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MedicalResearch.com: Medical Research Interviews

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MedicalResearch.com publishes exclusive interviews with medical researchers, who publish in major and specialty medical journals. Discuss latest heart disease, cancer, alzheimers, autism and numerous ...

MedicalResearch.com publishes exclusive interviews with medical researchers, who publish in major and specialty medical journals. Discuss latest heart disease, cancer, alzheimers, autism and numerous other medical research topics.

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

  • MedicalResearch.com Hemodialysis research, author interviews, dialysis updates and information on chronic kidney disease and end stage renal failure. Editor: Marie Benz, MD info@medicalresearch.com September 8 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
  • ICD Implantation and Cardiac Perforation Risk MedicalResearch.com Interview with: Jonathan Hsu, MD, MAS Cardiac Electrophysiology, Division of Cardiology University of California, San Diego (UCSD) • MedicalResearch.com: What are the main findings of the study? • Dr. Hsu: We found that the prevalence of cardiac perforation during modern day ICD implantation is 0.14%. • We also found that specific patient and implanter characteristics predict cardiac perforation risk: older age, female sex, left bundle branch block, worsened heart failure class, higher left ventricular ejection fraction, and non-single chamber ICD implant are associated with a greater odds of perforation, whereas atrial fibrillation, diabetes, previous cardiac bypass surgery, and higher implanter procedural volume are associated with a lower odds of perforation. • It appears that cardiac perforation from ICD implantation is associated with a substantially increased risk of other major in- hospital complications, prolonged hospitalization, and death. • In this large, national sample of first-time ICD recipients, cardiac perforation occurred in 625 out of 440,251 patients (0.14%). We identified several patient and implanter characteristics that predicted cardiac perforation risk. After multivariable adjustment, older age, female sex, left bundle branch block, worsened heart failure class, higher left ventricular ejection fraction, and non-single chamber ICD implant were associated with a greater odds of cardiac perforation. Conversely, atrial fibrillation, diabetes, previous cardiac bypass surgery, and higher implanter procedural volume were associated with a lower odds of perforation (all p values <0.05). Patients who experienced cardiac perforation had a substantially increased risk of adverse events both before and after adjustment for potential confounders, including a greater than 26-fold increased odds of any other associated major complication, 16-fold increased odds of prolonged hospital stay > 3 days, and 15-fold increased odds of in-hospital death. Read the rest of the interview on MedicalResearch.com
  • ICD Implantation and Cardiac Perforation Risk MedicalResearch.com Interview with: Jonathan Hsu, MD, MAS Cardiac Electrophysiology, Division of Cardiology University of California, San Diego (UCSD) • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hsu: It was somewhat surprising that a higher LVEF was associated with an increased odds of cardiac perforation. It is speculative to say that perhaps more forceful contractions of the heart muscle against the lead tip may predispose to cardiac perforation. Therefore, more research in this area is necessary. • MedicalResearch.com: What should clinicians and patients take away from this study? • Dr. Hsu: Increased risks from cardiac perforation from ICD implantation have important ramifications relevant to patients and practicing physicians, particularly as such major complications and longer hospital stays likely adversely affect patient quality of life and translate into increased healthcare utilization and costs. If indeed cardiac perforation is at the core of the majority of acute complications that occur in new ICD implants and the lead characteristics influence that risk, these data may inform lead manufacturers to be even more vigilant in assuring the safety of lead implant procedures. Additionally, knowledge that cardiac perforation is associated with a considerably increased risk of adverse events may allow for more aggressive treatment in those who experience the complication to avert further morbidity and mortality. By distinguishing easily recognizable predictors of cardiac perforation identified in this study, implanters may be better able to counsel patients regarding their risks, better able to quantify that risk, and may alter their approach (such as placing fewer total leads) in those most vulnerable. Therefore our study findings would be relevant to ICD implanters and patients undergoing this cardiovascular procedure. Read the rest of the interview on MedicalResearch.com
  • ICD Implantation and Cardiac Perforation Risk MedicalResearch.com Interview with: Jonathan Hsu, MD, MAS Cardiac Electrophysiology, Division of Cardiology University of California, San Diego (UCSD) • MedicalResearch.com: What further research do you recommend as a result of your study? • Dr. Hsu: Further research into the mechanisms of novel predictors found to be associated with cardiac perforation in our study is warranted, particularly regarding the association of LBBB and increased LVEF with a higher cardiac perforation risk, as well as the association of atrial fibrillation and diabetes with a lower cardiac perforation risk. • Specifically, now that these covariates have been identified, other device registries as well as prospective studies might consider special efforts to make sure these covariates are included on case report forms. • Citation: • Cardiac Perforation From Implantable Cardioverter-Defibrillator Lead Placement: Insights From the National Cardiovascular Data Registry • Jonathan C. Hsu, Paul D. Varosy, Haikun Bao, Thomas A. Dewland, Jeptha P. Curtis, and Gregory M. Marcus • Circ Cardiovasc Qual Outcomes. 2013;CIRCOUTCOMES.113.000299published online before print September 3 2013, doi:10.1161/CIRCOUTCOMES.113.000299 Read the rest of the interview on MedicalResearch.com
  • Cardiac Surgery: How Do Short Vacation Breaks by Surgeons Affect Patient Outcomes? MedicalResearch.com Interview with: Marco D. Huesch, MBBS, Ph.D. Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business. • MedicalResearch.com: What are the main findings of the study? • Answer: This study asked whether ‘learning by doing’ works backwards too, as ‘forgetting by not doing’. In an nutshell, the answer is ‘no’ among the Californian cardiac surgeons I examined with short breaks of around a month. • MedicalResearch.com: Were any of the findings unexpected? • Answer: The noted British surgeon James Paget pointed out more than a century ago that a physician “that ceases to gain knowledge is always losing it.” I hypothesized that at the patient-level, having a surgeon who had not performed cardiac bypass surgery in the calendar month before the month of the patient’s operation, would be associated with slightly longer stays and slightly worse in- hospital and 30-day mortality. However, this was not supported by my analysis of nearly 60,000 patients over a three-year period in California. Read the rest of the interview on MedicalResearch.com
  • Cardiac Surgery: How Do Short Vacation Breaks by Surgeons Affect Patient Outcomes? MedicalResearch.com Interview with: Marco D. Huesch, MBBS, Ph.D. Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: My findings suggest that either down time does not have significant adverse impacts on surgeon performance, or such down time has countervailing effects. In the latter interpretation, any adverse impact on manual dexterity or familiarity with operating room team members through absence may be balanced by the generally positive impacts of vacation time. In the former interpretation, well-practiced technical and planning tasks retain their familiarity or may be quickly recovered on re-appearance in the operating room. Those are both reassuring findings for patients and their clinicians, which ideally future research can continue to confirm. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: There are many problems in healthcare that are complex to deal with; conversely there are many more far simpler problems. If human capital – the degradable experience that a medical professional builds through practice – actually decays in some noticeable way after breaks in practice, then this would be a relatively simple and uncontroversial problem to deal with. Changes in staffing, in training, in coverage and in scheduling could address such a problem relatively easily. Future research should build on this small study of mine, and other studies (noticeably by Jason Hockenberry in Atlanta), to explore such human capital dynamics and their effect on patient outcomes. • Citation: • Huesch, M. D. (2013), The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California. Journal for Healthcare Quality. doi: 10.1111/jhq.12018 Read the rest of the interview on MedicalResearch.com
  • Rhabdomyolysis: Risk Prediction Score for Kidney Failure or Mortality MedicalResearch.com Interview with: Gearoid M. McMahon, MB, BCh Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, • MedicalResearch.com: What are the main findings of the study? • Answer: This study examined the incidence, causes and outcomes of rhabdomyolysis in two large University Teaching hospitals. Rhabdomyolysis is a characterized by an increase in serum creatine phosphokinase (CPK) and results from muscle damage from a variety of causes. The most important complication of rhabdomyolysis is acute kidney injury which can result in a need for dialysis. Using a series of laboratory and clinical variables that are readily available on admission, we constructed a risk score that can predict with some accuracy the likelihood that a patient with rhabdomyolysis might die or need dialysis during an admission. The final variables included in the model were age, gender, the cause of rhabdomyolysis and the admission CPK, creatinine, phosphate, bicarbonate and calcium. One of the advantages of this study was, because we had access to data from two institutions, we were able to derive the risk score in one hospital and confirm its accuracy in the second institution. • MedicalResearch.com: Were any of the findings unexpected? • Answer: In the past, it has been assumed that the degree of elevation of the CPK was a marker of severity of muscle damage and was therefore the most important factor in determining prognosis. However, we found that the initial CPK level was a poor predictor of outcomes. Instead, the most important determinants of a poor outcome were advanced age, the cause of rhabdomyolysis and the admission levels of phosphate and creatinine. Read the rest of the interview on MedicalResearch.com
  • Rhabdomyolysis: Risk Prediction Score for Kidney Failure or Mortality MedicalResearch.com Interview with: Gearoid M. McMahon, MB, BCh Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Using the risk calculator, patients with rhabdomyolysis can be stratified on admission into higher and lower risk categories. This could allow clinicians to be less aggressive with therapy in lower risk patients and thus potentially reduce the cost of these admissions. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Although this study was conducted in two institutions, these are large, tertiary facilities and it is uncertain whether or not this risk score would definitely be applicable outside this setting. It would be important validate the score in different settings – smaller hospitals and in the community. • Citation: • A Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis • Gearoid M. McMahon, MB, BCh; Xiaoxi Zeng, MD; Sushrut S. Waikar, MD, MPH JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.9774. Read the rest of the interview on MedicalResearch.com
  • Your Blood Pressure Affected by Spouse’s Social Network MedicalResearch.com Interview with: Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, Utah, • Dr. Uchino: The main findings from our paper is that independent of one’s own social network quality, the quality of a spouse’s social network was related to daily life ambulatory blood pressure (ABP) levels. More specifically, the more supportive (positive) ties, and the less aversive (negative) or ambivalent (both positive and negative) ties in a spouse’s social network, the lower was one’s own ABP. In addition, looking at the social networks of couples as a whole showed that couples who combined had more supportive ties and less aversive or ambivalent ties showed lower ABP. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Uchino: These findings were not unexpected given that prior work by researchers such as Dr. Repetti at UCLA has shown that social interactions outside of the marriage can “spillover” and create problems at home (e.g., negative mood, social withdrawal). However, it is the only study that we know of that extends such processes to potential health outcomes given that some of the differences that emerged met or exceeded cut-offs for “normal” ABP. Read the rest of the interview on MedicalResearch.com
  • Your Blood Pressure Affected by Spouse’s Social Network MedicalResearch.com Interview with: Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, Utah, • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Uchino: There is now a large epidemiological literature showing that relationships quality can influence health-relevant biological processes (e.g., blood pressure, inflammation) as well as mortality as shown by the recent meta-analysis by Dr. Holt-Lunstad at Brigham Young University. Just as some physicians ask patients about their stress or depression levels and the importance of managing it – similar issues can be asked about one’s relationships. For instance, it brings up the possibility of screening patients and their spouses for the quality of their relationships. For patients, I believe that it highlights the fact that the quality of our relationship has a real impact on how our body is functioning. It also underscores the importance of taking time to cultivate our relationships and make time for those individuals who are truly sources of support and perhaps minimize contact or try to resolve the more negative relationships in their lives. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Uchino: This research has some overlap with the ideas of Dr. Christakis at Harvard University on social contagion. In his seminal work, obesity is linked up to 2 to 3 degrees of network separation. It makes me wonder how far these relationship quality influences on ABP extend along the social networks of our friends and family and so on. Similarly, do these processes also influence the health trajectory of children whose parents have poor quality relationships? Finally, one of the most pressing issues is to uncover the mechanisms responsible for these links. We discussed a few (e.g., emotional spillover, defensive concern etc.) but future work will be needed to flush out these possibilities. • Citation: • The Quality of Spouses’ Social Networks Contributes to Each Other’s Cardiovascular Risk Bert N. Uchino mail, Timothy W. Smith, McKenzie Carlisle, Wendy C. Birmingham, Kathleen C. Light 26 Jul 2013 PLoS ONE doi:10.1371/journal.pone.0069809 Read the rest of the interview on MedicalResearch.com
  • Stuttering: What is the Natural History? Professor Sheena Reilly PhD FASSA Associate Director, Clinical and Public Health Research Murdoch Childrens Research Institute Professor of Speech Pathology Department of Paediatrics, University of Melbourn Royal Children’s Hospital Flemington Road Parkville Victoria 3052 Australia • MedicalResearch.com: What are the main findings of the study? • Prof. Reilly: Stuttering was more common than previously thought. The cumulative incidence of stuttering by four years old was 11%, which is more than twice what has previously been reported. Developmental stuttering was associated with better language development, non- verbal skills with no identifiable effect on the child’s mental health or temperament by four years of age. • MedicalResearch.com: Were any of the findings unexpected? • Prof. Reilly: The two main findings that surpassed us were that so many in our study of over 1600 children, started to stutter (11%) by 4 years of age, yet very few of these had recovered in the first 12 months after onset. We were also surprised to find the children who had stuttered had better receptive and expressive language skills. • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Reilly: Stuttering is very common in preschoolers. Children who stutter in the preschool years perform well in many other developmental domains during this time. Read the rest of the interview on MedicalResearch.com
  • Stuttering: What is the Natural History? Professor Sheena Reilly PhD FASSA Associate Director, Clinical and Public Health Research Murdoch Childrens Research Institute Professor of Speech Pathology Department of Paediatrics, University of Melbourn Royal Children’s Hospital Flemington Road Parkville Victoria 3052 Australia • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Prof. Reilly: First it would be great for someone to replicate our findings and second our goal is to see if we can determine whether there are factors that help predict whether children recover from or persist with stuttering • Lead researcher, Professor Sheena Reilly said parents could be happy in knowing that they can take a ‘watch and wait’ approach to their child’s stuttering. “Current best practice recommends waiting for 12 months before commencing treatment, unless the child is distressed, there is parental concern, or the child becomes reluctant to communicate. on these findings there wasn’t any evidence that watching and waiting would do any harm to their child’s language skills or social and emotional development” she said. • Due to the low rates of recovery in the study, researchers were unable to determine what predicts which kids will recover from stuttering, but say this will be the focus of research moving forward • Citation: • Natural History of Stuttering to 4 Years of Age: A Prospective Community-Based Study Sheena Reilly, Mark Onslow, Ann Packman, Eileen Cini, Laura Conway, Obioha C. Ukoumunne, Edith L. Bavin, Margot Prior, Patricia Eadie, Susan Block, and Melissa Wake • Pediatrics peds.2012-3067; published ahead of print August 26, 2013, doi:10.1542/peds.2012-3067 Read the rest of the interview on MedicalResearch.com
  • ACL Injuries and Landing Strategies Marc F. Norcross, PhD, ATC Assistant Professor School of Biological & Population Health Sciences, Exercise & Sport Science Program College of Public Health and Human Sciences Oregon State University Corvallis, OR 97331 • MedicalResearch.com: What are the main findings of the study? • Dr. Norcross: In the scientific community, there remains considerable disagreement over which direction of knee loading is most responsible for causing an anterior cruciate ligament (ACL) injury event. Many researchers tend to fall into one of three “camps” in which they believe quadriceps loading (sagittal plane), “knock-kneed” landing (frontal plane), or twisting (transverse plane) is the essential factor in the injury mechanism. However, we know from cadaver studies that combined loading from all of these different planes puts the most strain on the ACL. We found that men and women are equally likely to use a sagittal plane landing strategy that we believe increases the risk for ACL injury. However, females were about 3.6 times more likely than males to use a higher risk frontal plane landing strategy. This suggests that the increased likelihood of greater frontal plane loading in women coupled with the equal likelihood of using a high-risk sagittal plane strategy is likely at least partly responsible for women’s 2-6 times greater risk for ACL injury. MedicalResearch.com: Were any of the findings unexpected? • Dr. Norcross: We expected that the same individuals who use a high-risk sagittal plane landing strategy would also be the ones to use a high-risk frontal plane landing strategy. However, we did not find any relationship between the sagittal and frontal plane landing strategies of individuals in this study. Given our findings, we proposed that individuals at the greatest risk for ACL injury are likely to be the ones who land using a high-risk sagittal plane and a high-risk frontal plane landing strategy. This is because the way in which these individuals move is likely consistently placing greater combined loading on the ACL. So, when they perform a difficult or very explosive task, it could result in an excessively high load that may cause the ligament to fail. Read the rest of the interview on MedicalResearch.com
  • ACL Injuries and Landing Strategies Marc F. Norcross, PhD, ATC Assistant Professor School of Biological & Population Health Sciences, Exercise & Sport Science Program College of Public Health and Human Sciences Oregon State University Corvallis, OR 97331 • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Norcross: It is important to think about the total package related to landing technique and not just one aspect like being “knock-kneed” or stiff. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Norcross: The use of currently available ACL injury intervention programs are a great way to teach safer landing strategies and have been shown in controlled studies to reduce the risk for ACL injury. However, in my opinion, we must improve the way in which these programs are packaged so that there is widespread implementation by coaches and health care professionals. Until we do so, I believe that we are going to continue to face an uphill battle in reducing the ACL injury rate at the population level. • Citation: • Ankle-Dorsiflexion Range of Motion and Landing Biomechanics Chun-Man Fong, LAT, ATC; J. Troy Blackburn, PhD, ATC; Marc F. Norcross, MA, ATC; Melanie McGrath, PhD, ATC; Darin A. Padua, PhD, ATC Read the rest of the interview on MedicalResearch.com
  • Female Physicians Continue to Earn Less than Male Physicians MedicalResearch.com Interview with: Seth A. Seabury, PhD Department of Emergency Medicine, University of Southern California, Los Angeles Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles • MedicalResearch.com: What are the main findings of the study? • Dr. Seabury: We studied the trends in the earnings of male and female physicians in the US from 1987- 2010 using nationally representative data from the Current Population Survey (CPS). We found that, while the number of female physicians grew significantly, male physicians continue to have significantly higher earnings than female physicians. The difference in the median earnings of male physicians compared to female physicians actually increased from $33,840 in 1987-1990 to $56,019 in 2006-2010, though the difference across years was not statistically significant. Our approach controlled for differences in hours worked, so earnings gap was not driven by differences in work hours, though it could be explained by other factors we did not observe in our data (e.g., specialty choice). • Looking at other occupations in the US health care industry, the male-female earnings gap was smaller for pharmacists and registered nurses and decreased over time, but was large and increased for physicians assistants. On the other hand, our numbers indicate that outside of the health care industry, the male- female earnings gap fell by more than 45%. Even though significant gender inequality persists across the US, female physicians do not appear to have benefited from the relative gains that female workers outside the health care industry have. MedicalResearch.com: Were any of the findings unexpected? • Dr. Seabury: Other recent studies have indicated that earnings differences persist between male and female physicians, so it wasn’t necessarily surprising that we found a gap from 2006-2010. However, the size of the gap, and the fact that the gap had failed to close significantly in more than 20 years even though earnings equality outside the health care industry has improved a great deal, was surprising to us. Read the rest of the interview on MedicalResearch.com
