch.com: Where any of the findings unexpected? Dr. Roslin: Our initial hypothesis was that by preserving the pyloric valve that is the exit of the stomach, would regulate glucose tolerance. That wound up being partially true. Sleeve gastrectomy, which also preserves the pyloric valve had intermediate results to bypass and switch. This means that there are other things working that explain the ability for duodenal switch to regulate the glucose tolerance curve. MedicalResearch.com: What should patients and clinicians take away from this report? Dr. Roslin: The take away is that I believe that we will find that a modified or simplified version of the duodenal switch, that preserves adequate bowel length, and avoids issues of short bowel, will become the preferential procedure for bariatric surgery and severe type 2 diabetes. MedicalResearch.com: What further research would you recommend as a result of your study? Dr. Roslin: Further study should include randomized trials between bypass and proper calibrated duodenal switch with diabetic and non diabetic patients. Citation: Response to glucose tolerance testing and solid high carbohydrate challenge: Comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch Surg Endosc. 2013 Sep 10. [Epub ahead of print] Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P. Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA, Read the rest of the interview on MedicalResearch.com
    • HDL Function: Improved with Strength Training, Even in Overweight MedicalResearch.com Interview with: Christian K. Roberts Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing University of California, Los Angeles, CA • • • • • • • • • • • • • • MedicalResearch.com: How would you best summarize the main findings/results of this study? Answer: Our main finding was that HDL functioned better in its antioxidant role in subjects who participated in resistance exercise training (i.e. weight training) a minimum of 4 days a week, regardless of their weight—one group was lean (BMI <25) and the other overweight/obese (BMI >27) —than those who didn’t exercise (overweight, BMI >27, and untrained). In addition, HDL had similar effectiveness as an antioxidant in the overweight-trained group as in the as lean-trained group. Although indices of weight were associated with dysfunctional HDL, differences in fitness may be a better measure of who has healthier functioning HDL. MedicalResearch.com: How would you best summarize the main findings/results of this study? What are the benefits of these findings? Answer These findings suggest that regular strength training might improve HDL function and this may contribute to the beneficial effects of strength training on reducing cardiovascular disease risk, even in those who remain overweight. MedicalResearch.com: How would you best summarize the main findings/results of this study? Were any of the findings unexpected? Answer No, based on some of our recent studies, improvements in markers of metabolic and cardiovascular health appear to be improved with lifestyle modification, even in those overweight or obese. MedicalResearch.com: How would you best summarize the main findings/results of this study? What should clinicians and patients take away from your report? Answer: Clinicians and patients should be aware that the quantity isn’t the only thing to consider when focusing on HDL. Its qualitative properties as antioxidant and anti-inflammatory are important to consider. MedicalResearch.com: How would you best summarize the main findings/results of this study? What recommendations do you have for future research as a result of this study? Answer: Future research might consider estimating HDL’s functional properties and further investigate the roles of strength fitness and body weight in the context of HDL’s anti-atherosclerotic properties and other related indices of cardiovascular and metabolic health. Citation: Untrained Young Men Have Dysfunctional HDL Compared to Strength Trained Men Irrespective of Overweight/Obesity Status Christian K Roberts, Michael Katiraie, Daniel M Croymans, Otto O. Yang, and Theodoros Kelesidis J Appl Physiol jap.00359.2013; published ahead of print July 25, 2013, doi:10.1152/japplphysiol.00359.2013 Read the rest of the interview on MedicalResearch.com
    • Hypovolemic Shock: Fluid Resuscitation with Colloids vs Crystalloids MedicalResearch.com with: Professor Djillali Annane MD, PhD Raymond Poincaré Hospital, Garches, France CH d’Etampes, Etampes, France • • • • MedicalResearch.com: What are the main findings of the study? Answer: The CRISTAL trial was designed in 2002 to clarify whether correction of acute hypovolemia in critically ill patients with colloids may increase the risk of death as compared to resuscitation with crystalloids. The trial has enrolled 2857 patients in 57 ICUs in France, Belgium, Canada and North Africa. The relative risk of death was at 28 day of 0.96 (95% CI: 0.88 to 1.04; P=0.26), and at 90 day of 0.92 (95%CI: 0.86 to 0.99; P=0.03) in favor of colloids. Colloids-treated patients had more days alive and off mechanical ventilation and off vasopressor both within 7 days and 28 days of randomization. There was no evidence for increased risk of kidney injury with colloids. MedicalResearch.com: 

Were any of the findings unexpected?
 Answer: The trial was designed to confirm the superiority of crystalloids as suggested by the available evidence in 2002, at the time the trial was designed. Thus, it was very surprising to found fewer deaths at 90 days in colloids treated patients. As hydroxyethyl starches were used in close to 70% in the colloids arm, it was also surprising not to find an increase risk of renal injury. These findings may be explained by a very strict limitation of the dose of starches solution, the exclusion of patients with severe chronic renal diseases, potential kidney protection via reduction in the duration of circulatory shock and respiratory failure. In addition, in the crystalloids group, isotonic saline was used in almost ¾ of patients. It is well known that chloride rich solution such normal saline may alter renal function. Read the rest of the interview on MedicalResearch.com
    • Hypovolemic Shock: Fluid Resuscitation with Colloids vs Crystalloids MedicalResearch.com with: Professor Djillali Annane MD, PhD Raymond Poincaré Hospital, Garches, France CH d’Etampes, Etampes, France • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: 
In under-resuscitated hypovolemic ICU patients, treatment with colloids did not increase the risk of dying as compared with crystalloids. As mortality at 90-day was not the primary outcome, the findings of fewer death with colloids by this time point should be considered as exploratory findings to be confirmed in future trial. Meanwhile, there is no evidence in this group of patients to abandon the use of colloids. MedicalResearch.com: What recommendations do you have for future research as a result of this study? One of the main remaining issues is the role of buffered solutions. Thus, future trial should be designed to compare buffered versus non-buffered fluid therapies. Citation: Annane D, Siami S, Jaber S, et al. Effects of Fluid Resuscitation With Colloids vs Crystalloids on Mortality in Critically Ill Patients Presenting With Hypovolemic Shock: The CRISTAL Randomized Trial. JAMA. 2013;():-. doi:10.1001/jama.2013.280502. Read the rest of the interview on MedicalResearch.com