MedicalResearch.com - Medical Research Week in Review

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MedicalResearch.com: exclusive interviews with medical researchers from major and specialty health care journals and medical meetings.

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MedicalResearch.com - Medical Research Week in Review

  1. 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers from Major and Specialty Medical Research Journals and Meetings Editor: Marie Benz, MD info@medicalresearch.com May 9 2014 For Informational Purposes Only: Not for Specific Medical Advice.
  2. 2. Medical Disclaimer | Terms and Conditions • The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! • If you think you may have a medical emergency, call your doctor or 911 immediately. 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.com 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 MedicalResearch.com
  3. 3. Melanoma: How Many Lymph Nodes Should Be Excised? MedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, Italy • Melanoma: How Many Lymph Nodes Should Be Excised? • MedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, Italy • MedicalResearch: What are the main findings of the study? • Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively. MedicalResearch: Were any of the findings unexpected? • Dr. Rossi: These results reproduce those of Spillane et al. at the Melanoma Institute of Australia (ann surg oncol 2011; 18(9): 2521-2528). Read the rest of the interview on MedicalResearch.com
  4. 4. Melanoma: How Many Lymph Nodes Should Be Excised? MedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, Italy • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Rossi: Despite the clinical practice guidelines from the National Comprehensive Cancer Network report that there is insufficient evidence to identify a minimum number of lymph nodes that must be excised to consider a dissection adequate, these evidence based cut-offs can be taken into consideration by melanoma surgeons, while examining the pathological report of a given lymph node dissection, to monitor the quality of their performance. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Rossi: Prospective evaluation of quality assurance programs (including the minimum number of lymph nodes to be excised by lymph node dissection) at melanoma surgical Units on clinical practice and, likely, patients’ prognosis. • Citation: • Rossi C, Mozzillo N, Maurichi A, et al. Number of Excised Lymph Nodes as a Quality Assurance Measure for Lymphadenectomy in Melanoma. JAMA Surg. Published online May 07, 2014. doi:10.1001/jamasurg.2013.5676. Read the rest of the interview on MedicalResearch.com
  5. 5. Flu Vaccination During Pregnancy and Infant Outcomes MedicalResearch Interview: Dr Nicoline van der Maas MD Epidemiologist National Institute for Public Health and the Environment Centre for Infectious Disease Control Epidemiology and Surveillance The Netherlands • MedicalResearch: What are the main findings of the study? • Dr. van der Maas: The main finding, presented at the ESPID, is that we found no difference in growth, development and infection related contact rates with the general practitioner after the first year of life between infants of unvaccinated mothers and infants of mothers, vaccinated with an adjuvanted Influenza A (H1N1) vaccine during the second and third trimester of pregnancy. • The offer of a H1N1 vaccination to pregnant women in their second and third trimester did not have a negative impact on infants’ health during the first year of life. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. van der Maas: • A follow up study on infants’ health later on in life. • More controlled studies to vaccination during pregnancy, not only related to influenza, but also to other vaccine preventable diseases. • Studies on the acceptance, and feasibility. • Citation: Abstract presented at the: • ANNUAL MEETING OF THE EUROPEAN SOCIETY FOR PAEDIATRIC INFECTIOUS DISEASES (ESPID) • THE INFLUENCE OF VACCINATION AGAINST INFLUENZA A (H1N1) DURING PREGNANCY ON INFANT’S HEALTH IN THE FIRST YEAR OF LIFE Read the rest of the interview on MedicalResearch.com
  6. 6. Frailty Score Helps Predict Postoperative Mortality MedicalResearch.com Interview with: Kwang-il Kim, MD, PhD Associate Professor, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea • MedicalResearch: What are the main findings of the study? • Answer: There are few tools of preoperative risk stratification for the older adults. We found that not only disease itself but also frailty can lead to post-operative complication and mortality. So we made a scoring model to predict post-operative mortality and morbidity based on comprehensive geriatric assessment and it worked exactly. • MedicalResearch: Were any of the findings unexpected? • Answer: Under our predictive model, there was inflection point of mortality slope at point 5. Post- operative mortality of someone who scores 4~5 is below 10%, but it of other who scores 6~7 is about 30%. It was unexpected drastic change, so we think that there is physiologic threshold point. • MedicalResearch: What should clinicians and patients take away from your report? • Answer: Because the elderly are different from adults, clinicians have to focus on functional capacity, co- morbidity, and frailty for their older surgical patients. Make operative decision base on comprehensive geriatric assessment or our scoring model. If you depend on your own feeling, some older patients will suffer from post-operative complication and someone will forfeit his chance of surgery. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Answer: This study has shown promising results in Korean surgical patients. So we want to know about inter-racial difference first. And further trials will aim to assess the effect of intervention to correct frailty of older surgical patients. Hopefully, the intervention would be effective in reversing the frailty and contributing to better post-operative outcomes. • Sun-wook Kim, Ho-Seong Han, Hee-won Jung, Kwang-il Kim, Dae Wook Hwang, Sung-Bum Kang, Cheol-Ho Kim. Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surgery, 2014; DOI: 10.1001/jamasurg.2014.241 Read the rest of the interview on MedicalResearch.com