  • Female Physicians Continue to Earn Less than Male Physicians MedicalResearch.com Interview with: Seth A. Seabury, PhD Department of Emergency Medicine, University of Southern California, Los Angeles Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Seabury: While efforts to increase the number of female physicians have been at least partially successful, the earnings of female physicians lag behind those of male physicians by a significant margin, and there has been no improvement over the last 20+ years. While the root cause of this inequality is unclear, more needs to be done to ensure that female physicians receive equal opportunities for specialty choice and career advancement as do male physicians. • Citation: • Seabury SA, Chandra A, Jena AB. Trends in the Earnings of Male and Female Health Care Professionals in the United States, 1987 to 2010. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.8519. Read the rest of the interview on MedicalResearch.com
  • HIV Prevention: Using Social Networking MedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles • Dr. Young: Here’s the main take-home point: • There is a lot of excitement about the possibility of using technologies, big data, and mHealth to improve health outcomes and change behavior. However, • 1) little work has been done on this topic using sound research methods (for example, studies have asked people to report whether a technology changed behavior rather than objectively measuring whether it actually changed behavior. • 2) technologies have not been shown to create sustainable behavior change (i.e., the effects go away with time), and 3) it is unclear whether the people who really need to change behavior and improve health would use these technologies as intended. • Results are below. Study findings suggest that it is possible to use technologies to create sustainable health behavior change, however, only if the approach integrates the science behind how to change behavior. We validated that our approach combining behavioral science and social media can create sustainable health behavior change. Read the rest of the interview on MedicalResearch.com
  • HIV Prevention: Using Social Networking MedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles • Press Release: • Social Networking Technologies as an Emerging Tool for HIV Prevention: A Cluster Randomized Trial • Contact: Enrique Rivero (erivero@mednet.ucla.edu) • Behavioral psychology + social media = A scientifically-proven approach to increase HIV testing and prevention behaviors • Technique may also apply to other diseases, prevention efforts • Can social media and online communities be used to create sustainable health behavior change? • A new UCLA study published Sept. 3 in the peer reviewed journal Annals of Internal Medicine finds that combining behavioral science with social media/online communities can lead to sustainable health behavior change. The authors’ evidence-based approach for using social media and online communities not only leads to increased HIV testing and encourages significant behavior change among high risk groups, but also turns out to be one of the best HIV-prevention and testing approaches on the Internet. Read the rest of the interview on MedicalResearch.com
  • HIV Prevention: Using Social Networking MedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles • And it’s not just applicable to HIV prevention efforts, said Sean D. Young, assistant professor of family medicine and director of innovation for the center for behavior and addiction medicine at the David Geffen School of Medicine at UCLA and the study’s lead investigator. We found similar effects for general health and well-being. Because our approach combines behavioral psychology with social technologies, these methods might be used to change health behaviors across a variety of diseases. • The authors found that people in the study were highly engaged and maintained active participation in the study. “Internet HIV prevention interventions and mobile health applications have had very high dropout rates and problems getting people engaged, and this effect is even more pronounced among high-risk groups such as minority populations and men who have sex with men,” Young said. “However, our approach appeared to overcome these issues and changed behavior.” • The study is published Sept. 3 in the peer reviewed journal Annals of Internal Medicine. • A previous study published in February, also led by Young, found that social media could be useful in HIV and STD prevention efforts by increasing conversations about HIV prevention. • The researchers recruited 112 men who have sex with men either through banner ads placed on social networking sites such as Facebook, through a Facebook fan page with study information, through banner ads and posts on Craigslist, and from venues such as bars, schools, gyms and community organizations in Los Angeles. Of the participants, 60 percent were African American, 28 percent were Latino, 11 percent were white and 2 percent were Asian. • Each was randomly assigned to either an HIV group or a general health group on Facebook, the latter serving as the control, and then randomly assigned to two peer leaders within their groups. Participants were under no obligation to engage with peer leaders or other participants or to even remain members of their respective Facebook groups. They were also allowed to adjust their Facebook settings in order to control the amount of personal information they shared with other group members. • Throughout the study, participants were able to request and receive home-based HIV self-testing kits. At baseline and again at 12 weeks, participants completed a 92-item survey that included questions about Internet and social media usage, including their use to discuss health and sexual risk behaviors; general health behavior like exercise and nutrition; and sex and sexual health behaviors including HIV testing and treatment. Among other things, the researchers looked for evidence of behavior change, such as reduction of sexual partners, and requests for home-based HIV test kits with follow-ups to obtain test results. Read the rest of the interview on MedicalResearch.com
  • HIV Prevention: Using Social Networking MedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles • Among the findings: • 95 percent of the intervention participants voluntarily communicated on Facebook, along with 73 percent of the controls • 44 percent (25 of 57) of the intervention group requested the testing kits, compared with 20 percent (11 of 55) of the controls • Nine of the 57 intervention group participants took and mailed back the test kits to receive their results, compared with 2 of the 55 control group members, suggesting a greater likelihood that their approach can successfully lead one to take an HIV test. • The intervention group members chatted and sent personal messages with much higher frequency than did the control group members • African American and Latino men who have sex with men, who are at higher risk for becoming infected with HIV compared with the rest of the population, find social networks to be an acceptable platform for HIV prevention • African Americans and Latinos also find home-based tests to be an acceptable HIV testing method • Retention at follow-up was more than 93 percent, in contrast to the high dropout rates from other Internet-based HIV- prevention interventions. • The researchers note some limitations to the study. Among them are that they used only two Facebook communities per condition, meaning these methods should be tested with more people before implementing them . In addition, no best practices regarding the use of social networking for HIV communication have been established. • The next step will be to assess how this method might generalize to other populations, diseases, and prevention efforts, Young said. “We have created a potential paradigm for health behavior change using new social technologies,” he said. “We are beginning to explore this approach in other areas.” • Study co-authors are William G. Cumberland, Sung-Jae Lee, Devan Jaganath, Greg Szekeres, and Thomas Coates, all of UCLA. • Grants from The National Institute of Mental Health (K01 MH090884), the UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS), and the UCLA AIDS Institute funded this study. Read the rest of the interview on MedicalResearch.com
  • Spontaneous Renal Artery Dissection: Characteristics, Course, Associations Afshinnia, Farsad, M.D., M.S. Research Fellow and Clinical Lecturer Department of Nephrology University of Michigan Health System • MedicalResearch.com: What are the main findings of the study? • Answer: Spontaneous Renal Artery Dissection (SRAD) is most commonly observed in middle aged individuals. Although SRAD can have no association with other comorbidities at the time of presentation, we have noticed association with a number of systemic disorders such as hypertension, cancer, congestive heart failure, and rheumatologic diseases. In particular clustering of Fibromascular dysplasia (FMD), Ehlers-Danlos syndrome, poly arteritis nodosa, Poland syndrome, and nail patella syndrome in our patients has been striking. The most commonly observed presenting symptom is sudden onset severe flank pain which may be spontaneous or following physical stress. Other presenting features may include uncontrolled hypertension, groin and/or testicular pain, headache, nausea, vomiting, fever, dysuria, hematuria and blurry vision. MedicalResearch.com: Were any of the findings unexpected? • Answer: Association with a cluster of systemic disorders in our observation was quite unexpected and striking. Although uncontrolled hypertension at presentation may be reflection of pain or Renin-Angiotensin-Aldosterone System (RAAS) activation due to disrupted renal blood flow, history of longstanding hypertension even prior to dissection may reflect underlying vascular disorders such as FMD. Read the rest of the interview on MedicalResearch.com
  • Spontaneous Renal Artery Dissection: Characteristics, Course, Associations Afshinnia, Farsad, M.D., M.S. Research Fellow and Clinical Lecturer Department of Nephrology University of Michigan Health System • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: For patients: If sudden onset severe unremitting flank pain is experienced patients should seek urgent medical attention. Upon confirmation of SRAD, avoidance of strenuous physical activities such as heavy weight lifting is advised as recurrence of SRAD is not uncommon. Control of hypertension as a modifiable risk factor may protect against recurrence of SRAD. • For physicians: Radiographic imaging should confirm the diagnosis once SRAD is suspected. Confirmation is made by conventional renal artery angiography, CT angiogram or Magnetic Resonance Angiography (MRA). Presence of SRAD should draw physician’s attention to possible presence of other systemic disorders, and initiation of appropriate work up. Treatment options include supportive medical treatment (such as control of pain, blood pressure, management of coexistent symptoms ± anticoagulation), endovascular radiographic interventions (such as stenting), and surgical repair (including vascular reconstruction, anastomosis, and nephrectomy). Choice of therapy is individualized and is determined by severity and extent of dissection. Long term prognosis is a function of underlying comorbid conditions, although with appropriate medical or surgical management, long-term clinical outcome may appear favorable. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: SRAD may present sporadically. It may also be complication of other rare diseases. Our study besides several other case series and reports has suggested some of these rare diseases. However, foundation of consortium of SRAD allowing global registry of this entity may provide opportunity for its better understanding by shedding more light to its hidden aspects. Read the rest of the interview on MedicalResearch.com
  • Postmenopausal Women: Impact Brisk Walking MedicalResearch.com Interview with: Pascale Mauriège, PhD, Division of Kinesiology PEPS, Room 2148, Laval University, Québec, Canada G1K 7P4 • MedicalResearch.com: What are the main findings of the study? Answer: • 1) The impact of a 4-month brisk walking program (3 sessions/week of 45-min walking at 60% of heart rate reserve) on postmenopausal moderately obese (BMI=29-35 kg/m2) women’s perceived health, and more particularly the perceived ideal weight and stress level. • 2) The existence of a relationship between improvements in perceived ideal weight and fat mass reduction in the walking group. • 3) The lack of non respondents to our novel self-administered Short Perceived Health Questionnaire (SPHQ) that was completed within 2-3 min by all participant. • 4) The good reproductibility for five of six items of the SHPQ, and the validation of three questions against generic tools. • MedicalResearch.com: Were any of the findings unexpected ? • Answer: • The relationship between some items of perceived health and body composition, but also the reliability, the reproductibility and the good acceptance of the SPHQ. Read the rest of the interview on MedicalResearch.com
  • Postmenopausal Women: Impact Brisk Walking MedicalResearch.com Interview with: Pascale Mauriège, PhD, Division of Kinesiology PEPS, Room 2148, Laval University, Québec, Canada G1K 7P4 • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: • A brisk walking program exerts a favourable impact on cardiorespiratory fitness, and body composition (body weight and fat mass losses, as well as waist girth reduction), but also on perceived health. Although being less studied, this aspect is of importance as it is related to wellness’ participants. • Our data may encourage patients to engage in a brisk walking program, because of their multiple effects (physiological, morphological and psychological). • Furthermore, brisk walking is the most common feasible form of aerobic exercise for middle-aged women because of its safety (low risk of injuries), popularity (low cost) and accessibility to all public. • In summary, a brisk walking program increases fitness and wellness in postmenopausal women. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: • Additional studies are needed • to more accurately examine the relationships between changes in perceived health and those in body fatness and/or cardiorespiratory fitness after endurance training. • to continue the validation of the SPHQ agains other generic tools • to extend the SHPQ to the overall population (as for example, premenopausal women, men, and individuals of non French origin). • Citation: • Impact of brisk walking on perceived health evaluated by a novel short questionnaire in sedentary and moderately obese postmenopausal women. • Garnier S, Gaubert I, Joffroy S, Auneau G, Mauriège P. • From the 1Faculty of Sport Sciences and Human Kinetics, Université P. Sabatier, Toulouse, France; and 2Fédération Française d’Éducation Physique et de Gymnastique Volontaire, Paris, France. Menopause. 2013 Feb 4. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • CVD Risk: Metabolic Health, not BMI, determined risk in young women MedicalResearch.com Interview with: Dr Søren Skøtt Andersen and Dr Michelle Schmiegelow Study done in collaboration between Roskilde University Hospital and Gentofte University Hospital in Denmark • MedicalResearch.com: What are the main findings of the study? • Answer: The main finding of this study of young women was that a body mass index above or equal to 25 kg/m2 in metabolically healthy women was not associated with an increased risk of cardiovascular events (myocardial infarction or ischemic stroke) within 5 years of follow- up. A BMI >= 25 kg/m2 in women with any metabolic disorder was associated with a 4-fold significant increased risk of the end-point. As increasing BMI is strongly associated with risk of developing metabolic disorders, the key message of this study is to stress the importance of preventing the development of metabolic disorders in overweight/obese women during this possible “window of opportunity”. MedicalResearch.com: Were any of the findings unexpected? • Answer: We found it somewhat surprising that we were able to prove an association between metabolic unhealth and risk of cardiovascular events in a population of women as young as ours (median age only 31 years) within only 5 years of follow-up. Read the rest of the interview on MedicalResearch.com
  • CVD Risk: Metabolic Health, not BMI, determined risk in young women MedicalResearch.com Interview with: Dr Søren Skøtt Andersen and Dr Michelle Schmiegelow Study done in collaboration between Roskilde University Hospital and Gentofte University Hospital in Denmark • MedicalResearch.com: What should clinicians and patients take away from this study? • Answer: We hope that these results will raise awareness of the importance for clinicians to motivate overweight/obese young women to change their lifestyle (dietary habits, physical activity etc) in order to prevent the development of metabolic disorders and this advice should be offered at a young age. • MedicalResearch.com: What further research do you recommend as a result of your study? • Answer: The findings of our study should be investigated in other populations such as men, and more elderly populations. • Press Release: • Metabolically healthy women have same CVD risk regardless of BMI • Topics: Cardiovascular Disease Prevention – Risk Assessment and Management Read the rest of the interview on MedicalResearch.com
  • Acute Pericarditis: Study of Colchicine for Treatment and Prevention MedicalResearch.com Interview with:Massimo Imazio, MD, FESC Dipartimento di Cardiologia/Cardiology Department Maria Vittoria Hospital-ASLTO2 via Cibrario 72 10141 Torino, Italy • MedicalResearch.com: What are the main findings of the study? • Dr. Imazio: In a multicenter, double-blind trial, eligible adults with acute pericarditis (idiopathic/viral, post-pericardiotomy syndromes and pericarditis related to a systemic inflammatory disease) were randomly assigned to receive either colchicine (at a dose of 0.5 mg twice daily for 3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing ≤70 kg) or placebo in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen. The primary study outcome was incessant or recurrent pericarditis. • After a mean follow-up of 22 months (minimum 18 months) the primary outcome occurred in 20 patients (16.7%) in the colchicine group and 45 patients (37.5%) in the placebo group (relative risk reduction in the colchicine group, 0.56; 95% confidence interval, 0.30 to 0.72; number needed to treat, 4; P<0.001). MedicalResearch.com: Were any of the findings unexpected? • Dr. Imazio: Colchicine is able to halve recurrences also in the setting of acute pericarditis as well as after a first recurrence of pericarditis (CORP trial result. Annals of Internal Medicine 2011). Moreover colchicine may also reduce pericarditis-related hospitalizations and may contribute to reduce management costs. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Imazio: Most treatments are empirical in the setting of pericarditis. At present, colchicine is the most studied drug in this field, and we have enough evidence (an open label randomised trial, the COPE trial and a multicenter double blind randomised trial-present ICAP study), in my view, to support its use in acute pericarditis (first episode) as well as for the first recurrence of pericarditis after the index attack as supported by the previously published CORP trial. Read the rest of the interview on MedicalResearch.com
  • Acute Pericarditis: Study of Colchicine for Treatment and Prevention MedicalResearch.com Interview with:Massimo Imazio, MD, FESC Dipartimento di Cardiologia/Cardiology Department Maria Vittoria Hospital-ASLTO2 via Cibrario 72 10141 Torino, Italy • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Imazio: We still need additional evidence in patients with multiple recurrences but data from the CORP-2 trial will be available soon next year and will address this remaining issue. • The best treatment length is unknown and we may speculate that longer treatments (>3 months) may further reduce the proportion of recurrences during follow-up. Additional research may be needed on this issue. • Moreover we need basic research to better address the mechanism of colchicine action in acute and recurrent pericarditis. • Current guidelines recommend colchicine doses of 2 mg per day for 1 to 2 days, followed by a maintenance dose of 1 mg per day 18. However, lower doses may improve patient compliance and be equally efficacious. • The COPE, CORE, and CORP trials used a maintenance dose of 0.5 mg twice daily, which was reduced to 0.5 mg daily in patients weighing less than 70 kg. In our study, a loading dose was not given, and patients had similar side effects in the colchicine and placebo groups, a finding that supports the use of a weight-adjusted maintenance dose without any loading dose. • • As final comments, I would like to add that a number of limitations of our study should be considered. Our findings might not be generalizable to other clinical conditions or other patient populations; in this regard, we excluded patients with elevated levels of aminotransferases, creatinine, or troponin and those with liver disease, myopathy, blood dyscrasias, or inflammatory bowel disease. Our results should not be applied to women who are pregnant or lactating or to children. We also excluded patients with bacterial or neoplastic pericarditis. • Of note, colchicine is not approved for the prevention of recurrent pericarditis in North America or Europe, and its use as such is off- label. Our limited sample size might have precluded the identification of rare adverse effects. • Citation: • Massimo Imazio, M.D., Antonio Brucato, M.D., Roberto Cemin, M.D., Stefania Ferrua, M.D., Stefano Maggiolini, M.D., Federico Beqaraj, M.D., Daniela Demarie, M.D., Davide Forno, M.D., Silvia Ferro, M.D., Silvia Maestroni, M.D., Riccardo Belli, M.D., Rita Trinchero, M.D., David H. Spodick, M.D., and Yehuda Adler, M.D. for the ICAP Investigators • NEJM: September 1, 2013DOI: 10.1056/NEJMoa1208536 Read the rest of the interview on MedicalResearch.com
  • Endocarditis: Hospitalizations and Mortality Trends MedicalResearch.com Interview with: Behnood Bikdeli, MD Yale/YNHH Center for Outcomes Research and Evaluation One Church St, Suite 200 New Haven CT 0651 • MedicalResearch.com: What are the main findings of the study?