  7. 7. Prevention of Tick Bites With Insect Shield Clothing MedicalResearch.com Interview with: Meagan F. Vaughn, PhD Postdoctoral Trainee Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill • MedicalResearch: What are the main findings of the study? • Dr. Vaughn: Outdoor workers are at high-risk for tick-borne diseases. Adherence to recommended tick-bite prevention methods is poor. While permethrin treatment of clothing is highly protective against many arthropod vectors, the need for frequent reapplication lessens adherence. A double- blind randomized intervention was conducted to determine the effectiveness of long-lasting permethrin-impregnated uniforms for tick bite prevention among outdoor workers from North Carolina. Treatment group uniforms were factory-impregnated with long-lasting permethrin by Insect Shield, while control group uniforms received sham treatment. Participants completed weekly tick bite logs during two tick seasons. 130 participants reported 1,045 work-related tick bites over 5,251 person-weeks of follow-up. The effectiveness of long-lasting permethrin impregnated uniforms for prevention of work-related tick bites was 82% (p<0.001) for the first year and 34% (p=0.38) for the second year. These results indicate that long-lasting permethrin impregnated uniforms are highly effective for at least one year against tick bites among North Carolina outdoor workers. MedicalResearch: Were any of the findings unexpected? • Dr. Vaughn: Based on the results of a previous pilot study, we were not surprised to find a high rate of protection from tick bites among subjects wearing long-lasting permethrin impregnated clothing. Some reduction in effectiveness in the second year of follow-up was anticipated, but not to the extent we observed. It is possible that other factors, such as adherence to wearing only treated uniforms during the study, and exposure to heat, sunlight, and heavy wear, may have contributed to the observed decrease in effectiveness. It is likely that occasional wearers of long- lasting permethrin impregnated clothing would experience longer duration of effectiveness. Read the rest of the interview on MedicalResearch.com
  8. 8. Prevention of Tick Bites With Insect Shield Clothing MedicalResearch.com Interview with: Meagan F. Vaughn, PhD Postdoctoral Trainee Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Vaughn: For people who are frequently exposed to tick infested areas, particularly those with outdoor occupations, long-lasting permethrin impregnated clothing can provide a simple and effective option for reducing risk of tick bites and tick-borne infections. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Vaughn: We would expect that long-lasting permethrin impregnated clothing is protective against many different tick species, but additional long-term studies are needed in other locations to confirm this. Future studies should also focus on effects of environmental factors on knockdown capacity of long-lasting permethrin impregnated clothing. • Citation: • Long-lasting Permethrin Impregnated Uniforms Vaughn, Meagan F. et al. American Journal of Preventive Medicine , Volume 46 , Issue 5 , 473 – 480 Read the rest of the interview on MedicalResearch.com
  9. 9. Vaccination Mortality No Different For Boys or Girls MedicalResearch.com Interview with Tessa Schurink-van ‘t Klooster Epidemioloog Rijksvaccinatieprogramma Epidemiologie en Surveillance RIVM – Centrum Infectieziektebestrijding 3720 BA Bilthoven • MedicalResearch: What are the main findings of the study? • Answer: The main finding of this study was that we observed no differences in mortality rate ratios for females compared to males related to the type of last offered vaccination in DTP- and MMR-eligible age groups. MedicalResearch: Were any of the findings unexpected? • Answer: These findings were expected because non-specific effects of vaccination are less likely to influence overall mortality in high-income settings because of the low prevalence of infectious diseases and the small number of children who die due to infectious diseases. Read the rest of the interview on MedicalResearch.com
  10. 10. Vaccination Mortality No Different For Boys or Girls MedicalResearch.com Interview with Tessa Schurink-van ‘t Klooster Epidemioloog Rijksvaccinatieprogramma Epidemiologie en Surveillance RIVM – Centrum Infectieziektebestrijding 3720 BA Bilthoven • MedicalResearch: What should clinicians and patients take away from your report? • Answer: The results of this study indicates that when potentially non-specific effects of vaccination are present in this high-income setting, this is not reflected in changes in the difference in mortality between boys and girls. These findings in this large population-based study are reassuring for the continued trust in the safety of the national vaccination programme. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Answer: Ongoing evaluation of non-specific effects of vaccination on mortality and morbidity in high-income countries is needed to guide policy and to provide accurate information of the benefits and risks of vaccination. • Citation: Abstract presented at the 2014 European Society for Paediatric Infectious Diseases ESPID • Population wide study across more than a decade shows no difference in mortality related to the last type of vaccination offered between boys and girls Read the rest of the interview on MedicalResearch.com
  11. 11. Standardizing Medical Care By Patient Complexity Grouping MedicalResearch Interview with: Dr. David Cook MD Professor in the Department of Anesthesiology Division of Cardiovascular Anesthesiology Center for the Science of Health Care Delivery Mayo Clinic College of Medicine Rochester, Minnesota. • MedicalResearch: What are the main findings of the study? • Dr. Cook: The main finding of the study was that segmentation of a population of surgical patients into groups of higher and lower complexity allowed us to apply a standardized practice, focused factory model to surgical care delivery. A standardized care model improved care process measures such as time on mechanical ventilation or duration of a bladder catheter indwelling. The model reduced resource utilization, decreasing patient time in all care environments (operating room, ICU and on ?the floor?). The care model improved outcomes at 30 days and reduced the costs overall and in every care environment. In addition to the absolute improvements in quality and in cost, the standardized care model reduced variation in all measured variables. That reduction in variation may be even more important than the improved outcomes or reduced costs because we now know it is possible to make the health care experience predictable for these patients. That predictability is critically important to patients and providers, but it also has implications for health care metrics and payment models. • MedicalResearch: Were any of the findings unexpected? • Dr. Cook: In the manuscript we describe a complexity analysis. We used goods and services consumed by each individual patient as an index of their overall complexity of care. Then, we stratified about 2,000 cardiac surgical patients (cared for in 2012) from least to most complex. We found that the complexity index in more than half of the patients was relatively uniform. In contrast the most complex 20 percent were extremely complex, some having a complexity index of 8-10 times our median. This type of analysis points to the percentage of a population for which solution shop care, or conversely, a standardized care model, is most appropriate. Preliminary analysis of complexity in other practices suggests the structure of those practices may be very similar. This has implications for practice design and the distribution of patients to the appropriate type of care model and care environment. Read the rest of the interview on MedicalResearch.com
  12. 12. Standardizing Medical Care By Patient Complexity Grouping MedicalResearch Interview with: Dr. David Cook MD Professor in the Department of Anesthesiology Division of Cardiovascular Anesthesiology Center for the Science of Health Care Delivery Mayo Clinic College of Medicine Rochester, Minnesota. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Cook: Clinicians are often wary of standardization. There are many reasons for that wariness, but one is anxiety that a standardized care model or protocol may be applied inappropriately to those for whom it is not well suited. They are also concerned by decision making that is not at the point of care. Our results show the power of a standardized practice model, when applied appropriately. At a minimum, our work shows that a segment of the surgical population is very complex; for them a comprehensive, protocol-based care model is not appropriate. We were careful not to force patients into a care model for which they were not suited. At the same time, it is evident that standardization may improve care value for more than 60 percent of patients. The other clinician takeaway from our report is that our model was at least as safe as the conventional care model. For patients who received the standardized pathway, there was no increase in adverse outcomes such a respiratory failure, ICU readmission or hospital readmission. In fact, the care model was associated with improved 30-day outcomes. For patients the message is different. That message is that health care can be predictable, and it can be so reliable that, for most patients, we can be confident in telling them what their care expectations will be. I think there is also a cultural message here for patients, and that is that lower- cost care models can deliver excellent care. Read the rest of the interview on MedicalResearch.com
  13. 13. Standardizing Medical Care By Patient Complexity Grouping MedicalResearch Interview with: Dr. David Cook MD Professor in the Department of Anesthesiology Division of Cardiovascular Anesthesiology Center for the Science of Health Care Delivery Mayo Clinic College of Medicine Rochester, Minnesota. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Cook: The implication of this work is that the care model, and potentially the care environment, might be chosen on the basis of the predicted complexity of patients? medical status. We distributed patients to the care model based on a priori (pre-designation) and post hoc methods (physician review for continued suitability at the end of operation). That stratification to the care model (standardized or solution shop) was imperfect. Fortunately, our Mayo Clinic hybrid model allows patients the advantages of having both models there to support them. Ultimately, patients will benefit from the complementary nature of mathematical risk analysis and physician judgment. Some of the most important opportunities for research lie in developing better mechanisms to predict who is best served by a standardized vs. non-standardized care model. We need better tools to discriminate the boundaries of these populations so that we can deliver the right care to the right individual in the right environment. Another area of research will involve developing and evaluating new payment models based on population segmentation and the greater predictability of process, outcomes and costs that can arise from that. • Citation: • From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability • David Cook, Jeffrey E. Thompson, Elizabeth B. Habermann, Sue L. Visscher, Joseph A. Dearani, Veronique L. Roger, and Bijan J. Borah • Health Aff May 2014 33:5746-755; doi:10.1377/hlthaff.2013.1266 Read the rest of the interview on MedicalResearch.com