 • Dr. Bikdeli: We determined the trends in hospitalizations and mortality from endocarditis among US older adults from 1999 to 2010. Endocarditis is the most serious cardiovascular infection and our study that had a very large sample, signified the high burden of endocarditis in this time period. • Further, as a secondary question, we compared the trends in hospitalizations and outcomes before versus after 2007, a year in which the American Heart Association (AHA) made a very radical change in its recommendations. The 2007 AHA recommendations narrowed the indications for use of antibiotics to prevent endocarditis. Many people were concerned that after such recommendations, the rates of endocarditis might increase remarkably. Our study did not show a consistent increase in hospitalizations or outcomes after 2007. What is unique about our study is that we demonstrated these trends to be consistent after adjustments for demographic changes over time. Moreover, we demonstrated that the adjusted mortality rates did not show a consistent increase after 2007, when the AHA guidelines recommended restricted antibiotic prophylaxis for endocarditis. • MedicalResearch.com: Were any of the findings unexpected?
 • Dr. Bikdeli: Yes, in fact we observed a consistent decline in endocarditis hospitalization rates from 2006-2010. This interesting finding warrants further investigation. One possible explanation could the concerted efforts that have been used for reducing the rates of catheter-associated bloodstream infections. • Another surprising finding was the consistently higher rates of endocarditis and worse outcomes for black patients. This issue also requires more in-depth research. Read the rest of the interview on MedicalResearch.com
  • Endocarditis: Hospitalizations and Mortality Trends MedicalResearch.com Interview with: Behnood Bikdeli, MD Yale/YNHH Center for Outcomes Research and Evaluation One Church St, Suite 200 New Haven CT 0651 • MedicalResearch.com: What should clinicians and patients take away from your report?
 • Dr. Bikdeli: This is a very important question. We caution against under or over interpretations from our findings. First, as I said earlier, our study shows that the burden of endocarditis among elderly Medicare beneficiaries is very high, with a third of patients dying one year from diagnosis. • Second, we did not observe a consistent increase in hospitalization rates after 2007, when the AHA recommended for restrictive use of antibiotic prophylaxis. Our investigation was not a comparative effectiveness study to prove the non-inferiority of restrictive prophylaxis. However, the trends that we observed, as well as a few studies from the US, UK, and France, do not show a change in pattern of endocarditis hospitalizations after recommendations for restrictive antibiotic use. • Clinicians should consider the risks and benefits of prophylaxis on a case-by-case basis and should share the information with their patients for appropriate decision making. My personal opinion is that widespread antibiotic prophylaxis would not have a big beneficial impact, and is not free from adverse effects. Nevertheless, there may be several instances in which antibiotic prophylaxis for endocarditis is reasonable. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bikdeli: With regard to antibiotic prophylaxis for endocarditis, one would ideally want to see comparative effectiveness studies (e.g. randomized controlled trials). However, widespread antibiotic prophylaxis, most probably, has a small effect size. Therefore, a randomized trial to test its efficacy might require around 50,000 patients, make it extremely unlikely to happen in near future. What I expect to be helpful is continued surveillance investigations, similar to our study. Also, we certainly need to further investigate better therapeutic options for management of endocarditis, and would also need to address the disparities for high-risk subgroups, such as blacks. • Citation: • Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries Behnood Bikdeli, MD; Yun Wang, PhD; Nancy Kim, MD, PhD; Mayur M. Desai, PhD, MPH; Vincent Quagliarello, MD; Harlan M. Krumholz, MD, SM • J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.07.071 Read the rest of the interview on MedicalResearch.com
  • Gestational Diabetes: Associated with Low Pre-Pregnancy Adiponectin Levels MedicalResearch.com Interview with: Monique Hedderson, PhD Research Scientist Kaiser Permanente Northern California Oakland, CA 94612 • MedicalResearch.com: What are the main findings of the study? • Dr. Hedderson: It is fascinating to discover that metabolic abnormalities appear to be present, even years before pregnancy, in a large proportion of women who develop gestational diabetes. The findings from this study emphasize the importance of the pre- pregnancy period in future pregnancy outcomes. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hedderson: The magnitude of the findings were a surprise. Overweight or obese women with lower than average levels of adiponectin were found to be seven times more likely to develop the condition than women of average BMI with normal adiponectin levels. It is rare to find an association that strong. We also found that women who were normal weight but had lower than average levels of adiponectin had a 3.5 fold increased risk of GDM. This is important because although we know obesity is one of the strongest risk factors for GDM, less is known about risk factors among normal weight women who develop GDM. It was also surprising that the association between adiponectin and GDM risk was independent of other known risk factors for GDM, including measures of insulin resistance. This suggests that it may be acting through a unique mechanism. Read the rest of the interview on MedicalResearch.com
  • Gestational Diabetes: Associated with Low Pre-Pregnancy Adiponectin Levels MedicalResearch.com Interview with: Monique Hedderson, PhD Research Scientist Kaiser Permanente Northern California Oakland, CA 94612 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hedderson: I think clinicians need to be aware of the importance of the pre-pregnancy period. With the current obesity epidemic, more than 30% of women are entering pregnancy overweight or obese. We know know obesity is associated with several pregnancy complications, including gestational diabetes, and most women retain excess weight after pregnancy. There is a growing body of evidence to suggest that achieving a health body weight before pregnancy would reduce a number of pregnancy complications, including gestational diabetes. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hedderson: There is scientific evidence that weight loss and certain dietary factors may increase adiponectin levels. However, more research is needed to determine the best strategies to improve adiponectin levels. Lifestyle intervention studies designed to prevent diabetes by decreasing dietary fat intake and increasing physical activity have been shown to be extremely effective at reducing the risk of diabetes in at risk populations. It is likely that similar interventions in young, reproductive aged women would be effective at reducing gestational diabetes, but more studies are needed to confirm the effectiveness in younger populations. Citation: • Low Prepregnancy Adiponectin Concentrations Are Associated With a Marked Increase in Risk for Development of Gestational Diabetes Mellitus • Monique M. Hedderson, Jeanne Darbinian, Peter J. Havel, Charles P. Quesenberry, Sneha Sridhar, Samantha Ehrlich, and Assiamira Ferrara • Diabetes Care published ahead of print August 29, 2013, doi:10.2337/dc13-0389 Read the rest of the interview on MedicalResearch.com
  • Nerve Block after Surgery Reduced Narcotic Usage, Shortened Hospital Stays MedicalResearch.com Interview with: Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047 • MedicalResearch.com: What are the main findings of the study? • Answer: Our goal was to see whether the transversus abdominis plane (TAP) block reduced complications and shortened the hospital stay of patients undergoing colorectal operations. The TAP block is a nerve block injection given at the conclusion of the operation which reduces pain in the operative area. Results showed that the mean hospital stay dropped to less than 2.5 days after the surgical procedure, significantly lower than the 3.7 days which the University Hospitals Case Medical Center Care pathway had already described for more than 1,000 consecutive patients. In our new study, we employed the TAP block and the Enhanced Recovery Pathway (ERP) on 100 patients. We found that 27 patients went home the next day and another 35 went home 48 hours after their operations. That is considerably better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation. With a third of patients leaving the day after colorectal resection, we feel these results are significant. • We also found that the TAP block allows patients to bypass or at least reduce the amount of narcotics they are often given after an operation. Though narcotics can help reduce pain, these agents also can slow down recovery. The TAP block wears off just in time for patients to skip the worst of the pain that occurs immediately after the operation, and the block does not appear to pose any significant risks to patients. • MedicalResearch.com: 
Were any of the findings unexpected? • Answer: The old thinking was that if patients went home early, they have a higher chance of readmission, but the data continue to show that is not the case. Patients who went home earliest had the lowest readmission rate. Although my group has seen this in previous studies, the new study affirms those findings. There were no mortalities, and patients who stayed longer in hospital tended to have more complications. • Of the eight patients with complications, such as urinary tract infections, gastrointestinal bleeds or small bowel obstructions, only two of this group were discharged within 48 hours. Those patients who had complications or required a longer stay were probably more high-risk patients anyway, because of advanced age or additional health conditions. Standardized criteria for discharge from hospital also play an important role in these results. Read the rest of the interview on MedicalResearch.com
  • Nerve Block after Surgery Reduced Narcotic Usage, Shortened Hospital Stays MedicalResearch.com Interview with: Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047 • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: I predict that Enhanced Recovery Pathways (ERP) will become standard practice for colorectal surgical patients in the next five years, although some health care organizations are already using them to a variable extent. The ERP protocol counters traditional conventions about how patients should prepare for, and recover from, colorectal operations. These standardized steps—which have been shown to speed recovery and improve outcomes—include letting patients eat the day after the procedure instead of waiting several days, encouraging them to walk around after procedures instead of staying in bed, optimizing analgesia, and controlling intravenous fluid volumes. • Using a TAP block to reduce hospital stay and narcotics use also has implications for reducing health care costs. In addition to the cost of each day in hospital, painkillers and other medications for colorectal surgical patients can cost many hundreds of dollars for each patient. The TAP block costs just $20 per patient. There are so many things we have to be careful of and cost is one of them. This is a low cost way to help patients feel better and recover sooner. • However, TAP blocks in the ERP protocol will require more evidence from further studies, such as a randomized clinical trial. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: The next step is a randomized clinical trial. In fact, my research team has already initiated a randomized double-blinded trial to compare a group of colorectal surgical patients who receive the TAP block with another group who will not. • If things continue to go well, my expectation is that we’ll eventually be giving the TAP to everyone, because it helps with reducing the pain. As quality and outcomes improve, we will also continue to see an increasing percentage of patients who are fit to be discharged the day after colorectal resection. • Citation: • Outcomes of Discharge after Elective Laparoscopic Colorectal Surgery with Transversus Abdominis Plane Blocks and Enhanced Recovery Pathway • Favuzza J, Delaney CP. • Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH. J Am Coll Surg. 2013 Sep;217(3):503-6. doi: 10.1016/j.jamcollsurg.2013.03.030. Epub 2013 Jun 28. Read the rest of the interview on MedicalResearch.com
  • Mental Health Disorders and Risk of Shortened Lifespan MedicalResearch.com Interview with: Arif Khan, MD Medical Director, Northwest Clinical Research Center Adjunct Professor of Psychiatry Duke University Medical Center and Christine Khan, Psychiatric Nurse Northwest Clinical Research Center Bellevue, WA 98007 • MedicalResearch.com: What are the main findings of your study? • The original idea set in early 20th century that psychiatric patients discharged from mental hospitals had a shortened life span or faced early death was supported by this analysis of psychiatric patients participating in research trials for new medications. There was no increased risk of early death or shortened life span for participating in these research clinical trials. • Life span shortening or increased risk of early death is highest among patients with schizophrenia, followed by patients with major mood disorders such as Bipolar Mood Disorder and Major Depression. • Such a decrease in life span or increased risk of early death not seen among patients with anxiety disorders and adult ADHD. • 40% of increased early death risk was due to suicide among patients with schizophrenia and major mood disorders. • Even after taking out the risk associated with suicide, the increased early death risk or shortened life span was two-fold or higher among patients with schizophrenia and major mood disorders compared to general population and mostly due to heart attacks and strokes and similar illnesses. • This shortening of life span or an increase in early death could not be fully accounted for by poor medical care or ongoing severe medical illnesses as such patients were not included in these research trials and good quality medical care was provided during trial participation. • There was definite evidence that treatment with medication compared to the placebo or ‘sugar pill’, if anything mitigated this risk of early death or shortened life span, although the reason for such finding is unknown at present. The only exception was the class of medications such as Elavil and Tofranil which are not commonly used nowadays. • Lastly, it is likely that psychiatric illnesses are associated with inherent risk of brain, heart and other organ abnormalities and thus carry serious risk of early death such as the risk seen in patients with high blood pressure or high cholesterol. • Citation: • Khan A, Faucett J, Morrison S, Brown WA. Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials. JAMA Psychiatry. 2013;():-. doi:10.1001/jamapsychiatry.2013.149. Read the rest of the interview on MedicalResearch.com
  • Coronary Angiography: Vitamin C and Protection Against Contrast-Induced Kidney Disease MedicalResearch.com Interview with: Umar Sadat, MD, PhD Addenbrooke’s Hospital Cambridge, United Kingdom • MedicalResearch.com: What are the main findings of the study? • Dr. Sadat: Vitamin C offers significant nephroprotection against contrast induced-acute kidney injury (CI-AKI) in patients undergoing coronary angiography. Patients receiving Vitamin C were observed to have 33% less risk of CI-AKI compared to those receiving placebo or other treatment. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Sadat: The robustness of this meta-analysis was evident at every step, which though unexpected was very reassuring too. This makes the results of this meta-analysis very reliable. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Sadat: Although most clinical trials have investigated the use of N-acetylcysteine against CI-AKI, there is lack of convincing and consistent evidence about its use. Although our meta analysis is the first ever pooled analysis of randomized controlled trials assessing nephroprotective role of vitamin C against CI-AKI, the robustness of our meta analysis should encourage clinicians to use this pharmacological agent to protect against CI-AKI in patients undergoing contrast media-enhanced radiological procedures, particularly in those with pre existing renal impairment. • For patients, our results may be very reassuring and encouraging in that vitamin C can protect their kidneys from dye-induced kidney damage, particularly when there is pre existing impairment of kidney functions. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Sadat: Future studies should aim at investigating the underlying mechanisms involved in the nephroprotective role of vitamin C against CI-AKI. • Our meta-analysis included patients who were undergoing coronary angiography. Future studies may include patients undergoing peripheral angiography such as patients with peripheral vascular disease, or patients undergoing endovascular aortic procedures such as endovascular aortic aneurysm repair (EVAR). • All such future studies should be adequately powered and use validated biomarkers of renal injury, rather than use non-validated renal biomarkers- changes in which may not translate into clinically relevant outcomes. • • Citation: • Does ascorbic acid protect against contrast induced- acute kidney injury in patients undergoing coronary angiography – a systematic review with meta-analysis of randomized controlled trials. • Umar Sadat, MD, PhD; Ammara Usman, MB BS, MBA; Jonathan H. Gillard, MD, FRCR; Jonathan R. Boyle, MD, FRCS Read the rest of the interview on MedicalResearch.com
  • Rheumatoid Arthritis: Nurse-Led Care Effectiveness and Patient Satisfaction MedicalResearch.com Interview with: Mwidimi Ndosi, PhD, MSc, BSc (Hons), RN. Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN) Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds England • MedicalResearch.com: What are the main findings of the study? • Answer: The aims of this study was to determine the clinical and cost-effectiveness of nurse- led care for people with rheumatoid arthritis. • The main findings were: • (i) Patients seeing clinical nurse specialists for their rheumatoid arthritis follow-up care do not get an inferior treatment. (ii) Nurse-led care is safe and in some aspects presents added value to patients (iii) Nurse-led care represents good value for money in terms of disease management for people with RA. • MedicalResearch.com: Were any of the findings unexpected? • Answer: It was expected that nurse-led care would be associated with greater patient satisfaction as this has been shown in other chronic diseases. • It was however surprising to see that patients under nurse-led care saw greater improvement in their disease activity, despite making fewer medication changes than rheumatologist-led care. Read the rest of the interview on MedicalResearch.com
  • Rheumatoid Arthritis: Nurse-Led Care Effectiveness and Patient Satisfaction MedicalResearch.com Interview with: Mwidimi Ndosi, PhD, MSc, BSc (Hons), RN. Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN) Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds England • MedicalResearch.com: What should clinicians and patients take away from your report? • MedicalResearch.com: This was a pragmatic trial, assessing the effectiveness of an established practice in the UK and this report provides a robust evidence of its effectiveness. Since in rheumatology, nurse-led care follows a ‘complementary model’, patients are likely to get additional benefits and this model of care should be given a serious consideration in other chronic conditions. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Since the future of care for people with rheumatic diseases is likely to involve more multidisciplinary collaboration, further research is should look into ways this model of care can achieve better outcomes with more efficiency in different subgroups of patients. • Citation: • The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial • Mwidimi Ndosi, Martyn Lewis, Claire Hale, Helen Quinn, Sarah Ryan, Paul Emery, Howard Bird, Jackie Hill • Ann Rheum Dis annrheumdis-2013-203403Published Online First: 27 August 2013 doi:10.1136/annrheumdis-2013-203403 Read the rest of the interview on MedicalResearch.com
  • Type 2 Diabetes: Fruit and Fruit Juice Consumption MEDICALRESEARCH.COM: INTERVIEW WITH: Qi Sun, MD ScD Assistant Professor of Medicine Channing Division of Network Medicine Brigham and Women’s Hospital and Harvard Medical School, Assistant Professor Department of Nutrition, Harvard School of Public Health , Boston, MA 02115 • MEDICALRESEARCH.COM: What are the main findings of the study? • Response: We have three major findings. • First, we found that total fruit consumption was consistently associated with lower risk of developing type 2 diabetes in these large scale studies among U.S. men and women. • Second, we found that different individual fruits were differentially associated with diabetes risk. For example, higher intakes of blueberries, grapes or raisins, apples or pears are particularly associated with a lower diabetes risk. • Last, we found that fruit juice was associated with a higher diabetes risk, and replacing fruit juices with whole fruits will likely lead to reduced diabetes risk. • MEDICALRESEARCH.COM: Were any of the findings unexpected? • QS: One of the study hypotheses is that fruits with high glycemic index or glycemic load are less beneficial than fruits with lower values of these indices. However, our data do not suggest that the glycemic properties of fruits play an important role in the associations with diabetes. • MEDICALRESEARCH.COM: What should clinicians and patients take away from your report? • QS: Our findings endorse the recommendation on increasing whole fruits consumption, rather than fruit juices, in diabetes prevention. However, whether patients of diabetes should also maintain or increase fruit consumption was not addressed in this study. • MEDICALRESEARCH.COM: What recommendations do you have for future research as a result of this study? • QS: Future studies are needed to shed light on the mechanisms underlying our findings that consumption of certain fruits is particularly beneficial on lowering diabetes risk. For example, it is interesting to understand whether the polyphenol contents of a specific fruit determine its association with diabetes risk. In addition, it is important to extend this research to other populations, such as diabetes patients, and to other diseases, such as heart disease and cancer. • Citation: • Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies • Isao Muraki research fellow , Fumiaki Imamura investigator scientist , JoAnn E Manson professor of medicine , Frank B Hu professor of nutrition and epidemiology , Walter C Willett professor of epidemiology and nutrition , Rob M van Dam associate professor , Qi Sun assistant professor • BMJ 2013;347:f5001 doi: 10.1136/bmj.f5001 Read the rest of the interview on MedicalResearch.com