  14. 14. Does Marijuana Increase Stroke Risk in Young Adults? MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center • MedicalResearch: What are the main findings of the study? • Dr. Dutta: We analyzed data from the Stroke Prevention in Young Adults Study in order to evaluate for an association between self-reported marijuana use and ischemic stroke. 1,101 cases and 1,154 age, gender, and race-matched controls, aged 15-49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Interviews were conducted to assess for various potential stroke risk factors, including illicit drug, alcohol, and tobacco use. Individuals reporting use of vasoactive illicit drugs, including cocaine and amphetamines, were excluded, yielding 751 cases and 813 controls. Logistic regression analysis was used to determine the association between marijuana use and ischemic stroke, adjusting for age, gender, race, current tobacco use, current alcohol use, hypertension, and diabetes. • We did not find a positive association between marijuana use and ischemic stroke risk in our population of young-onset stroke patients compared to matched controls, even after controlling for current tobacco and alcohol use, hypertension, and diabetes. A statistically significant inverse relationship was observed between remote use (defined as any use over one year ago) and stroke risk (adjusted OR 0.77, CI 0.61-0.98, p = 0.03). We also looked to see whether recent use (in the past 30 days), and particularly recent heavy use, was associated with ischemic stroke risk as has been suggested in the medical literature. Though our data did not show this association, the number of patients reporting recent use in our study was very small-------. Read the rest of the interview on MedicalResearch.com
  15. 15. Does Marijuana Increase Stroke Risk in Young Adults? MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center • MedicalResearch: Were any of the findings unexpected? Dr. Dutta: Our hypothesis that marijuana use is associated with ischemic stroke was not supported by our data. Also, the inverse relationship seen between remote use and stroke risk was not expected. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Dutta: Although there is a growing body of medical literature describing a possible link between marijuana and ischemic stroke, we still do not have enough epidemiologic data to support an overall association. However, there may be a subgroup of individuals who are more prone to ischemic stroke in the setting of marijuana use. In several case series1,2 and review3, the majority of stroke cases attributed to marijuana use occurred in young males who reported heavy and often chronic marijuana use. Most had few traditional stroke risk factors. There was a tendency towards strokes affecting the posterior circulation, and a distinct imaging pattern seen of multifocal intracranial stenosis. Additionally, a high prevalence of marijuana use has been reported in a large series of patients experiencing reversible cerebral vasoconstriction syndrome4, raising the possibility that the drug may impact cerebral autoregulation. Numerous cardiovascular complications have also been reported in the setting of marijuana use (see recent reviews by Thomas, Kloner, and Rezkalla5,6), which may be another mechanism by which the drug could theoretically increase stroke risk in certain individuals. One of the challenges faced in studying the relationship between stroke and marijuana use is the fact that marijuana users often report concomitant use of tobacco and/or additional ilicit substances which may also increase stroke risk. A previous case-control study by Barber et al. showed a positive association between marijuana use and ischemic stroke risk prior to adjusting for tobacco, but nearly all stroke cases reported concomitant tobacco use7. It is also difficult to isolate the effects of cannabis itself given that marijuana may be mixed with tobacco, other street drugs, or chemical additives. Read the rest of the interview on MedicalResearch.com
  16. 16. Does Marijuana Increase Stroke Risk in Young Adults? MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center • Additionally, although our data did show an inverse relationship between remote marijuana use and ischemic stroke risk, this does not necessarily infer a protective effect. One limitation of the study in this regard is that we do not have information about how frequently or heavily individuals used remotely, which could impact stroke risk. There also may be uncovered biases that could have contributed to this finding. For example, there may be something about this group of individuals that lowered their stroke risk independent of marijuana use. Perhaps they stopped using marijuana in addition to other behavior modifications, such as improved diet, exercise, or tobacco cessation in an effort to become more health conscious. Marijuana use has been previously associated with presence of hypertension, dyslipidemia, and higher caloric intake7 so use of the drug may be a marker of a lifestyle characterized by increased risk for cardiovascular disease. However, it is overall reassuring to remote users that this particular group did not appear to be at increased risk for stroke. • With use of both recreational and medical marijuana on the rise, patients are increasingly inquiring about the safety of use and health care providers are being faced with tough decisions about how to best guide patients. Certainly patients with known stroke or cardiovascular risk factors should cautioned about potential vascular side effects, and decisions about use of medical marijuana for treatment of a chronic condition should be based on evaluation of the benefit/risk ratio for each individual patient. Read the rest of the interview on MedicalResearch.com