  • Diabetes Complicates Surgical Recovery MedicalResearch.com Interview with: Ta-Liang Chen, MD, PhD Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan • MedicalResearch.com: What are the main findings of the study? • Reply: Diabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries. • MedicalResearch.com: Were any of the findings unexpected? • Reply: Diabetes-related eye involvement, peripheral circulatory disorder, ketoacidosis, renal manifestations, and coma complicated postoperative mortality. • MedicalResearch.com: What should clinicians and patients take away from your report? • Reply: Perioperative assessment, high quality of care and family support are needed for this specific population. Medical resources should be appropriately allocated to patients with diabetes and coexisting medical conditions when they undergo noncardiac surgeries. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Reply: Future researches need to investigate the impact of preoperative medication, and fasting glucose level on the adverse events after non-cardiac surgeries. • Citation: • Adverse Outcomes After Noncardiac Surgery in Patients With Diabetes: A nationwide population-based retrospective cohort study Diabetes Care published ahead of print August 29, 2013, doi:10.2337/dc13-0770 • Chun-Chieh Yeh, Chien-Chang Liao, Yi-Cheng Chang, Long-Bin Jeng, Horng-Ren Yang, Chun-Chuan Shih, and Ta-Liang Chen Read the rest of the interview on MedicalResearch.com
  • Alzheimer Disease: Homozygous Genetic Loci Identified MedicalResearch.com Interview with: Ekaterina Rogaeva, PhD Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine , University of Toronto, Toronto, Ontario, CanadaCambridge Institute for Medical Research and Department of Clinical Neurosciences, University of Cambridge, Cambridge, England • MedicalResearch.com: What are the main findings of the study? • Answer: We tested the hypothesis that late-onset Alzheimer disease (AD) might be in part explained by the homozygosity of unknown loci. In a genome-wide study of a Caribbean Hispanic population with noticeable inbreeding and high risk of AD we assessed the presence of long runs of homozygosity (ROHs) – regions where the alleles inherited from both parents are identical. Our results suggest the existence of recessive AD loci, since the mean length of the ROH per person was significantly longer in AD cases versus controls, and this association was stronger in familial AD. • The association of ROHs with AD could either reflect the cumulative risk effects of multiple ROHs or the contribution of specific loci harboring recessive mutations in a subset of AD patients. To address the latter possibility we identified overlapping ROH segments (consensus regions) and calculated the case/control ratio for each of 1,415 consensus regions. The most significant association with AD was observed for two genes: EXOC4, encoding a component of the exocyst complex involved in the trafficking of the NMDA receptor; and CTNNA3, encoding alpha catenin interacting with PSEN1 (known AD gene). • MedicalResearch.com: Were any of the findings unexpected? • Answer: Thus far, all known causal AD genes (APP, PSEN1 and PSEN2) are responsible for an autosomal dominant inheritance of disease For the first time we showed that autosomal recessive inheritance could also contribute to AD, when one copy of a mutant allele cause Read the rest of the interview on MedicalResearch.com
  • Alzheimer Disease: Homozygous Genetic Loci Identified MedicalResearch.com Interview with: Ekaterina Rogaeva, PhD Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine , University of Toronto, Toronto, Ontario, CanadaCambridge Institute for Medical Research and Department of Clinical Neurosciences, University of Cambridge, Cambridge, England • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Knowledge about the genetics of AD is important to manage the challenges of aging populations, since it is the most prevalent form of dementia. The results of our ROH-study is especially important for clinicians assessing AD patients from regions where consanguineous marriages are frequently practised (e.g. the Middle East) or from populations with a noticeable degree of inbreeding (e.g. Caribbean Hispanics). Families with both history of AD and an inbred background should be included in genetic studies to search for recessive defects as described above. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future studies would require the analysis of large independent and relatively inbred data sets that might confirm the loci detected in our study and/or reveal novel recessive AD genes. In order to characterize the molecular defects underlying AD, the first step is to conduct deep sequencing of the top significant loci in a subset of samples with ROHs overlapping EXOC4 and CTNNA3 loci, followed-up by segregation studies in AD families and the assessment of potential pathological mutations in different ethnic groups. • Citation: • Evidence of Recessive Alzheimer Disease Loci in a Caribbean Hispanic Data Set Genome-wide Survey of Runs of HomozygosityGhani M, Sato C, Lee JH, et al. Evidence of Recessive Alzheimer Disease Loci in a Caribbean Hispanic Data Set: Genome-wide Survey of Runs of Homozygosity. JAMA Neurol. 2013;():-. doi:10.1001/jamaneurol.2013.3545. Read the rest of the interview on MedicalResearch.com
  • Breast Cancer Risk: Increased by Pre- First Pregnancy Alcohol Intake MedicalResearch.com Interview with: Ying Liu, MD, PhD Instructor, Division of Public Health Sciences Department of Surgery Washington University School of Medicine St. Louis, MO 63110 • MedicalResearch.com: What are the main findings of the study? • Answer: Alcohol intake between menarche (first menstrual period) and first pregnancy was consistently associated with increased risks of breast cancer and proliferative benign breast disease. For every 10 gram/day alcohol intake (approximately a drink a day) during this specific time period, the risk for breast cancer increased by 11% and the risk for proliferative benign breast disease increased by 16%. • MedicalResearch.com: Were any of the findings unexpected? • Answer: The adverse effect of pre-pregnancy alcohol intake on breast cancer risk was stronger as the time period between menarche and first pregnancy lengthened. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Young women should reduce their alcohol drinking to less than one drink a day, especially during this critical time period, as a key tool to reduce their breast cancer risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future work is needed to resolve what accounts for this association and what we could do to counteract the adverse effect of pre-pregnancy drinking on breast cancer risk. • Citation: • Alcohol Intake Between Menarche and First Pregnancy: A Prospective Study of Breast Cancer Risk Ying Liu, Graham A. Colditz,, Bernard Rosner, Catherine S. Berkey, Laura C. Collins, Stuart J. Schnitt, James L. Connolly, Wendy Y. Chen, Walter C. Willett, and Rulla M. Tamimi • Alcohol Intake Between Menarche and First Pregnancy: A Prospective Study of Breast Cancer Risk JNCI J Natl Cancer Inst first published online August 28, 2013 doi:10.1093/jnci/djt213 Read the rest of the interview on MedicalResearch.com
  • Depression: Association with Low Physical Activity, Prolonged Sitting MedicalResearch.com Interview with: Jannique van Uffelen, PhD, MSc (epidemiology), MSc (human movement sciences), BHealth Senior Research Fellow Active Ageing INSTITUTE OF SPORT, EXERCISE & ACTIVE LIVING (ISEAL) VICTORIA UNIVERSITY • MedicalResearch.com: What are the main findings of the study? • Answer: We examined the link between sitting-time and physical activity with current and future depressive symptoms in 8,950 mid aged women, who participated in the Australian Longitudinal Study on Women’s Health. • Both high sitting-time and low physical activity levels were associated with higher risk of current depressive symptoms, and in combination, the risk further increased. Compared with women sitting ≤4 hours/day and meeting the physical activity recommendations of at least 150 minutes of moderate intensity activity per week, women who sat >7 hrs/day and who did no physical activity were three times as likely to have depressive symptoms. However, only lack of physical activity was associated with increased risk of future depressive symptoms, irrespective of sitting-time. Women who did no physical activity were 26% more likely to have future depressive symptoms than women meeting physical activity recommendations. • Depressive symptoms did not predict changes in sitting-time. However, compared with women without symptoms, women with depressive symptoms were 20% less likely to increase their physical activity levels over time. This suggests a vicious circle whereby inactive women are more likely to have future depressive symptoms and those with depressive symptoms are less likely to increase their activity levels. • MedicalResearch.com: Were any of the findings unexpected? • Answer: An interesting finding in our study was that sitting-time was associated with current depressive symptoms, but not with future symptoms. There are several potential explanations for this, which are described in more detail in the article. A particularly interesting explanation is the potential of reverse causality. Fatigue and loss of energy are common depressive symptoms and it could therefore be the case that, instead of high sitting-time causing depressive symptoms, depressive symptoms cause high sitting-time. Although this seems to be a logical explanation, we did not find evidence for reverse causation in our study. Read the rest of the interview on MedicalResearch.com
  • Depression: Association with Low Physical Activity, Prolonged Sitting MedicalResearch.com Interview with: Jannique van Uffelen, PhD, MSc (epidemiology), MSc (human movement sciences), BHealth Senior Research Fellow Active Ageing INSTITUTE OF SPORT, EXERCISE & ACTIVE LIVING (ISEAL) VICTORIA UNIVERSITY • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Based on the findings of our study, lifestyle interventions to alleviate current depressive symptoms and prevent future symptoms should include strategies to increase activity levels commensurate with meeting the physical activity recommendations for public health. These recommendations indicate that , to promote and maintain health, adults should do a minimum of 30 minutes of moderate intensity aerobic activity on 5 days per week, or 20 minutes of vigorous intensity aerobic activity on 3 days per week, or any combination of moderate and vigorous intensity activity to meet the minimum activity level. Lifestyle interventions could also include strategies to reduce sitting-time to alleviate current symptoms, which is in line with common practice to reduce behavioural inactivity in the treatment of depression. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: More prospective studies are needed to clarify the association between sitting-time and depressive symptoms over time and to further examine the direction of the association. Furthermore, as there are indications that the association between sedentary behaviour and mental health differs by domain, such as occupational sitting or leisure time sitting, the link between domain specific sitting time and depressive symptoms is a direction for future research. • For a 6 minute video cast of the paper, please see: http://www.scivee.tv/node/60419 • • Citation: • Sitting-Time, Physical Activity, and Depressive Symptoms in Mid-Aged Women • Jannique G.Z. van Uffelen, Yolanda R. van Gellecum, Nicola W. Burton, Geeske Peeters, Kristiann C. Heesch, Wendy J. Brown • American Journal of Preventive Medicine – September 2013 (Vol. 45, Issue 3, Pages 276-281, DOI: 10.1016/j.amepre.2013.04.009 Read the rest of the interview on MedicalResearch.com
  • Rheumatoid Arthritis: Are Two Drugs Better than One? MedicalResearch.com Interview with: Dr. Janet E Pope Division of Rheumatology, Department of Medicine The University of Western Ontario, St Joseph’s Health Centre 268 Grosvenor Street, London, ON, Canada N6A 4V2 • MedicalResearch.com: What are the main findings of the study? • Dr. Pope: We performed a RCT of patients who were stable for 6 months of etanercept added to methotrexate (inadequate responders to Mtx) who were randomized to stopping Mtx or continuing Mtx to determine if in the next 6 months (and later as the trial continues) the response rate would be the same if Mtx was discontinued. Overall, Mtx + etanercept was not statistically equivalent to etanercept alone (ie non-inferiority did not occur); implying 6 months after stopping Mtx, the etanercept patients on monotherapy performed slightly less well than those on combination therapy. • In a pre-specified subset analysis, both patients who started in lower DAS28; and/or were in a low DAS28 at 6 months seemed to do equally well if Mtx was stopped or continued, but if not in a low DAS28 at 6 months, stopping Mtx on average slightly worsened the DAS28. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Pope: Yes and no. Most studies have shown that two drugs are better than one in RA. This seems to be the case in the CAMEO trial, but if in a low disease state, this likely can be maintained for at least another 6 months after Mtx is discontinued. We are looking at a longer durability of response and drop out rate for those in each treatment group to see if in the long term (as may be found in some registries), Mtx is better for less drop out over time. Read the rest of the interview on MedicalResearch.com
  • Rheumatoid Arthritis: Are Two Drugs Better than One? MedicalResearch.com Interview with: Dr. Janet E Pope Division of Rheumatology, Department of Medicine The University of Western Ontario, St Joseph’s Health Centre 268 Grosvenor Street, London, ON, Canada N6A 4V2 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Pope: If in a low disease state in RA with Mtx and etanercept, perhaps Mtx can be stopped but if not in remission or a low disease state Mtx should not be stopped. We can’t answer about lowering Mtx or lowering etanercept as that was not part of this study. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Pope: It would be interesting to answer the above questions (dose reduction of one drug or the other) and we will look at retention in the study (both drop outs and maintaining response) in the two groups for another 12 months and we have the pharmacogenomics on the patients to determine if there are certain genes that predispose to more or less retention for both treatment arms. • Citation: • The Canadian Methotrexate and Etanercept Outcome Study: a randomised trial of discontinuing versus continuing methotrexate after 6 months of etanercept and methotrexate therapy in rheumatoid arthritis Janet E Pope, Boulos Haraoui, J Carter Thorne, Andrew Vieira, Melanie Poulin-Costello, Edward C Keystone • Ann Rheum Dis annrheumdis-2013-203684Published Online First: 26 August 2013 doi:10.1136/annrheumdis-2013-203684 Read the rest of the interview on MedicalResearch.com
  • Pregnancy: Birth Defects Risks with Oral Fluconazole MedicalResearch.com Interview with: Ms. Mølgaard-Nielsen Statens Serum Institut Copenhagen S, Denmark • MedicalResearch.com: What are the main findings of the study? • Answer: Use of oral fluconazole during early pregnancy did not increase the risk of birth defects overall in common therapeutic doses. We also looked at 15 individual birth defects of previous concern and oral fluconazole was not associated with an increased risk for 14 of these birth defects. However, we did see an increase in the risk of tetralogy of Fallot, an uncommon congenital heart defect, but the number of exposed cases was few. • MedicalResearch.com: Were any of the findings unexpected? • Answer: In 2011, the U.S. Food and Drug Administration, FDA, issued a warning on the teratogenic risk associated with fluconazole based on birth defects seen in 5 infants whose mothers had been treated with high- and long-term doses during pregnancy due to severe fungal infections. Similar defects had been observed in animal studies. With the use of the unique Danish national registries, we identified all pregnant women in Denmark in the period 1996-2011 and conducted the largest study ever examining the association between fluconazole in common therapeutic doses and birth defects. Our findings were not unexpected, but still, a large comprehensive study was necessary to address any concerns that the teratogenic effects seen for high- and long term fluconazole doses translated into similar effects for common therapeutic use. Read the rest of the interview on MedicalResearch.com
  • Pregnancy: Birth Defects Risks with Oral Fluconazole MedicalResearch.com Interview with: Ms. Mølgaard-Nielsen Statens Serum Institut Copenhagen S, Denmark • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Many pregnant women suffer from vaginal candidiasis, which is the most common clinical indication for use of oral fluconazole. First-line treatment for vaginal candidiasis during pregnancy is vaginal preparations of topical azole antifungal drugs because of their minimal systemic absorption. However, in cases when topical treatment is ineffective this study provides comprehensive safety information and may help inform clinical decisions when treatment with oral fluconazole is considered in pregnancy. Furthermore, pregnant women can be reassured since this study does not support a teratogenic effect of fluconazole used in common therapeutic doses during pregnancy. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: In our study, the increased risk of tetralogy of Fallot is based on only 7 cases born of mothers using fluconazole, and we therefore suggest that this association needs to be confirmed in another and preferably larger study before anything certain can be concluded. • Citation: • Use of Oral Fluconazole during Pregnancy and the Risk of Birth Defects • Ditte Mølgaard-Nielsen, M.Sc., Björn Pasternak, M.D., Ph.D., and Anders Hviid, Dr.Med.Sci. • N Engl J Med 2013; 369:830-839August 29, 2013DOI: 10.1056/NEJMoa1301066 Read the rest of the interview on MedicalResearch.com
  • Kaiser’s Hypertension Program Dramatically Improves Blood Pressure Control in Large Population MedicalResearch.com Interview with: Dr. Marc Jaffe, MD Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group Associate Clinical Professor of Medicine, UCSF Endocrinology and Internal Medicine Kaiser South San Francisco Medical Center South San Francisco, California 94080 • MedicalResearch.com: What are the main findings of the study? • Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates. • If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Jaffe: There is hope for patients with hypertension to get their blood pressure under control, especially if their health care providers follow some of the steps outlined in our paper. This model is replicable, and we published this article in JAMA so other hospitals and health systems could implement elements of this system that was so successful for us. Perhaps by following these methods, clinicians can improve blood pressure control nationwide. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Jaffe: We hope other hospitals and health systems will try out the elements that were successful for us with this program as well as other strategies and report on their own results so the health care system as a whole can benefit. • Citation: • Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program. JAMA. 2013;310(7):699-705. doi:10.1001/jama.2013.108769. Read the rest of the interview on MedicalResearch.com
  • Cancer Patients: Coping, Medication Adherence if under Financial Distress MedicalResearch.com Interview with: S. Yousuf Zafar, MD, MHS Assistant Professor of Medicine Duke Cancer Institute • MedicalResearch.com: What are the main findings of the study? • Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients used different cost- coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan. MedicalResearch.com: Were any of the findings unexpected? • Dr. Zafar: Our results suggested that nonadherent patients tended to alter their lifestyles in order to defray the costs of prescription medication. Non-adherence might serve as a signal for more pervasive difficulties with paying for health care. These findings weren’t unexpected as much as they described the extent to which patients were suffering as a result of treatment-related financial burden. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Zafar: Dr. Zafar Patients aren’t talking to their doctors about their financial burden, but they are still at risk of experiencing financial distress. Clinicians should understand that the interventions we prescribe might cause more than physical toxicity — they might also result in financial toxicity. Not all patients need or want to discuss costs, but clinicians should be open to the idea of cost discussions, and more importantly, be prepared to point patients towards potential resources to help with their financial needs. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Zafar: Now that we know cancer care can incur a financial burden for our patients, we should design interventions that can identify patients most at risk for experiencing it. We need to help patients identify appropriate resources and talk to their doctors about cost when making major treatment decisions. • Citation: • Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer • Leah L. Zullig, Jeffrey M. Peppercorn, Deborah Schrag, Donald H. Taylor, Jr, Ying Lu, Gregory Samsa, Amy P. Abernethy, and S. Yousuf Zafar Read the rest of the interview on MedicalResearch.com