  17. 17. Does Marijuana Increase Stroke Risk in Young Adults? MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Dutta: Future studies are needed to clarify the relationship between chronicity and burden of marijuana use and ischemic stroke, both remotely and in the time period immediately preceding stroke. This is particularly important from a public health standpoint. We know that use is on the rise in teens and young adults, and with legalization (of both medical and recreational marijuana) there will be increasing numbers of individuals using regularly. Fortunately it may be easier to study the effects of the drug moving forward, as those using regulated marijuana under medical supervision will be easier to identify and follow (without fear of legal repercussion), and hopefully it will be easier to exclude confounding effects of other substances such as tobacco and illicit drugs. Also, in cases of stroke that occur in the setting of marijuana use, attention to cerebrovascular imaging patterns may help to determine whether marijuana induces changes in cerebral autoregulation that predispose to stroke. • 1. Wolff et al. Stroke 2011;42:1778-1780 • 2. Singh et al. J Stroke Cerebrovasc Dis. 2012;21:555-560. • 3. Desbois and Cacoub. Ann Vasc Surg. 2013;Oct;27(7):996-1005 • 4. Ducros et al. Brain 2007;130:3091-101. • 5. Rezkalla et al. J Am Heart Assoc. 2014;3:e000904 • 6. Thomas et al. Am J Cardiol 2014;113:187-190 • 7. Barber et al. Stroke 2013;44:2327-2329 • 8. Rodondi et al. Am J Cardiol 2006;98:478-484. • Citation: • Marijuana Use and the Risk of Ischemic Stroke: The Stroke Prevention in Young Adults Study Abstract Presented at the American Academy of Neurology May 2014 Tara Dutta2, Kathleen Ryan2Yuching Cheng2, Steven Kittner1 and John Cole2 Neurology April 8, 2014 vol. 82 no. 10 Supplement S55.003 Read the rest of the interview on MedicalResearch.com
  18. 18. Hepatitis C: Patient Reported Outcomes After Treatment MedicalResearch.com Interview with: Zobair Younossi, MD, MPH Chairman, Department of Medicine, Inova Fairfax Hospital Vice President for Research, Inova Health System Falls Church, Virginia, USA • MedicalResearch: What are the main findings of the study? • Dr. Younossi: We conducted the analysis of the patient reported outcomes (PROs) data that were systematically collected during clinical trials of sofosbuvir-containing regimens. The highlights of our findings are as follows: • Patients with Hepatitis C (HCV) have a significant impairment of their health related quality of life including those related to activity and fatigue. Their work productivity is also impaired. • Cirrhosis can add additional negative impact on some of these patient reported outcomes. • During treatment, patients with cirrhosis who were treated with an interferon-free sofosbuvir and ribavirin containing regimen did experience mild decline in their patient related outcome scores. However, this decline was similar for HCV patients with or without cirrhosis. • On the other hand, patients with cirrhosis who were treated with an interferon-containing regimen showed a significant decline in their patient reported outcomes scores compared to those with Hepatitis C and without cirrhosis. • Nevertheless, at the end of week 12 follow up, there was no longer a significant deficit in PROs noted regardless of the treatment arm for patients with cirrhosis. • Furthermore, for the patients (HCV and cirrhosis) who achieved a sustained virologic response at 12 weeks, there were significant improvements (compared to baseline) in some PRO scores. • During treatment, changes in patient reported outcomes scores were similar between cirrhotics and non-cirrhotics for both treatment regimens (all p>0.05). Read the rest of the interview on MedicalResearch.com
  19. 19. Hepatitis C: Patient Reported Outcomes After Treatment MedicalResearch.com Interview with: Zobair Younossi, MD, MPH Chairman, Department of Medicine, Inova Fairfax Hospital Vice President for Research, Inova Health System Falls Church, Virginia, USA • MedicalResearch: Were any of the findings unexpected? • Dr. Younossi: In general, our data shows that Hepatitis C patients with cirrhosis can tolerate the new regimens quite well. Additionally, HCV cirrhotic patients who achieve SVR, not only could potentially benefit clinically, but also in terms of their health related quality of life, fatigue and possibly work productivity. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Younossi: The most important take away messages from our study, as I alluded to above, are that at baseline, patients with HCV and cirrhosis have more patient impairment in patient reported outcomes than those with Hepatitis C without cirrhosis but during treatment, both groups are affected in a similar fashion. • But probably most important is that after achieving a sustained virologic response, patients with Hepatitis C induced cirrhosis actually show improvement in their patient reported outcomes most notably in their vitality, emotional well-being, fatigue and other quality of life domains. Finally, at any time point, fatigue and depression are the most important drivers of patient reported outcomes impairment. Read the rest of the interview on MedicalResearch.com
  20. 20. Hepatitis C: Patient Reported Outcomes After Treatment MedicalResearch.com Interview with: Zobair Younossi, MD, MPH Chairman, Department of Medicine, Inova Fairfax Hospital Vice President for Research, Inova Health System Falls Church, Virginia, USA • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Younossi: It will be important that future studies investigating different type of interferon-free treatment regimens for Hepatitis C consider patients’ perspective by including validated patient reported outcomes endpoints.. • Citation: • Younossi, Z. M., Stepanova, M., Nader, F., Jacobson, I. M., Gane, E., Nelson, D., Lawitz, E. and Hunt, S. L. (2014), Patient-reported outcomes in chronic hepatitis C patients with cirrhosis treated with sofosbuvir-containing regimens. Hepatology. doi: 10.1002/hep.27161 Read the rest of the interview on MedicalResearch.com
  21. 21. Cannabis Further Impairs Functioning In College Students With Psychiatric Disorders MedicalResearch.com Interview with: Meesha Ahuja, MD Department of Psychiatry and Human Behavior of the Warren Alpert Medical School of Brown University Young Adult Behavioral Health Program at Rhode Island Hospital • MedicalResearch: Why did you decided to study this topic? • Dr. Ahuja: Severe mental illness is more common among college students than it was a decade ago, and the number of college students presenting for psychiatric care both on and off campus has dramatically increased. The rates of cannabis use have also been increasing among college students in the United States since the mid-1990s. The concomitant use of cannabis and other substances among general samples in psychiatric treatment has been linked to poorer clinical outcomes including increased hospitalizations, increased symptomatology, poorer treatment adherence, higher treatment resistance. However, before doing this study, there was no research that examined the effect of cannabis and other substance use disorders on the scholastic and general functioning of college students in psychiatric care. • MedicalResearch: Where was this study done? • Dr. Ahuja: This study was conducted at the Young Adult Behavioral Health Program at Rhode Island Hospital where college students from eight different colleges throughout the state come for psychiatric care. Read the rest of the interview on MedicalResearch.com