  • Observation Status: Effect of “Two Midnights” Rule on LOS, Skilled Nursing Placement MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine • MedicalResearch.com: What are the main findings of the study? • Answer: The Centers for Medicare and Medicaid Services (CMS) has changed their definition for observation status. Previously, observation status was determined by Interqual clinical criteria. The new rule states that all patients with length of stay < 2 midnights, with few exceptions, will be observation, and patients staying ≥ 2 midnights will be inpatient. We applied the proposed (now final) CMS rules change to our present inpatient and observation patients to model the potential effects of this policy change. We found that many more short stay inpatients at our hospital (8,231) would lose inpatient status (and therefore be hurt by the rules change) than longer stay observation patients (1,211) who would be helped by gaining inpatient status. At our hospital, this would have resulted in significant financial losses. • We also found that only a small number (35%) of observation patients would gain skilled nursing facility benefit with these rules. • Finally, we studied the relationship between time of day of admission and achievement of a 2 midnight stay. Clearly, patients admitted just before midnight will achieve 2 midnights much more quickly hours-wise than a patient admitted at 1:00am. We studied the relationship between the 2 midnight stay and actual length of stay (in hours) and found that 46.9% of patients <2 midnights fell in the overlap zone between our shortest ≥ 2 midnight stay (26.6 hours) and longest <2 midnight stay (47.2 hours). In other words, 46.9% of <2 midnight stay patients would be assigned observation status instead of inpatient by virtue of time of day of presentation in relation to midnight. • MedicalResearch.com: Were any of the findings unexpected? • Answer: We were surprised by the number of patients who would lose inpatient status under these rules change, and we were surprised that more people would not gain skilled nursing facility coverage with this rules change. Perhaps most interesting and relevant to practicing hospitalists is the overlap in length of stay between patients with <2 midnight and ≥ 2 midnight stays. This means that a hospitalist may be caring for 2 identical patients with identical problems needing identical care, but their insurance coverage (Medicare Part A or Part B), and their status (inpatient versus observation) will be different simply based on the time of day they present with respect to midnight. Read the rest of the interview on MedicalResearch.com
  • Observation Status: Effect of “Two Midnights” Rule on LOS, Skilled Nursing Placement MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Clinicians need to follow these new rules in caring for their patients. However, clinicians are also responsible for systems improvement. These rules may unfortunately create an increase in length of stay, as the incentives for crossing 2 midnights are great, and the disconnect between actual length of stay and midnight stay is significant. Increased length of stay would add additional unnecessary cost to the system. If this happens, clinicians need to be prepared to provide feedback to Medicare, and hopefully these rules can be modified in the future. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: We will need to continue to monitor the actual clinical and financial effects of these rules change. • Citation: • Sheehy AM, Graf B, Gangireddy S, et al. Hospitalized but Not Admitted: Characteristics of Patients With “Observation Status” at an Academic Medical Center. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.8185 Read the rest of the interview on MedicalResearch.com
  • Diabetes with CAD: Genetic Link Related to Glutamic Acid Metabolism MedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Assistant Professor of Medicine Harvard Medical School Assistant Professor of Nutrition Harvard School of Public Health • MedicalResearch.com: What are the main findings of the study? • Answer: The main findings include, we for the first time identified a genetic variant predisposing to high risk of coronary heart disease in patients with type 2 diabetes, using genome-wide association (GWA) approach. More interesting, we demonstrated that the variant may affect expression of a gene involved in metabolism of amino acid glutamic acid, which has been related to insulin secretion and heart health in previous studies. • MedicalResearch.com: Were any of the findings unexpected? • Answer: It is not surprising to find novel genetic variants that are related to heart disease specifically in diabetic patients, because these patients have several folds higher risk of heart disease as compared with non-diabetic population. The effects of some genetic variants may be only expressed or exaggerated in diabetic patients, who are characterized by a variety of metabolic abnormalities such as high glucose, dyslipidemia, hypertension, and obesity. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Our findings show evidence that elevated cardiovascular risk complicated to diabetes is at least partly determined by genetics; and open possibility to development of new therapeutic approach targeting the pathway related to glutamic acid metabolism. In addition, it is of great interest to further study potential lifestyle and dietary factors that may affect metabolism of amino acids glutamine and glutamic acid. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: • First, I would recommend more population studies to validate our findings, especially in other ethnic populations. • Second, functional studies would be the essential next step to illustrate the precise mechanisms underlying the genetic effects. • Finally, I strongly suggest epidemiologist to investigate lifestyle and dietary factors that may affect glutamic acid metabolism. These findings would be important regarding prevention of heart disease in diabetic patients. • Citation: • Qi L, Qi Q, Prudente S, et al. Association Between a Genetic Variant Related to Glutamic Acid Metabolism and Coronary Heart Disease in Individuals With Type 2 Diabetes. JAMA. 2013;310(8):821-828. doi:10.1001/jama.2013.276305. Read the rest of the interview on MedicalResearch.com
  • Obesity: Inflammatory Markers May Detect Risk of Diabetes, Heart Disease MedialResearch.com Interview with: Dr Catherine M. Phillips Health Research Board Centre for Diet and Health Research Room 4.033, Department of Epidemiology and Public Health Western Gateway Building, University College Cork, Cork, Ireland • MedialResearch.com: What are the main findings of the study? • Answer: Obesity is associated with increased risk of diabetes and heart disease leading to reduced life expectancy. However in recent years it has been recognized that not all obese individuals are at increased risk – these individuals have been described as being metabolically healthy obese (MHO) in that despite carrying excess weight they do not have the typical abnormal metabolic features associated with obesity such as hypertension, insulin resistance and alterations to their lipid profile. • It is not clear what factors determine whether an obese person becomes metabolically healthy or unhealthy. In this study conducted at the Dept. of Epidemiology and Public Health at University College Cork, Ireland, we examined levels of a range of inflammatory markers in 2047 middle-aged Irish adults to investigate to what extent differences between metabolically healthy and unhealthy obese and non-obese male and female adults are explained by inflammatory status. Participants, who were between the ages of 50 and 69, completed lifestyle questionnaires, physical and clinical assessments, and underwent blood testing so their body mass index (BMI), metabolic profiles and inflammatory markers could be determined. We found that, regardless of a person’s BMI, having a favorable inflammatory profile was associated with being metabolically healthy. Specifically metabolically healthy individuals presented with lower levels of complement component 3, C reactive protein, tumour necrosis factor alpha, interleukin 6, plasminogen activator inhibitor-1, reduced white blood cell count and higher adiponectin levels compared to their metabolically unhealthy counterparts. • MedialResearch.com: Were any of the findings unexpected? • Answer: Whether inflammation accounts for the metabolic differences observed between metabolically healthy and unhealthy individuals is relatively unknown. Conflicting findings regards inflammatory status and MHO have been previously reported – which may be due to a number of reasons including differences in ethnicity and age-group, small subject numbers and investigation of a limited number of limited inflammatory markers, together with different metabolic health criteria being used to define MHO. Our study involves characterisation of the largest range of inflammatory markers among metabolic health obese and non-obese phenotypes conducted to date. Furthermore we examined inflammatory status across a range of metabolic health definitions, as no standard metabolic health definition exists. Read the rest of the interview on MedicalResearch.com
  • Obesity: Inflammatory Markers May Detect Risk of Diabetes, Heart Disease MedialResearch.com Interview with: Dr Catherine M. Phillips Health Research Board Centre for Diet and Health Research Room 4.033, Department of Epidemiology and Public Health Western Gateway Building, University College Cork, Cork, Ireland • MedialResearch.com: What should clinicians and patients take away from your report? • Answer: The findings of our research may be of public health importance and clinical significance in terms of both screening and stratification based on an individual’s metabolic health phenotype. From a public health standpoint, we need better methods for identifying which obese people face the greatest risk of diabetes and heart disease. A better understanding of obese subgroups may be useful in the identification of individuals who are most unhealthy and thus at greatest cardiometabolic risk for whom appropriate therapeutic or intervention strategies should be prioritized and/or developed. • MedialResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Inflammatory markers may offer a potential strategy for identifying people who could benefit most from interventions and requires further investigation. Furthermore the potential of medical, lifestyle or dietary interventions to attenuate the transition from metabolically healthy to unhealthy obesity, or indeed reversion from an unhealthy to a healthy metabolic state remains an intriguing possibility, which would be worthwhile to address in future research. • Citation: • Does Inflammation Determine Metabolic Health Status in Obese and Nonobese Adults? • Catherine M. Phillips and Ivan J. Perry • Does Inflammation Determine Metabolic Health Status in Obese and Nonobese Adults? JCEM jc.2013-2038; doi:10.1210/jc.2013-2038 Read the rest of the interview on MedicalResearch.com
  • Prostate Cancer: Coffee and Tea Association MedicalResearch.com Interview with: Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center Seattle, WA 98109-1024 • MedicalResearch.com: What are the main findings of the study? • Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease. In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day. The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Stanford: We did not know what to expect as few studies of coffee or tea in relation to prostate cancer outcomes have been published. There is another recent study, however, that found a similar 60% reduction in risk for development of metastasis or prostate cancer-specific death in association with coffee consumption. We also did not know how risk of prostate cancer recurrence/progression might vary according to the level of coffee intake. Although we observed that risk declined with increasing number of cups of coffee per day, even prostate cancer patients who reported drinking one cup per day experienced over a 50% decline in their risk of having their prostate cancer come back or recur. Read the rest of the interview on MedicalResearch.com
  • Prostate Cancer: Coffee and Tea Association MedicalResearch.com Interview with: Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center Seattle, WA 98109-1024 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Stanford: More research is needed on the potential health benefits of coffee in prostate cancer patients, but for men who have been diagnosed with prostate cancer our research suggests that coffee consumption (even 1 cup per day) may be of benefit in terms of reducing risk of having the cancer recur or progress. Coffee contains a number of chemicals that may reduce cancer cell growth, increase cancer cell death, and have other chemopreventive activities such as anti-inflammatory and antioxidant effects. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Stanford: Future research based on larger prostate cancer patient cohorts with long-term follow-up for assessment of disease recurrence/progression and prostate cancer-specific mortality events and in which detailed coffee consumption is measured (amount and frequency of coffee consumption, caffeinated or uncaffeinated coffee use, method of coffee preparation used) could provide more support for this association. In addition, more research into the chemopreventive activities of specific chemicals in coffee could be informative for advancing our understanding of potential mechanisms. • Citation: • Coffee and tea consumption in relation to prostate cancer prognosis. • Geybels MS, Neuhouser ML, Wright JL, Stott-Miller M, Stanford JL. • Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands, milan.geybels@maastrichtuniversity.nl. Cancer Causes Control. 2013 Aug 2. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Leaving Hospital Against Medical Advice Raises Readmission, Death Risk MedicalResearch.com Interview with: Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba Winnipeg, Manitoba R3A 1R9 MedicalResearch.com: What are the main findings of the study? Answer: Our study evaluated consequences of leaving the hospital against medical advice (AMA). It is a large, population-based analysis, that evaluated all hospitalizations from which patients were discharged alive, among all adults in the Canadian province of Manitoba over a 19 year period; this was over 1.9 million hospitalizations. Outcomes assessed were hospital readmission and death over 6 months after the event. Specifically, we compared these outcomes for those who left the hospital against medical advice, compared to those who remained in the hospital until their doctors felt it was safe to be discharged — and these comparisons adjusted for a variety of patient and illness characteristics. Among the 1.9 million hospitalizations, there were 21,417 that ended with the patients leaving against medical advice, this is 1.1% of the total. Without adjustment for other variables, leaving against medical advice was associated with double the rate of unscheduled hospital readmission within 30 days (24.0 vs. 12.1%); after adjustment, the odds of unscheduled hospital readmission within 30 days was 3-fold higher for someone who left against medical advice compared to one who did not. After adjustment, the odds of death at 90 days were 2.51-fold higher for those who left against medical advice. The increased rates of hospital readmission and death associated with leaving the hospital against medical advice were both evident within one week after hospitalization, and though the excess risks of readmission and death declined subsequently, they appeared to plateau, remaining above baseline out to at least 6 months Read the rest of the interview on MedicalResearch.com
  • Leaving Hospital Against Medical Advice Raises Readmission, Death Risk MedicalResearch.com Interview with: Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba Winnipeg, Manitoba R3A 1R9 • MedicalResearch.com: Were any of the findings unexpected? • Answer: We were somewhat surprised that the adverse consequences of leaving the hospital against medical advice were so persistent. If the effects were solely related to incomplete treatment of the acute illness for which they were admitted to the hospital, you would expect the effect to decay back to baseline within a time period shorter than the 6 months of our study. The persistence of these effects suggests that these adverse consequences may also relate to a second mechanism, for example patient characteristics or health behaviors that correlate with the tendency to leave against medical advice. One candidate is a general tendency to nonadherence with medical recommendations, which has previously been associated with increased mortality. An implication of this finding is that interventions aimed at reducing the consequences for patients of leaving the hospital against medical advice may require not only efforts to convince them to stay, but also longitudinal interventions extending beyond hospitalization. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The primary thing is that we have convincingly shown that leaving the hospital against medical advice is associated with adverse consequences for patients. This information could be used to try and convince those contemplating leaving against medical advice to not do so. Read the rest of the interview on MedicalResearch.com
  • Leaving Hospital Against Medical Advice Raises Readmission, Death Risk MedicalResearch.com Interview with: Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba Winnipeg, Manitoba R3A 1R9 • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: The next planned stage in our research efforts is to dig deeper into the reasons people leave the hospital against medical advice, and the mechanisms that cause the adverse effects of doing so. Our eventual goal is to design an intervention strategy that can be used to reduce the adverse consequences associated with leaving the hospital against medical advice. • Citation: • Rates of readmission and death associated with leaving hospital against medical advice: a population-based study • Allan Garland, Clare D. Ramsey, Randy Fransoo, Kendiss Olafson, Daniel Chateau, Marina Yogendran, and Allen Kraut • Rates of readmission and death associated with leaving hospital against medical advice: a population-based study CMAJ cmaj.130029; published ahead of print August 26, 2013, doi:10.1503/cmaj.130029 Read the rest of the interview on MedicalResearch.com
  • Depression and Systolic Blood Pressure Variability MedicalResearch.com Interview with: Marcos A Sanchez-Gonzalez, M.D., Ph.D., EPC Postdoctoral Associate Department of Biomedical Sciences College of Medicine The Florida State University • MedicalResearch.com: What are the main findings of the study? • Answer: • The findings of our study were the following: • (1) The low frequency component of systolic blood pressure variability (LFSBP; a marker of sympathovagal tone) was a stronger predictor of depressive symptoms than conventional measures of cardiovascular functioning such as laboratory measurement of blood pressure and heart rate variability as well as home based ambulatory blood pressure monitoring • (2) Depressive symptoms were associated with a blunted LFSBP response to sympathetic stimulation via cold pressor test; and • (3) Participants with acute depression (a score of ≥16 using the CES-D scale) had higher LFSBP than those with normal depressive symptom scores. These findings suggest that depressive symptoms evoke alterations in vascular sympathetic activity, and more importantly, this alteration is occurs early in the progression of the disease. This is fascinating owing to the fact that we have documented a common pathway of disease between depression and cardiovascular diseases. • MedicalResearch.com Were any of the findings unexpected? • Answer: These findings were somewhat surprising. Although we were expecting to find associations between LFSBP and depressive symptoms, finding that the LFSBP values in acutely depressed participants were twofold compared with those without acute depression was striking. • MedicalResearch.com What should clinicians and patients take away from your report? • Answer: Depressive disorders are diagnosed clinically without the use of any measurable biological marker. We believe that monitoring LFSBP could be used as a biomarker for depression used as part of the existing criteria. • MedicalResearch.com What recommendations do you have for future research as a result of this study? • Answer: Prospective studies that are aimed at examining the effects of differing therapeutic interventions to treat depression symptomatology via LFSBP modification to prevent cardiovascular morbidity and mortality are warranted. • Citation: • Sympathetic Vasomotor Tone Is Associated With Depressive Symptoms in Young Females: A Potential Link Between Depression and Cardiovascular Disease.Sanchez-Gonzalez MA, May RW, Koutnik AP, Kabbaj M, Fincham FD. • Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida. • Am J Hypertens. 2013 Aug 9. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Depression: Effectiveness of Collaborative Care MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School Sir Henry Wellcome Building University of Exeter Washington Singer Building The Queen’s Drive Exeter EX4 4QQ United Kingdom • MedicalResearch.com: What are the main findings of the study? • Answer: We found that collaborative care improves depression immediately after treatment compared to usual care, has effects that persist to 12 month follow-up and is preferred bypatients over usual care. • This difference in effect equated to a standardized effect size of 0.26 (95% CI 0.07 to 0.46). More participants receiving collaborative care than those receiving usual care met criteria for recovery (odds ratio 1.67 (95% confidence interval 1.22 to 2.29); number needed to treat=8.4) and response (1.77 (1.22 to 2.58); 7.8 at 4 months. • At 12 months follow up more participants in collaborative care than those in usual care met criteria for recovery (odds ratio 1.88 (95% confidence interval 1.28 to 2.75); number needed to treat=6.5) and response (1.73 (1.22 to 2.44); 7.3. • Collaborative care is as effective in the UK healthcare system—an example of an integrated health system with a well developed primary care sector—as in the US. MedicalResearch.com: Were any of the findings unexpected? • Answer: We expected to find that collaborative care was more effective than standard care. Our results are identical to those reported in the latest Cochrane review of collaborative, which contained 79 RCTs. Read the rest of the interview on MedicalResearch.com