  22. 22. Cannabis Further Impairs Functioning In College Students With Psychiatric Disorders MedicalResearch.com Interview with: Meesha Ahuja, MD Department of Psychiatry and Human Behavior of the Warren Alpert Medical School of Brown University Young Adult Behavioral Health Program at Rhode Island Hospital • MedicalResearch: What are the main findings of the study? • Dr. Ahuja: Of the 113 youth (mean age 21, 67% female) in the study, all had a primary non- substance use disorder. In addition, 24% had comorbid cannabis use disorders and 18% had alcohol use disorders. Those with cannabis use disorders were statistically more likely to be on medical leave from school, had lower functioning as assessed by their Global Assessment of Functioning score, and were more likely to be diagnosed with a bipolar disorder than those without cannabis use disorders. • MedicalResearch: Were any of these findings unexpected? • Dr. Ahuja: It was interesting to see that cannabis use disorders were more common than alcohol use disorders. Given the recent decriminalization of cannabis in many states and the media coverage focusing on cannabis, I would expect this trend to continue to increase. Read the rest of the interview on MedicalResearch.com
  23. 23. Cannabis Further Impairs Functioning In College Students With Psychiatric Disorders MedicalResearch.com Interview with: Meesha Ahuja, MD Department of Psychiatry and Human Behavior of the Warren Alpert Medical School of Brown University Young Adult Behavioral Health Program at Rhode Island Hospital • MedicalResearch: What are the conclusions and implications of this study? • Dr. Ahuja: These findings suggest that the use of cannabis by college students in psychiatric treatment is associated with greater functional impairment and greater likelihood of being on medical leave. The high rate of cannabis use disorders among college students in psychiatric care warrants combined treatment approaches that should be available on or near campus. In addition, awareness of cannabis’ relationship to worsening psychiatric disorders is needed, especially given its widespread use. • Citation: • “The Impact of Cannabis on the Functioning of Youth With Psychiatric Disorders.” Abstract presented at the American Psychiatric Association Meeting. May 3, 2014. • Read the rest of the interview on MedicalResearch.com
  24. 24. Bilateral Mastectomy Rates Higher In Hospitals Where Immediate Reconstruction Available MedicalResearch.com Interview with: Judy C. Boughey, MD Chair, Division of Surgery Research Mayo Clinic, Rochester, Minn. • MedicalResearch.com: What are the main findings of the study? • Dr. Boughey: Rates of bilateral mastectomy are higher in hospitals with immediate breast reconstruction available. Bilateral mastectomy rates were highest in hospitals with high volumes of immediate breast reconstruction. Large, teaching, urban, and Northeastern hospitals were more likely to have higher immediate breast reconstruction volumes. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Boughey: Hospitals with immediate breast reconstruction have higher rates of bilateral mastectomy. It cannot be clearly determined from this data whether the patients requesting bilateral mastectomy and wanting immediate reconstruction seek out care at institutions able to provide reconstruction or whether the availability of immediate reconstruction increases the likelihood that a patient decides to pursue bilateral mastectomy rather than unilateral mastectomy. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Boughey: Further understanding of factors impacting patient decision making regarding bilateral mastectomy and immediate reconstruction is needed to help guide patient counseling. • Abstract Presented at the American Society of Breast Surgeons April 30-May4 2014 The Impact of Availability of Immediate Breast Reconstruction on Bilateral Mastectomy Rates for Breast Cancer Across the United States • Elizabeth B. Habermann1, 2, Kristine M. Thomsen1, Tina J. Hieken2, Judy C. Boughey2 Read the rest of the interview on MedicalResearch.com
  25. 25. Snacking Between Meals May Increase Liver and Belly Fat MedicalResearch.com Interview with: Mireille Serlie, MD PhD Academic Medical Center University of Amsterdam Department of Endocrinology and Metabolism Amsterdam, The Netherlands • MedicalResearch What are the main findings of the study? • Dr. Serlie: We studied the effects of hypercaloric high sugar or high fat/high sugar drinks consumed with the 3 main meals (representing an increase in meal size) or in between the 3 main meals (representing an increase in meal frequency or snacking). All subjects gained a similar amount of body weight but only the ones that snacked showed an increase in liver and abdominal fat. This suggests that besides caloric content and diet composition, eating pattern independently contributes to liver and abdominal fat accumulation. We also observed a trend for a decrease in hepatic insulin sensitivity in the high fat/high sugar frequency group only. • MedicalResearch: Were any of the findings unexpected? • Dr. Serlie: We expected that snacking would have differential effects on glucose metabolism and that high sugar drinks would have the most pronounced effect on liver fat. We were surprised though that in these healthy lean males liver fat significantly increased in both snacking groups within 6 weeks but not in the groups consuming these drinks together with the 3 main meals. We did not expect that eating pattern would have an independent effect on liver and abdominal fat. Apparently the continuous exposure to nutrients promotes storage of fat within the liver while cycles of fasting and feeding do not. This is at least true for healthy lean males on a short term hypercaloric diet. Read the rest of the interview on MedicalResearch.com