  • Depression: Effectiveness of Collaborative Care MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School Sir Henry Wellcome Building University of Exeter Washington Singer Building The Queen’s Drive Exeter EX4 4QQ United Kingdom • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Between group differences can obscure response rates in individual patients. We have, therefore, presented the data on meaningful clinical differences using numbers needed to treat and two criteria commonly applied in the depression literature and regarded as clinically meaningful. • These criteria were recovery (falling below a recognized point on the PHQ-9 symptom scale); and response (a 50% reduction in symptoms of depression). • Using these metrics, it is particularly noteworthy that at 12 months, 56% of participants receiving collaborative care “recovered”—15% more than in usual care. Health services would, therefore, need to treat 6.5 patients using collaborative care to produce one additional patient with a sustained recovery compared with usual care. • In other words if GPs think that 15% more people recovered at 12 months is worth having (I certainly do), then they should push to have collaborative care included in the standard care pathways for depression. We see no reason why collaborative care should not be suitable for almost all patients with depression in primary care. The majority of our trial patients presented with complex physical health and mental health co-morbidities, and a substantial number came from socio- economically deprived backgrounds with low social, employment and financial resources. The proportion of people with non-white cultural and ethnic backgrounds was representative of the UK population. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future trials should test enhancements of the basic collaborative care model by developing, testing, and delivering better treatments within the effective collaborative care organizational framework, rather than test collaborative care itself, given that the effects of collaborative care are now firmly established. • Citation: • Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomized controlled trialRichards DA ,Hill JJ ,Gask L, Lovell K ,Chew-Graham C ,Bower P ,et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ 2013;347:f4913 Read the rest of the interview on MedicalResearch.com
  • Vertebral Fractures: Inflammation, hsCRP association in Men MedicalResearch.com Interview with: Anna Eriksson MD, PhD Centre for Bone and Arthritis Research Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden • MedicalResearch.com Interview with: Anna Eriksson MD, PhD Centre for Bone and Arthritis Research Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden • MedicalResearch.com: What are the main findings of the study? • Answer: The main findings of the study are that low-grade inflammation as measured by high sensitive CRP (hsCRP) is a risk factor for fractures in men, and that this is mainly driven by an increased risk for vertebral fractures. Previous epidemiological research has shown that higher levels of hsCRP is associated with an increased risk for fractures in women but until now it has not been known whether this applies also to men. The associations between hsCRP and fracture risk remained also after controlling for a wide range of known risk factors for fractures. There were no associations between hsCRP and BMD in our study. This implies that low-grade inflammation is an independent risk factor for fractures. MedicalResearch.com: Were any of the findings unexpected? • Answer: Given the previous findings in women, the association between hsCRP levels and fracture risk also in men was not unexpected. However, previous studies have not had the power to discriminate between different types of fractures, hence the fact that vertebral fractures was the fracture type mainly associated with hsCRP was unexpected to us and the result of exploratory sub analyses. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Low grade inflammation is an independent risk factor for fractures in men. This could be kept in mind when the fracture risk is assessed in a patient. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: It would be interesting to more thoroughly study the magnitude of the fracture increase at different levels of hsCRP in different populations. Perhaps hsCRP could be included in the FRAX fracture risk assessment tool in the future. It would also be interesting to study more inflammation markers and also bone structure, to understand more about potential causal mechanisms underlying the increased fracture risk. • Citation; • High sensitive CRP is an independent risk factor for all fractures and vertebral fractures in elderly men: The MrOS Sweden study • Eriksson AL, Movérare-Skrtic S, Ljunggren O, Karlsson M, Mellström D, Ohlsson C. • Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. • J Bone Miner Res. 2013 Jul 15. doi: 10.1002/jbmr.2037. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Pediatric Magnet Ingestions Continue to Rise MedicalResearch.com Interview with: Dr. Jonathan Silverman, MD Department of Pediatrics University of Washington in Seattle, Washingto • MedicalResearch.com: What are the main findings of the study? • Dr. Silverman: We looked at the incidence of magnet foreign body injuries in children between 2002-2011, using a Consumer Products Safety Division surveillance database. We found an estimated 22, 581 cases over that period. Most strikingly, we found a rise in the incidence of magnet ingestions (in cases per 100,000 children/yr) from 0.57 (95% CI 0.22- 0.92) in 2002-2003 to 3.06 (95% CI 2.16-3.96) in 2010-2011. The mean age for ingested magnets was 5, but for nasal magnets was 10. Multiple magnet ingestions and magnet injuries requiring hospital admission were much more common in the second half of the study period, corresponding with the rising popularity of small, high-powered, desktop magnet sets. However, due to limited detail from the database, we were unable to say with any certainty whether injuries were specifically due to these magnet sets. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Silverman; We were quite surprised by the magnitude of the rise in magnet ingestion over this time period. Also the older mean age for nasal foreign bodies supports anecdotal evidence and case reports that these magnets are sometimes used as faux oral piercings in pre-teens and teens, who may then accidentally swallow the magnets. Interestingly, while magnet ingestions rose dramatically over our 10 year study period, nasal magnetic foreign bodies have declined in recent years. The reason for this decline is unclear. Read the rest of the interview on MedicalResearch.com
  • Pediatric Magnet Ingestions Continue to Rise MedicalResearch.com Interview with: Dr. Jonathan Silverman, MD Department of Pediatrics University of Washington in Seattle, Washingto • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Silverman: It’s important that clinicians are aware of the risk of magnet ingestions—particularly multiple magnet ingestion in children. When multiple magnets or single magnets with other metallic foreign bodies are ingested, they can attract across loops of bowel resulting in fistulae, perforations, abdominal sepsis, and even death. Often these patients present with non-specific abdominal complaints, such as vague pain or vomiting which can easily be dismissed as a viral gastroenteritis or functional abdominal pain. Older children may be too embarrassed to admit that they swallowed magnets. If a clinician suspects magnet ingestion, obtain an x-ray. Metal detectors are too insensitive to exclude these tiny foreign bodies. Consult gastroenterology or surgical colleagues to aid in management decisions. There is an excellent algorithm published by Hussain and colleagues that may also be consulted: http://www.ncbi.nlm.nih.gov/pubmed/22785419. As for parents, keep these small high-powered magnet sets out of the house—it’s very easy to lose a couple magnets out of a set of 200 tiny balls, which might later be found and ingested by a curious toddler. If you suspect your child may have ingested one or more magnets, seek medical attention immediately. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Silverman: While our study demonstrated the dramatic rise in magnet ingestions, we weren’t able to comment on the circumstances of injury, most specifically, which types of magnets were most involved in these injuries. More work can be done to try and clarify this. Recently there has been more regulatory action taken by the Consumer Products Safety Commission (CPSC) to reduce the availability of high- powered magnet sets. It is imperative that follow up studies are undertaken to assess the effectiveness of these interventions. Read the rest of the interview on MedicalResearch.com
  • Pediatric Magnet Ingestions Continue to Rise MedicalResearch.com Interview with: Dr. Jonathan Silverman, MD Department of Pediatrics University of Washington in Seattle, Washingto • This is an informational video for teens: • http://www.cpsc.gov/Newsroom/Multimedia/?vid=61829 • Here is an informational video for parents: • http://www.youtube.com/watch?v=rGYR_GaOfvA&feature=youtu.be • This is the public link to the NASPGHAN guidelines. • http://www.naspghan.org/user- assets/Documents/pdf/NASPGHAN%20magnet%20ingestion%20algorithm%20AB%20edits%20May%2029%202012.pdf • Citation: • Increase in Pediatric Magnet-Related Foreign Bodies Requiring Emergency Care. • Silverman JA, Brown JC, Willis MM, Ebel BE. • Department of Pediatrics, University of Washington, Seattle, WA. • Ann Emerg Med. 2013 Jul 19. pii: S0196-0644(13)00603-3. doi: 10.1016/j.annemergmed.2013.06.019. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Stroke: Ultra-Early Thrombolysis Therapy MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Associate Professor Department of Neurology Helsinki University Central Hospital PL 340, 00290 HUS • MedicalResearch.com: What are the main findings of the study? • Dr. Strbian: That providing early treatment is not enough, we have to be ultra-early. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Strbian: In a single center study, we showed, in addition to better outcome, also lower mortality to be associated with ultra-early treatment. This was not confirmed in the current multicenter study. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Strbian: That after recognition of the symptoms, we have to do act fast and do as much as possible during patient transport to the hospital, and as little as possible after patient’s admission, meaning that only necessary actions shall be done before administering the clot-busting therapy. • MedicalResearch.com What recommendations do you have for future research as a result of this study? • Dr. Strbian: We launched a global project to decrease door-to-needle time (SITS-WATCH), which is described at “clinicaltrials.gov”. Also, pre-hospital delays shall be minimized, and we have to increase public awareness of stroke symptoms vie media, people shall memorize “FAST” approach (Face, Arm, Speech, Time). • Citation: • Ultra-Early Intravenous Stroke Thrombolysis: Do All Patients Benefit Similarly? • Daniel Strbian, Peter Ringleb, Patrik Michel, Lorenz Breuer, Jyrki Ollikainen, Kei Murao, David J. Seiffge, Simon Jung, Victor Obach, Bruno Weder, Ashraf Eskandari, Henrik Gensicke, Angel Chamorro, Heinrich P. Mattle, Stefan Engelter, Didier Leys, Heikki Numminen, Martin Köhrmann, Werner Hacke, and Turgut Tatlisumak • Stroke. 2013;STROKEAHA.111.000819 published online before print August 22 2013, doi:10.1161/STROKEAHA.111.000819 Read the rest of the interview on MedicalResearch.com
  • CRT-D: Cardiac Resynchronization plus Defibrillator – Predicting Who Does Best MedicalResearch.com Interview with: Dr Pamela N Peterson MD Denver Health Medical Center, CO • MedicalResearch.com: What are the main findings of the study? • Answer: We assessed the outcomes of mortality, rehospitalization, and procedural complications among 24,169 patients in the NCDR-ICD Registry with left ventricular systolic dysfunction receiving a cardiac resynchronization device in addition to an implantable defibrillator for the primary prevention of sudden cardiac death between 2006 and 2009. After stratification by the QRS complex morphology and duration on the ECG and adjustment for measured differences in other characteristics, patients with left bundle branch block (LBBB) and QRS durations of at least 150 msec had significantly lower rates of mortality and rehospitalization at 3 years compared with patients with non-LBBB QRS morphology and/or QRS duration of 120-149 msec. Rates of mortality and readmission were generally highest in patients with non-LBBB and QRS duration of 120-149 msec. Rates of procedural complications at 30- and 90-days were similar across strata of QRS morphology and duration. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Generally, longer QRS duration and LBBB QRS morphology are markers of adverse prognosis in patients with LV systolic dysfunction. In this cohort of patients who received CRT-D therapy, patients with both LBBB and wider QRS actually experienced better outcomes. Read the rest of the interview on MedicalResearch.com
  • CRT-D: Cardiac Resynchronization plus Defibrillator – Predicting Who Does Best MedicalResearch.com Interview with: Dr Pamela N Peterson MD Denver Health Medical Center, CO • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: These findings support current guideline recommendations for patient selection for CRT-D therapy, with an emphasis on QRS duration and morphology as important criteria in identifying patients who may have better outcomes with this therapy. The strongest guideline recommendations for CRT in patients with LVSD are for those patients with LBBB and QRS complexes of at least 150 msec—those who in our study had the best outcomes. This study is also important because it provides information about outcomes in patients in contemporary practice who receive device therapy outside of the relatively rarified context of randomized trials. However, because there was no comparison group, we could not determine the relative associations between CRT-D vs. ICD therapy alone in any of the patient groups. Thus, one should not conclude that this study provides insights into the possible effectiveness of CRT-D in any specific patient group. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: More refined data that helps clinicians, patients, and policy makers identify those who will derive the most benefit from relatively expensive technologies like CRT-D will be important to optimizing care quality and efficiency. Both trials and observational observational studies that assess the comparative effectiveness of CRT-D in patients for whom the benefits of the therapy are less clear (e.g. those with non-LBBB QRS morphology or shorter QRS duration) will be important to informed patients election for this therapy. • Citation: • QRS Duration, Bundle-Branch Block Morphology, and Outcomes Among Older Patients With Heart Failure Receiving Cardiac Resynchronization Therapy • Peterson PN, Greiner MA, Qualls LG, Al-Khatib SM, Curtis JP, Fonarow GC, Hammill SC, Heidenreich PA, Hammill BG, Piccini JP, Hernandez AF, Curtis LH, Masoudi FA. • Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA • JAMA. 2013 Aug 14;310(6):617-26. doi: 10.1001/jama.2013.8641. Read the rest of the interview on MedicalResearch.com
  • Overactive Bladder: Use of Antimuscarinics MedicalResearch.com Interview with: Kirill Kosilov Far Eastern Federal University Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation • MedicalResearch.com Interview with: • Kirill Kosilov Far Eastern Federal University Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation • MedicalResearch.com What are the main findings of the study? • Answer: Our study in a group of elderly patients showed that the combination of antimuscarinic drugs in a dosage which is higher than the usual recommended one is an effective treatment option for patients with OAB in those cases where treatment with one antimuscarinic drug was poorly effective. Side effects occurred almost equally in patients treated with only one antimuscarinic drug compared to the combined dosage. • MedicalResearch.com Were any of the findings unexpected? • Answer: All the main results of our work have been widely anticipated. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: In most cases, urinary incontinence associated with neurogenic overactive bladder well managed with high doses of antimuscarinic drugs without increasing the risk of side effects. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: In subsequent studies, we hope to compare the different forms of securing and retaining a good effect on the lead with high doses of antimuscarinic treatment in elderly patients • Citation: • Management of Overactive Bladder (OAB) in Elderly Men and Women with Combined, High-Dosed Antimuscarinics without Increased Side Effects • UroToday Int J. 2013 August;6(4):art 47. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.06 Read the rest of the interview on MedicalResearch.com
  • Breast Cancer Screening: Risk of False-Positive Results MedicalResearch.com Interview with: Solveig Hofvind, PhD Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Majorstua 0403, Oslo, Norway • MedicalResearch.com: What are the main findings of the study? • Dr. Hofvind: We find that if 100 women aged 50 years attend the Norwegian Breast Cancer Screening Program as recommended, every two years until they are 69 years, four women will undergo a needle biopsy with benign outcome (a false positive needle biopsy). • In the same group of women, twenty women will be recalled for further examination and have additional imaging, ultrasound, and/or a biopsy with negative outcome (a false positive screening result). • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hofvind: The results are an agreement with findings from European screening programs, but the cumulative risk is substantial lower as reported from the U.S. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hofvind: False positive screening results are not a substantial harm in mammographic screening, as performed in Norway and most European countries. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hofvind: We need to investigate the risk of cancer in women who have a false positive screening results. Do they run a higher or lower risk of breast cancer? • Citation: • Roman, M., Hubbard, R. A., Sebuodegard, S., Miglioretti, D. L., Castells, X. and Hofvind, S. (2013), The cumulative risk of false-positive results in the Norwegian Breast Cancer Screening Program: Updated results. Cancer. doi: 10.1002/cncr.28320 Read the rest of the interview on MedicalResearch.com
  • Breast Cancer: Surgical Oophoretomy + Tamoxifen – Impact on Bone Loss MedicalResearch.com: Interview with: Richard R. Love, MD MS International Breast Cancer Research Foundation Professor of Medicine and Public Health The Ohio State University Columbus, OH • MedicalResearch.com: What are the main findings of the study? • Answer: Surgical oophorectomy and tamoxifen treatment was associated with no loss of bone mineral density (BMD) in the femoral neck, and loss of BMD in the first year, followed by stabilization in the lumbar spine. MedicalResearch.com: Where any of the findings unexpected? • Answer: The finding of no loss of BMD at all in the femoral neck over two years in this large study was unexpected and a favorable result for treated women. • MedicalResearch.com: What should patients and providers take home from your report? • Answer: Clinical implications: In most of the world, in premenopausal hormonal receptor positive patients surgical oophorectomy plus tamoxifen is as effective as adjuvant therapy as usual chemotherapies plus hormonal therapy, while all other such treatments are associated with BMD loss at both femoral and lumbar sites. Increasingly it is being recognized that for luminal A phenotype/genotype breast cancers hormonal therapy should be the treatment of choice. A strong case can be made that surgical oophorectomy plus tamoxifen is the most effective such hormonal treatment, and now with these data that its impact on BMD is more favorable than the impacts from usual treatments. • Citation: • Bone mineral density following surgical oophorectomy and tamoxifen adjuvant therapy for breast cancer. • Love RR, Young GS, Laudico AV, Van Dinh N, Uy GB, Quang LH, De La Peña AS, Dofitas RB, Bisquera OC Jr, Siguan SS, Salvador JD, Mirasol-Lumague MR, Navarro NS Jr, Linh ND, Jarjoura D.International Breast Cancer Research Foundation, Madison, Wisconsin. • Cancer. 2013 Aug 20. doi: 10.1002/cncr.28302. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Stretch Marks: Four Genetic Markers Near Elastin Gene Identified MedicalResearch.com Interview with: Joyce Y Tung Ph.D. Research Team 23andMe Inc. Mountain View, California, USA • MedicalResearch.com: What are the main findings of the study? • Dr. Tung: 23andMe researchers identified four genetic markers that were significantly associated with the development of stretch marks, including one near the elastin (ELN) gene. This finding may further explain why some individuals are more susceptible to the skin condition. Given that loose skin is a symptom of syndromes caused by deletion or loss-of- function mutations in ELN, these results also support the hypothesis that variations in the elastic fiber component of the skin extracellular matrix contribute to the development of stretch marks. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Tung: One of our the genetic markers we found to be associated with stretch marks has previously been associated with body mass index (BMI), so we looked to see whether other genetic markers associated with BMI were associated with stretch marks. Interestingly, one of the genetic markers was associated with stretch marks after adjusting for BMI. This suggests that stretch marks and BMI may share some common biology, independent of simple weight gain. Read the rest of the interview on MedicalResearch.com
  • Stretch Marks: Four Genetic Markers Near Elastin Gene Identified MedicalResearch.com Interview with: Joyce Y Tung Ph.D. Research Team 23andMe Inc. Mountain View, California, USA • MedicalResearch.com: What should clinicians and patients take away from this study? • Dr. Tung: None of the existing treatments for stretch marks are completely effective in removing stretch marks. Interestingly, most popular treatments including topical treatments and laser treatments focus on stimulating collagen production, rather than elastin production, to improve the appearance of stretch marks, although some also increase elastic fibers.(1) • These findings may provide further insight into future methods for the prevention and treatment of stretch marks. • MedicalResearch.com: What recommendations do you have for future research as a result of your study? • Dr. Tung: There is some overlap between genes associated with stretch marks and genes associated with BMI. The potential effect of genes associated with obesity on stretch marks, both independent of and via changes in BMI, is an intriguing area for further study. These genes provide a new view into the biology of stretch marks, and more work is needed to understand the complex mechanisms that drive these changes in the skin. • (1)Elsaie ML, Baumann LS, Elsaaiee LT (2009) Striae distensae (stretch marks) and different modalities of therapy: an update. Dermatol Surg 35:563–573 • Citation: • Genome-wide association analysis implicates elastic microfibrils in the development of non-syndromic striae distensae J Invest Dermatol. 2013 Apr 30. doi: 10.1038/jid.2013.196. [Epub ahead of print] • Tung JY, Kiefer AK, Mullins M, Francke U, Eriksson N. • 23andMe Inc., Mountain View, California, USA. • PMID:23633020 [PubMed - as supplied by publisher] Read the rest of the interview on MedicalResearch.com
  • Delirium Prediction Rule: the AWOL Tool MedicalResearch.com Interview with: Vanja Douglas, MD Sara & Evan Williams Foundation Endowed Neurohospitalist Chair Assistant Professor of Clinical Neurology UCSF Department of Neurology Neurology Clerkship Director Editor in Chief, The Neurohospitalist • MedicalResearch.com: What are the main findings of the study? • Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient’s risk of developing delirium during that hospitalization. MedicalResearch.com: Were any of the findings unexpected? • Answer: We hypothesized that a simple delirium prediction rule would include a measure of underlying cognitive dysfunction, old age, and illness severity. We also hypothesized that the prediction rule might include other risk factors such as visual and hearing dysfunction, immobility, or dehydration but that was not borne out in our cohort. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Because it can be performed by nurses in roughly 2 minutes, the AWOL tool may be a practical way to systematically risk-stratify elderly medical patients upon admission to the hospital and allow providers to triage those patients for whom delirium prevention strategies should be applied. However, in our study the AWOL tool did not perform as well in the validation cohort as it did in the derivation cohort, and therefore any implementation of the tool in clinical practice should be undertaken with the understanding that its performance should be locally validated. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: I would like to see further research validating the AWOL tool in other hospitals as well as research that attempts to refine the AWOL tool or develop even more effective yet equally simple delirium risk-stratification models. Another avenue for research taking advantage of this tool would be in using it to identify high-risk patients who might be eligible to participate in the investigation of novel delirium prevention strategies and/or therapies. • Citation: • The AWOL tool: Derivation and validation of a delirium prediction ruleDouglas, V. C., Hessler, C. S., Dhaliwal, G., Betjemann, J. P., Fukuda, K. A., Alameddine, L. R., Lucatorto, R., Johnston, S. C. and Josephson, S. A. (2013), The AWOL tool: Derivation and validation of a delirium prediction rule. J. Hosp. Med.. doi: 10.1002/jhm.2062 Read the rest of the interview on MedicalResearch.com
  • Electronic Health Record Utilization as a Measure of Hospital Care Intensity MedicalResearch.com Interview with: Saul Blecker, MD, MHS Assistant Professor Department of Population Health NYU School of Medicine New York, NY 10016 • MedicalResearch.com: What are the main findings of the study? • Dr. Blecker: We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Blecker: The magnitude of temporal variation was significant. For instance, during daytime hours, utilization of the EHR was 75% higher on weekdays versus weekends. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Blecker: Further validation of EHR utilization as a measure of care intensity is needed. In particular, future research should address whether EHR utilization is related to clinical outcomes and whether tracking EHR utilization can be useful in improving quality of hospital care. • Citation: • Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity. • Blecker S, Austrian JS, Shine D, Braithwaite RS, Radford MJ, Gourevitch MN. • Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University Langone Medical Center, New York, New York. J Hosp Med. 2013 Jul 31. doi: 10.1002/jhm.2068. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Type 2 Diabetes: Lifetime Medical Costs MedicalResearch.com Interview with: Xiaohui Zhuo PhD Health economist Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention • MedicalResearch.com: What are the main findings of the study? • First, someone diagnosed with type 2 diabetes may pay an average of about $85,500 treating the disease over his or her lifetime. Lifetime cost is higher for women, and for patients who developed the disease earlier in life. • Second, treating diabetic complications account for more than half of lifetime costs, and a majority of which is attributed by damage to large blood vessels, which can lead to coronary heart disease and stroke. MedicalResearch.com: Were any of the findings unexpected? • Answer: Diabetes is a well-known costly disease. The substantial lifetime medical cost found in the article therefore is not a big surprise. However, it is important to document the lifetime cost for at least two reasons: • First, to better understand the financial return of type 2 diabetes prevention and control, i.e., how much medical costs will potentially be saved from preventing one case of type 2 diabetes; • Second, for healthcare policy makers, to get a better sense of the long-term impact of new onset of diabetes on the healthcare budget. This has become increasingly important given the rapid increase of the number of the incident cases in the U.S. and worldwide. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: There are two take-home messages from our study: • First, the substantial lifetime cost is a clear indication that, anything that can prevent or delay the onset of Type 2 diabetes could lead to a sizeable reduction in healthcare costs in the future. • Second, our study also highlights the importance of glycemic control to prevent diabetic complications among persons who already have type 2 diabetes. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Our study only examines the medical cost of treating diabetes. However, this is only a part of the picture. Diabetic patients also spend more because they tend to have more other medical conditions and related spending. Therefore, future study to compare persons with diabetes and persons without is warranted to provide a whole picture of the lifetime economic burden of the disease. • Citation: • Lifetime Direct Medical Costs of Treating Type 2 Diabetes and Diabetic Complications Xiaohui Zhuo, Ping Zhang, Thomas J. Hoerger • American Journal of Preventive Medicine – September 2013 (Vol. 45, Issue 3, Pages 253-261, DOI: 10.1016/j.amepre.2013.04.017) Read the rest of the interview on MedicalResearch.com
  • Renal Sympathetic Denervation: Using Baroreflex To Predict Who Might Benefit MedicalResearch.com Interview with: Dr. Axel Bauer, MD, FESC, F-ISHNE Prof. Dr. med. Axel Bauer is head of the coronary care and chest pain unit and primary investigator in the research group of biosignal analysis and sudden death of the cardiology department of the Eberhard-Karls-Universität Tübingen, Germany. • MedicalResearch.com: What are the main findings of the study? • Dr. Bauer: Catheter-based renal sympathetic denervation is a promising treatment option in patients with resistant arterial hypertension. However, it is invasive and might have presently unknown adverse side effects in the long-term. Therefore, identification of patients who benefit from RDN and, equally importantly, those who do not is of great importance. With assessment of baroreflex sensitivity (BRS) we found a way to do that. Patients with resistant hypertension and impaired BRS at baseline benefited the most from RDN in terms of reduction of mean systolic BP on (ABPM) while RDN had no effect in patients with preserved BRS. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Bauer: We hypothesized that in patients with impaired BRS and presumably increased sympathetic tone, RDN would exhibit the most pronounced effects. Therefore, the main findings were not unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Bauer: RDN is not equally effective in every single patient. A non-invasive 30 minute measurement can help to identify patients who benefit from RDN and patients who do not. Given the invasive nature of RDN and potential presently unknown adverse side effects in the longterm these findings are important. However, findings need to be validated in independent cohorts. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bauer: First, these findings need to be validated in independent cohorts. Future studies should test whether an individualized approach to antihypertensive treatment by RDN based on assessment of BRS translates into a better clinical outcome. • Citation: • Impaired Cardiac Baroreflex Sensitivity Predicts Response to Renal Sympathetic Denervation in Patients with Resistant Hypertension • PDF • Christine S. Zuern, MD; Christian Eick, MD; Konstantinos D. Rizas, MD; Sarah Bauer; Harald Langer, MD; Meinrad Gawaz, MD, FESC; Axel Bauer, MD, FESC, F-ISHNE • J Am Coll Cardiol. Published online August 21, 2013. Read the rest of the interview on MedicalResearch.com
  • Infantile Pyloric Stenosis: Associated with Low Plasma Lipids MedicalResearch.com Interview with: Bjarke Feenstra, Ph.D. Senior Research ScientistStatens Serum Institut Artillerivej 5, 2300 Copenhagen S Denmark • MedicalResearch.com: What are the main findings of the study? • Dr. Feenstra: We discovered a new genome-wide significant locus for infantile hypertrophic pyloric stenosis (IHPS) in a region on chromosome 11 harboring the apolipoprotein (APOA1/C3/A4/A5) gene cluster and also confirmed three previously reported loci. Characteristics of the new locus led us to propose the hypothesis that low levels of circulating lipids in infants are associated with increased risk of IHPS. We addressed this hypothesis by measuring plasma lipid levels in prospectively collected umbilical cord blood from a set of 46 IHPS cases and 189 matched controls. We found that levels were on average somewhat lower in the children who went on to develop the condition. MedicalResearch.com: Were any of the findings unexpected? • Dr. Feenstra: Yes, in the discovery phase of the study, we used a hypothesis-free approach to search the genome for variants associated with pyloric stenosis. Rather than focusing on specific candidate genes, we wanted to be able to discover unexpected connections. However, the association between low lipid levels and increased risk of the disease is consistent with a number of previous epidemiological findings. • • Boys have four-fold higher risk of pyloric stenosis compared to girls, and their cholesterol levels are on average lower than levels in girls at birth. • Bottle-fed babies have higher risk of pyloric stenosis, and bottle-feeding is known to be associated with lower levels of circulating cholesterol. • Pyloric stenosis incidence dropped in several countries in the 1990s while breast feeding incidence (and thereby average lipid levels in infants) increased. • Pyloric stenosis is a prominent clinical feature in many reports of Smith-Lemli-Opitz syndrome, a rare inborn defect of cholesterol biosynthesis associated with low cholesterol levels in infants at birth. Read the rest of the interview on MedicalResearch.com
  • Infantile Pyloric Stenosis: Associated with Low Plasma Lipids MedicalResearch.com Interview with: Bjarke Feenstra, Ph.D. Senior Research ScientistStatens Serum Institut Artillerivej 5, 2300 Copenhagen S Denmark • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Feenstra: We must caution that further study is needed to determine whether our findings represent a causal link between cholesterol levels and risk of IHPS. If, however, that proves to be the case, it would be highly interesting to investigate whether dietary modifications to ensure normal lipid levels might protect newborns in families with a history of IHPS from developing the condition. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Feenstra: I think it would be really interesting to better understand the interplay between lipid metabolism and other genetic and environmental risk factors for IHPS. Which combination of risk factors is required for the condition to occur? Further study is clearly also needed to shed light on the biological mechanisms underlying our findings. One approach that might be revealing would focus on the essential role of cholesterol in nervous system development given the deficiencies in enteric innervation seen in pyloric sphincter muscle tissue from patients with IHPS. • Citation: • Feenstra B, et al “Plasma lipids, genetic variants near APOA1, and the risk of infantile hypertrophic pyloric stenosis” JAMA 2013; 310(7): 714-721. Read the rest of the interview on MedicalResearch.com
  • Coffee Intake: Risk Factor for Higher Mortality in Men, Not Women MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD Assistant Professor Department of Exercise Science Arnold School of Public Health University of South Carolina Columbia, SC 29208 • MedicalResearch.com: What are the main findings of the study? • Answer: Coffee intake was a risk factor with higher mortality in men, but not in women. Men who drank more than 28 cups of coffee weekly had a 21% higher risk of dying when comparing with their non-coffee- consuming peers. In addition, younger men (age<55 years) who drank more than 28 cups of coffee weekly had a 56% increase in mortality from all-cause and younger women had a greater than 2-fold higher risk of all-cause mortality than those who did not drink coffee. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: MODERATION is key. Drinking 1-4 cups per day coffee seem safe and avoid heavy coffee consumption especially for people who are younger than 55 year. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future research should examine other causes of death such as cancer and investigate the mechanism between coffee intake and health benefits or risks. • Citation: • Association of coffee consumption with all-cause and cardiovascular disease mortality • Junxiu Liu, MD; Xuemei Sui, MD, PhD; Carl J. Lavie, MD; James R. Hebert, ScD; Conrad P. Earnest, PhD; Jiajia Zhang, PhD; and Steven N. Blair, PED • Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2013;nn(n):1-9 Read the rest of the interview on MedicalResearch.com
  • Biological Clock: Removing Protein Repressor Boosts Clock Function MedicalResearch.com Interview with: Ruifeng Cao, MD,PhD Postdoctoral Fellow Laboratory of Nahum Sonenberg McGill University Department of Biochemistry Montreal, QC H3A 1A3, Canada • MedicalResearch.com: What are the main findings of the study? • Answer: Circadian (~24h) timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria. In mammals, including humans, a circadian clock in the brain drives daily rhythms in sleep and wakefulness, feeding and metabolism, and many other essential processes. We studied how protein synthesis, which is a fundamental process underlying many biological activities, is controlled in the brain clock in mice and identified a protein that functions as a clock repressor. By removing the repressor protein, the clock function is improved. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Usually, when we remove some proteins from the body, we expect to see some functions compromised due to the lack of these proteins. However, we were surprised to see that the mutant mice, which don’t have the repressor protein in their clocks, exhibited enhanced clock function. For example, by inducing a state like jet lag in these mice, we found that they were able to adapt to time zones changes in about half of the time required by normal mice. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Our findings suggest that the function of the brain clock can be boosted by decreasing the activity of a specific repressor protein. This discovery could lead to the development of more effective agents to treat clock-related disorders, including jet lag, sleep disorders, shift work disorders, and chronic conditions like depression and Parkinson’s disease. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: The obstacle to translate the current finding from bench to bedside is lack of a pharmacological agent that can inhibit the clock repressor specifically in the clock or more broadly, in the brain. Large scale screening of small chemical compounds targeting the repressor may facilitate discovery of “tonics” for the brain clock in the future. • Citation: • Translational Control of Entrainment and Synchrony of the Suprachiasmatic Circadian Clock by mTOR/4E-BP1 Signaling 79(4) pp. 712 – 724; Ruifeng Cao, Barry Robinson, Haiyan Xu, Christos Gkogkas, Arkady Khoutorsky, Tommy Alain, Akiko Yanagiya, Tatiana Nevarko, Andrew C. Liu, Shimon Amir et al. Read the rest of the interview on MedicalResearch.com
  • Medial Knee Osteoarthritis: Lateral Wedge Insoles MedicalResearch.com Interview with: Matthew Parkes Research Statistician Research in Osteoarthritis Manchester (ROAM) Arthritis Research UK Epidemiology Unit Institute of Inflammation and Repair The University of Manchester Manchester M13 9PT • MedicalResearch.com: What are the main findings of the study? • Answer: Looking at all trials of lateral wedge insoles, they seem to reduce pain slightly. • However, looking at trials which compare lateral wedges to flat wedges, they don’t appear to differ in terms of pain reduction. • MedicalResearch.com: Were any of the findings unexpected? • Answer: The fact that the flat vs. wedged insole trials were so consistent in showing no superiority of wedges over flat insoles was perhaps unexpected, given the wide-ranging opinions both in support of and against wedges. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: That, aside from a placebo effect, wedge insoles provide little arthritis pain relief. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Shoe inserts would be a popular and cheap approach for treating knee arthritis. It is likely that different types of shoes or orthotics are effective, even if those wedge insoles that are used currently are not. • Link to article: http://jama.jamanetwork.com/article.aspx?articleid=1730513 • Citation: • Parkes MJ, Maricar N, Lunt M, et al. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis: A Meta-analysis. JAMA. 2013;310(7):722-730. doi:10.1001/jama.2013.243229. Read the rest of the interview on MedicalResearch.com
  • Gestational Diabetes Mellitus and Sleep Apnea MedicalResearch.com: Interview with Sirimon Reutrakul MD Section of Endocrinology Department of Medicine Rush University Medical Center Chicago, Illinois 60612 • MedicalResearch.com: What are the main findings of the study? • Answer: We found a strong association between obstructive sleep apnea and gestational diabetes mellitus. In pregnant women diagnosed with gestational diabetes, the risk of obstructive sleep apnea is increased nearly 7-fold compared to those without gestational diabetes. In addition, we found that in non-diabetic women, pregnancy is associated with more disrupted sleep. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Obstructive sleep apnea is a known risk factor for abnormal glucose metabolism, so the findings were somewhat expected. However, we did not expect such a strong association between the two conditions, and that nearly 75% of the women with gestational diabetes had obstructive sleep apnea. This rate is similar to the non-pregnant diabetic population. Keep in mind that most women in our study were overweight or obese. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Based on these findings, women who have gestational diabetes should be considered for evaluation of obstructive sleep apnea, especially if other risk factors, such as hypertension and obesity, and symptoms, such as frequent snoring, are present. In addition, women already diagnosed with obstructive sleep apnea should be monitored and screened for gestational diabetes during pregnancy. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Because our data are preliminary, the result should be confirmed in a larger study. The issue of whether treating obstructive sleep apnea during pregnancy will affect glucose metabolism remains unanswered. • Citation: • Sirimon Reutrakul, Nausheen Zaidi, Kristen Wroblewski, Helen H. Kay, Mahmoud Ismail, David A. Ehrmann, and Eve Van Cauter • Interactions Between Pregnancy, Obstructive Sleep Apnea, and Gestational Diabetes Mellitus JCEM jc.2013-2348; doi:10.1210/jc.2013-2348 Read the rest of the interview on MedicalResearch.com