  26. 26. Snacking Between Meals May Increase Liver and Belly Fat MedicalResearch.com Interview with: Mireille Serlie, MD PhD Academic Medical Center University of Amsterdam Department of Endocrinology and Metabolism Amsterdam, The Netherlands • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Serlie: Hypercaloric snacking leading to an increase in body weight favors accumulation of liver and abdominal fat. Reducing the consumption frequency of high fat/high sugar snacks and high sugar drinks and allowing for cycles of fasting and feeding might have beneficial effects on liver and abdominal fat. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Serlie: This study needs to be repeated in females and older individuals. Also it might be of interest to study whether reducing snacking throughout the day reduces liver fat in abdominally obese patients with hepatic steatosis and whether it affects components of the metabolic syndrome. I would also be interested in the effect of reducing meal frequency on the development of obesity in children. • Citation: • Karin E Koopman, Matthan WA Caan, Aart J Nederveen, Anouk Pels, Mariette T Ackermans, Eric Fliers, Susanne E la Fleur, Mireille J Serlie. Hypercaloric diets with increased meal frequency, but not meal size, increase intrahepatic triglycerides: A randomized controlled trial. Hepatology, 2014; DOI: 10.1002/hep.27149 Read the rest of the interview on MedicalResearch.com
  27. 27. Maintaining Physical Activity Important For Healthy Aging MedicalResearch.com Interview with: Luisa Soares-Miranda, PhD Research Center in Physical Activity, Health and Leisure Faculty of Sport, University of Porto Rua Dr. Plácido Costa, Porto PORTUGAL • MedicalResearch: What are the main findings of the study? • Dr. Soares-Miranda: Modest physical activity, such as the distance and pace of walking, is important for the heart’s electrical well being of older adults. In our study, older adults that increased their walking pace or distance had a better heart rate variability when compared with those that decreased their walking pace or distance. Our results suggest not only that regular physical activity later in life is beneficial, but also that certain beneficial changes that occur may be reduced when physical activity is reduced. This supports the need to maintain modest physical activity throughout the aging process. Even small increases can lead to a better health, while reducing physical activity has the opposite effect. So, any physical activity is better than none, and more is better. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Soares-Miranda: A broad type of physical activities exists however, with aging, walking predominates as the major physical activity and is a good way to achieve physical activity recommendations for aerobic exercise. I think that if a senior feels confortable with his/her usually physical activity (independently of what the chosen activity is), he or she should not slow down and should try to slowly do more in terms of duration and intensity. If walking is the main physical activity, try to walk an extra block or walk at a faster pace. It is never too late to start and to do more. Read the rest of the interview on MedicalResearch.com
  28. 28. Maintaining Physical Activity Important For Healthy Aging MedicalResearch.com Interview with: Luisa Soares-Miranda, PhD Research Center in Physical Activity, Health and Leisure Faculty of Sport, University of Porto Rua Dr. Plácido Costa, Porto PORTUGAL • MedicalResearch: What recommendations do you have for future research as a result of this study? Dr. Soares-Miranda: Continue to show that being physically active is beneficial, not only on an individually basis but also at a social level. In my understanding, everyone benefits. • Citation: • Physical Activity and Heart Rate Variability in Older Adults: The Cardiovascular Health Study • Luisa Soares-Miranda, Jacob Sattelmair, Paulo Chaves, Glen Duncan, David S. Siscovick, Phyllis K. Stein, and Dariush Mozaffarian • Circulation. 2014;CIRCULATIONAHA.113.005361published online before print May 5 2014, doi:10.1161/CIRCULATIONAHA.113.005361 Read the rest of the interview on MedicalResearch.com
  29. 29. Prostate Cancer: Low Testosterone Levels Linked to Aggressive Disease MedicalResearch.com Interview with: Dr. Ignacio F. San Francisco Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile • MedicalResearch: What are the main findings of the study? • Answer: Increasingly, men with low-risk prostate cancer are undergoing a close monitoring regimen called active surveillance, instead of moving forward immediately with treatment. However it is still unclear which men will develop evidence for worsening or more aggressive disease during active surveillance. In this study of 154 men with Gleason 6 prostate cancer followed for 38 months, we found that low levels of free testosterone were significantly associated with increased risk of developing more aggressive disease. We found no significant association with total testosterone concentrations, although there was a general trend towards increased risk with lower levels. • MedicalResearch: Were any of the findings unexpected? • Answer: Not totally, because we already published few years ago that men with low free testosterone had more aggressive prostate cancer. MedicalResearch: What should clinicians and patients take away from your report? • Answer: These results suggest low levels of testosterone are associated with more aggressive prostate cancer. This contradicts long-held beliefs that high testosterone is risky for prostate cancer, and low testosterone is protective. • MedicalResearch: What recommendations do you have for future research as a result of this study? Answer: The results of this study provide additional valuable information to clinicians and their patients regarding risk factors for prostate cancer progression in men undergoing active surveillance. In borderline cases, the presence of low values of free testosterone may help determine whether it is more prudent to initiate treatment rather than continue observation. Citation: • Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance • San Francisco, I. F., Rojas, P. A., DeWolf, W. C. and Morgentaler, A. (2014), Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance. BJU International. doi: 10.1111/bju.12682 Read the rest of the interview on MedicalResearch.com