  • Coronary Artery Disease: Hypertension and Prognostic Score MedicalResearch.com Interview with Dr. Anthony Bavry, MD MPH Interventional Cardiology Assistant Professor of Medicine University of Florida Gainesville, FL 32610 • MedicalResearch.com: What are the main findings of the study? • Dr. Bavry: Among individuals with chronic stable coronary artery disease, it is possible to define a group who are at relatively low risk for adverse cardiovascular events. • MedicalResearch.com:Were any of the findings unexpected? • Dr. Bavry: The importance of low systolic blood pressure of imparting long-term risk to patients was unexpected. This finding could influence clinical decisions about how low blood pressure should be treated among these patients. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Bavry: Among patients with chronic stable coronary artery disease and systolic blood pressure < 110 mm Hg, consideration should be given to reducing anti-hypertensive therapy. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bavry: Future research could use the INVEST risk score to assist in personalizing diagnostic/therapeutic decisions. • Citation: • Simple Integer Risk Score to Determine Prognosis of Patients With Hypertension and Chronic Stable Coronary Artery Disease • Anthony A. Bavry, Dharam J. Kumbhani, Yan Gong, Eileen M. Handberg, Rhonda M. Cooper‐DeHoff, and Carl J. Pepine • J Am Heart Assoc. 2013;2:e000205, originally published August 15, 2013, doi:10.1161/JAHA.113.000205 Read the rest of the interview on MedicalResearch.com
  • Stem Cells: Different Cell Sources Advantages and Disadvantages Medical Research.com Interview with: Katrin Streckfuss-Boemeke, PhD Department of Cardiology and Pneumology Heart Research Center Göttingen (HRCG) University Medical Center Göttingen 37075 Göttingen Germany • Medical ResearcH.com: What are the main findings of the study? • Answer: The main finding is that human induced pluripotent stem cells (hiPSCs) can be generated from different somatic cell sources including bone marrow mesenchymal stem cells (MSCs), hair keratinocytes, and skin fibroblasts, but MSCs and fibroblasts are more easily reprogrammed than keratinocytes. • All generated hiPSCs can differentiate into cardiomyocytes with an efficiency ranging from 3 to 42%. However, the highest cardiac differentiation efficiency was achieved from MSC- derived hiPSCs. • Although the cardiac differentiation efficiency varied among different cell lines, there is no significant difference in the functionalities of cardiomyocytes derived from different hiPSC lines. • Medical Research.com: Were any of the findings unexpected? • Answer: We find that the Oct and Nanog promoters in keratinocytes are significantly higher methylated than those in MSCs and fibroblasts, possibly explaining the lower reprogramming efficiencies in keratinocytes. Read the rest of the interview on MedicalResearch.com
  • Stem Cells: Different Cell Sources Advantages and Disadvantages Medical Research.com Interview with: Katrin Streckfuss-Boemeke, PhD Department of Cardiology and Pneumology Heart Research Center Göttingen (HRCG) University Medical Center Göttingen 37075 Göttingen Germany • Medical Research.com: What should clinicians and patients take away from your report? • Answer: It is known that hiPSCs are a promising cell source for investigating cardiac diseases, and performing drug screenings on a patient-specific level. • Our study shows that different somatic cell sources can be used for the generation of hiPSCs with different advantages and disadvantages. For the patient plucked hairs as the cell source for reprogramming still offer significant advantages over skin biopsies and bone marrow aspirates, because they can be easily obtained in contrast to the other two cell types, where clinical specialists are needed. Therefore, it is possible to generate hair keratinocyte cultures from many patients who cannot undergo a skin biopsy or a bone marrow aspiration. • Nevertheless, before clinicians start to use hiPSCs in disease modeling and in regenerative medicine, they have to address many aspects including which donor cell source would be the best regarding the accessibility, the most efficient differentiation into certain cell types they need, and how to use the cells afterwards. • Although not demonstrated yet, it appears predictable that patient-specific hiPSC-derived cells can be used soon for clinical application. Whether this will be of therapeutic value remains to be studied. • Medical Research.com: What recommendations do you have for future research as a result of this study? • Answer: In this study we show that MSC-iPSCs differentiate into cardiomyocytes with higher efficiency than hiPSCs from fibroblasts or keratinocytes. To analyze the molecular mechanisms for this higher efficiency of cardiac differentiation of MSC-iPSCs a genome-wide transcriptional profiling and DNA methylation profiling in iPSCs from all cell sources is necessary. • Furthermore, it has to be addressed whether it is possible to generate hiPSCs from different cell sources without viral particles for further clinical applications. • Citation: • Comparative study of human-induced pluripotent stem cells derived from bone marrow cells, hair keratinocytes, and skin fibroblasts. • Streckfuss-Bömeke K, Wolf F, Azizian A, Stauske M, Tiburcy M, Wagner S, Hübscher D, Dressel R, Chen S, Jende J, Wulf G, Lorenz V, Schön MP, Maier LS, Zimmermann WH, Hasenfuss G, Guan K. • Department of Cardiology and Pneumology, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. • Eur Heart J. 2012 Jul 12. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Insulin Resistance in Adolescents and Urinary Phthalates MedicalResearch.com: Interview with Leonardo Trasande, MD, MPP Departments of Pediatrics, Environmental Medicine, Population Health, and Medicine, School of Medicine, and Wagner School of Public Service, and Steinhardt School of Culture, Education, and Human Development, Department of Nutrition • MedicalResearch.com: What are the main findings of the study? • Answer: We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents. The association is highly robust to multiple sensitivity analyses, and specific to phthalates commonly found in food. Further, longitudinal study of dietary phthalate exposures is needed. • MedicalResearch.com: 

Were any of the findings unexpected? • Answer: Associations persisted despite controlling for bisphenol A, another endocrine disrupting chemical commonly found in foods, and HOMA-IR and insulin resistance were not significantly associated with metabolites of lower-molecular weight phthalates commonly found in cosmetics and other personal care products. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: While further studies are needed, it should be noted that alternatives to DEHP include wax paper and aluminum wrap; indeed, a dietary intervention which introduced fresh foods that were not canned or packaged in plastic reduced DEHP metabolites by 53-56%. Fresh fruit consumption may also reduce DEHP exposure, given reduced contact of plastic prior to consumption. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Additional, longitudinal studies are needed, both to confirm the association and elaborate the different potential mechanisms involved. • Citation: • Urinary Phthalates and Increased Insulin Resistance in Adolescents • Leonardo Trasande, Adam J. Spanier, Sheela Sathyanarayana, Teresa M. Attina, and Jan Blustein • Pediatrics peds.2012-4022; published ahead of print August 19, 2013, doi:10.1542/peds.2012-4022 Read the rest of the interview on MedicalResearch.com
  • Autism Risk in Siblings MedicalResearch.com: Interview with: Therese Koops Grønborg PhD student/ph.d.-studerende, MSc Section of Biostatistics/Sektion for Biostatistisk Department of Public Health/Institut for Folkesundhed Aarhus University Bartholins Allé 2, DK-8000 Aarhus C, Denmark • MedicalResearch.com: What are the main findings of the study? • Answer: There are three important findings in our study. • We estimated a population-based Autism Spectrum Disorder (ASD) sibling recurrence risk relative to the background population and found an almost seven-fold increase. While this indeed is an increased risk, it is also lower than what other recent studies have suggested. • We also compared the relative recurrence risk for full and maternal/paternal half siblings and found a lower relative recurrence risk in half siblings than in full siblings, which supports the genetic pathway to ASD. The recurrence risk for maternal half siblings is still higher than for the background population suggesting that factors unique to the mother, such as the intrauterine environment and perinatal history, may contribute to ASD. • Last, but not least, we estimated the time trends in the relative recurrence risk. While the ASD prevalence has been increasing for several years, we found no time trends in the relative recurrence risk, suggesting that the factors contributing to the risk for ASDs recurrence in siblings (perhaps a combination of genes and environment) have not changed over time. • MedicalResearch.com: Were any of the findings unexpected? • Answer: I think we were a bit surprised the relative recurrence risk came out so low. We did not know what to expect about the trends over time, but it is very interesting that while the ASD prevalence has increased during the last two decades, the relative recurrence risk has more or less remained constant in the same time period. Read the rest of the interview on MedicalResearch.com
  • Autism Risk in Siblings MedicalResearch.com: Interview with: Therese Koops Grønborg PhD student/ph.d.-studerende, MSc Section of Biostatistics/Sektion for Biostatistisk Department of Public Health/Institut for Folkesundhed Aarhus University Bartholins Allé 2, DK-8000 Aarhus C, Denmark • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: If you have a child with ASD the risk of having another child with the same condition is about 7%, which is lower than what other recent studies have suggested. Whether that is considered a high or low risk is up to each affected family to decide. This is an average based on many families and individual counseling to each family is necessary. As we also acknowledge in our article, there is a possibility that this is an underestimate for families with the more severe ASD cases. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: It would be interesting to investigate families with at least two affected children and consider the subsequent children. This would require a large data pool since there are not that many of these families. Also, when the individuals from our study are old enough to have had children of their own and some of these children also have been diagnosed with ASD, it would be of great interest to study the parent-child recurrence risk. But, we’ll have to wait some years for that. • If possible, it would also be interesting to expand the full and half siblings analysis with information about which parent the children are living with. • Citation: • Therese K. Grønborg, Diana E. Schendel, Erik T. Parner. Recurrence of Autism Spectrum Disorders in Full- and Half-Siblings and Trends Over TimeA Population-Based Cohort Study. JAMA Pediatrics, 2013 DOI: 10.1001/jamapediatrics.2013.2259 Read the rest of the interview on MedicalResearch.com
  • Chronic Kidney Disease: Blood Pressure and Mortality MedicalResearch.com Interview with: Dr.Csaba P. Kovesdy MD FASN., The Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program in Nephrology University of Tennessee Health Science Center Chief of Nephrology Division of Nephrology, Memphis VA Medical Center • MedicalResearch.com: What are the main findings of the study? • Dr. Kovesdy: In this study of >650,000 US veterans with CKD we found that categories of lower SBP/DBP combinations are associated with lower mortality only as long as the DBP component remains above a threshold of approximately 70 mmHg, and that patients with BP values in the range of 130-159/70-89 mmHg had the lowest mortality. Patients who might be considered to have “ideal” blood pressure (<130/80) actually had increased mortality due to the inclusion of individuals with low systolic and diastolic blood pressures. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Kovesdy: The most surprising finding of our study is that when considering SBP and DBP together in the same patient a low DBP seems to “trump” the effects of a high SBP, and patients with ideal DBP and elevated SBP had better outcomes than patients with ideal SBP and low DBP. This finding may have therapeutic implications, since treating an elevated SBP in a patient with isolated systolic hypertension is a common practical scenario. Read the rest of the interview on MedicalResearch.com
  • Chronic Kidney Disease: Blood Pressure and Mortality MedicalResearch.com Interview with: Dr.Csaba P. Kovesdy MD FASN., The Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program in Nephrology University of Tennessee Health Science Center Chief of Nephrology Division of Nephrology, Memphis VA Medical Center • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Kovesdy: Current guidelines advocate treatment of only elevated blood pressure, and ignore the potential dangers of over-treatment. • Patients with CKD are considered to be a high-risk category, and hence even stricter blood pressure targets are advocated in them. Our findings go against this notion, since we found that low blood pressures can also be associated with increased mortality. Caution is advised, especially in patients who present with a high SBP combined with a low DBP. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Kovesdy: It will be necessary to test these findings in a clinical trial, since the observational nature of our study only allows us to establish associations, but causality cannot be implied. • Citation: • Blood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease: A Cohort Study • Csaba P. Kovesdy, MD; Anthony J. Bleyer, MD; Miklos Z. Molnar, MD, PhD; Jennie Z. Ma, PhD; John J. Sim, MD; William C. Cushman, MD; L. Darryl Quarles, MD; and Kamyar Kalantar-Zadeh, MD, PhDAnn Intern Med. 2013;159(4):233 doi:10.7326/0003-4819-159-4-201308200-00004 Read the rest of the interview on MedicalResearch.com
  • Hospital Discharge Practice: Room for Improvement in Communication, Comprehension MedicalResearch.com Interview with: Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut • MedicalResearch.com: What are the main findings of the study? • Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that: • 40% of patients could not understand or explain the reason they were in the hospital in the first place; • A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand; • Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist; • Only 44% accurately recalled details of their appointments. • In other words, we didn’t do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home. • We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients – that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients – we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn’t even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn’t find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Unfortunately, our results weren’t all that different from studies from other institutions. Lots of researchers have found that patients understand much less than we think about their hospital stays – probably because of a combination of things: we are not very good at explaining, we are not very focused on the post-discharge period, patients are sick and often confused and find it hard to remember a lot of new information. • What was surprising about this study though was the mismatch between patient perception and their actual knowledge. Even though their knowledge wasn’t very accurate and the instructions doctors gave them not very patient-friendly, nearly all the patients told us they understood what to do just fine, understood their diagnosis, found their materials very readable, and so forth. Yet we were writing things like “You had unstable angina” or “You should follow a 2g Na diet” in their instructions. This is concerning in that we typically assess the quality of our discharge care by asking patients how they felt about it. If their perceptions are too rosy-colored, we may be fooling ourselves into thinking we are doing a pretty good job when in fact our patients don’t understand key things at all. Read the rest of the interview on MedicalResearch.com
  • Hospital Discharge Practice: Room for Improvement in Communication, Comprehension MedicalResearch.com Interview with: Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Clinicians should take a good hard look at their practices. Do they do discharge summaries on the day of discharge and send them to the outpatient doctor? • Does everyone go home with an appointment? • Are the patient instructions actually patient-friendly, or are they written in medical jargon? • And they should consider calling a few patients up and actually checking to see what they know.Teachers give their students tests to see what they know, and are held accountable to state exams. We never hold our clinicians accountable to be sure their patients understand what they are saying. • Patients should be aware that there are a few things they need to know going home – what their diagnosis was, what their medications should be, what their follow-up plans are, what they need to watch out for, and what still needs to be follow up by their outpatient doctor. They should not be shy about asking the same questions over and over until they are sure they understand and they should involve friends and family whenever possible. The National Patient Safety Foundation has an excellent program called Ask Me 3 which is worth adopting as a patient: • What is my main problem? • What do I need to do? • Why is it important for me to do this? • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Our study was not large enough to see whether the lack of discharge planning and/or lack of understanding on the part of patients actually led to adverse outcomes after discharge. Is this in part why readmission rates are so high? We are not sure. Future research might try to establish a causal link more directly. But it is important to remember that there is no single silver bullet. It is almost certainly not enough just to give everyone an appointment, or just to be sure that everyone understands their diagnosis, or just to send the outpatient doctor the discharge summary. It is likely that we will need to get all of those things – and others – right in order to see an effect on adverse outcomes. • Citation: • Horwitz LI, Moriarty JP, Chen C, et al. Quality of Discharge Practices and Patient Understanding at an Academic Medical Center. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.9318. Read the rest of the interview on MedicalResearch.com
  • Lung Cancer: Calcineurin Pathway Helps Enable Metastases MedicalResearch.com Interview with: Sandra Ryeom, PhD, Assistant professor of Cancer Biology, Perelman School of Medicine, University of Pennsylvania • MedicalResearch.com: What are the main findings of the study? • Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling was all unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: This pathway may be ‘targetable’ in the treatment of lung metastases. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: We are currently exploring whether this pathway in endothelial cells is specific to lung metastases or whether it plays a critical role in other organ site metastases. • Citation: • The Calcineurin-NFAT-Angiopoietin-2 Signaling Axis in Lung Endothelium Is Critical for the Establishment of Lung Metastases • Takashi Minami, Shuying Jiang, Keri Schadler, Jun-ichi Suehiro, Tsuyoshi Osawa, Yuichi Oike, Mai Miura, Makoto Naito, Tatsuhiko Kodama, Sandra Ryeom Cell Reports 15 August 2013 Read the rest of the interview on MedicalResearch.com
  • Heart Failure: Impact of Physician Continuity after Discharge MedicalResearch.com Interview with: Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont. • MedicalResearch.com: What are the main findings of the study? • Answer: Heart Failure carries a high risk of readmission/death in the first 30 days after hospital discharge (approximately 20%) – even in this cohort of patients with first time diagnosis of heart failure who were discharged home to the community. Patients who do not have an outpatient physician follow-up visit in the first 30 days after discharge have poorer outcomes at 30 days, 3 months, 6 months, and 12 months. Although outcomes are similar for patients who see an unfamiliar or a familiar physician in that first 30 days, over the longer term follow-up with a familiar physician is associated with better outcomes than follow-up with unfamiliar physician(s). MedicalResearch.com: Were any of the findings unexpected? • Answer: I was surprised that follow-up with a familiar physician was more beneficial than follow-up with any physician – current guidelines recommend follow-up within any physician within 30 days of discharge. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The transition from hospital to home is a high-risk situation for patients with heart failure and it is important to have outpatient follow-up within that first month after discharge to ensure successful transition, optimization of medications, etc. While follow-up with any physician is beneficial, follow-up with a physician familiar with the patient is even more beneficial (familiar defined as having seen the patient at least twice as an outpatient prior to their heart failure hospitalization or during their heart failure hospitalization). • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: My study only examined the impact of physician continuity after a discharge for heart failure. Future studies should examine whether this relationship also exists for patients with other medical conditions and whether it applies in settings other than recent hospital discharge. • Citation: • Finlay A. McAlister, Erik Youngson, Jeffrey A. Bakal, Padma Kaul, Justin Ezekowitz, and Carl van Walraven • Impact of physician continuity on death or urgent readmission after discharge among patients with heart failure CMAJ cmaj.130048; published ahead of print August 19, 2013, doi:10.1503/cmaj.130048 Read the rest of the interview on MedicalResearch.com