  30. 30. Mortality Dropped After Massachusetts Health Care Reform MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard School of Public Health / Brigham & Women’s Hospital Boston, MA 02115 • MedicalResearch.com: What are the main findings of the study? • Dr. Sommers: We find that over the first four years since Massachusetts’ 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period. We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health. Overall, we estimate that the health reform law prevented over 320 deaths per year in the state – or one life saved per 830 adults gaining health insurance. Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease. We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Sommers: Previous research on the health impacts of gaining insurance have been mixed. In general, health insurance has been shown to improve financial risk protection, help people pay medical bills, and promote better access to care. But studies – most recently the Oregon Health Insurance Experiment – have offered inconsistent evidence about whether expanding insurance produces better health outcomes, particularly for objective clinical measures. So our results are noteworthy in that respect, but perhaps not surprising: here we take advantage of a large natural experiment with several hundred thousand people gaining health insurance, and we have four years of data after the law. That gave us much more statistical power to find the sort of population- level impact that other well-designed but smaller studies may not have been able to detect. Read the rest of the interview on MedicalResearch.com
  31. 31. Mortality Dropped After Massachusetts Health Care Reform MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard School of Public Health / Brigham & Women’s Hospital Boston, MA 02115 • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Sommers: The main implications are that expanding health insurance can produce not only benefits in terms of improved access to care and perceived health, but reduced population-level mortality. Moreover, our study suggests that near-universal health insurance disproportionately benefits some of the groups that have traditionally had worse health outcomes in the U.S. – racial and ethnic minorities and adults with low incomes. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Sommers: Though it is difficult to generalize directly from one state to the country as a whole, the study offers suggestive insights into what kinds of population-level health effects could possibly occur under the ACA. The natural next step for research in this area is to evaluate the impact of national health reform, in terms of its effects on coverage, access to care, and health. • Citation: • Changes in Mortality After Massachusetts Health Care Reform A Quasi-experimental Study Benjamin D. Sommers, MD, PhD; Sharon K. Long, PhD; and Katherine Baicker, PhD Ann Intern Med. 2014;160(9):585-593. doi:10.7326/M13-2275 Read the rest of the interview on MedicalResearch.com
  32. 32. Alzheimer’s : Amyloid Deposits In Healthy People Signals Increased Brain Atrophy MedicalResearch.com Interview with: Niklas Mattsson MD, PhD University of California San Francisco Center for Imaging of Neurodegenerative Diseases VA Medical Center San Francisco, CA 94121, USA • MedicalResearch.com: What are the main findings of the study? • Dr. Mattsson: The main finding of this study was that cognitively healthy people with signs of emerging beta-amyloid pathology had increased regional brain atrophy rates. We used serial CSF samples to identify people with normal CSF beta-amyloid42 levels at baseline but declining levels over time. Since low CSF beta-amyloid42 reflects the presence of amyloid plaques in the brain, these persons may be in a transitional state of emerging beta-amyloid pathology. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Mattsson: One unexpected finding was that the increased atrophy rates were not primarily seen in the medial temporal lobe, which is believed to be an early site of atrophy in Alzheimer’s disease. Rather, we found increased atrophy rates in the frontal and parietal lobes. These are brain regions where early amyloid deposition occurs. Therefore, it is possible, although not proven, that the results reflect early local amyloid toxicity Read the rest of the interview on MedicalResearch.com
  33. 33. Alzheimer’s : Amyloid Deposits In Healthy People Signals Increased Brain Atrophy MedicalResearch.com Interview with: Niklas Mattsson MD, PhD University of California San Francisco Center for Imaging of Neurodegenerative Diseases VA Medical Center San Francisco, CA 94121, USA • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Mattsson: The results support the idea that pathological processes associated with Alzheimer’s disease, such as amyloid accumulation and brain injury, starts already prior to cognitive impairment. However, the exact relationship between the different pathologies is still not clear. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Mattsson: It is important to clarify the sequence of pathological events in Alzheimer’s disease, and validate biomarkers reflecting these events. Our study was done in a small cohort and needs to be replicated. Also, future studies may test how the presence of tau pathology affect our findings. • Citation: • Mattsson N, Insel PS, Nosheny R, et al. Emerging β-Amyloid Pathology and Accelerated Cortical Atrophy. JAMA Neurol. Published online April 28, 2014. doi:10.1001/jamaneurol.2014.446. Read the rest of the interview on MedicalResearch.com
  34. 34. Cirrhosis: Data Supports Surveillance for Liver Cancer Screening MedicalResearch.com Interview with: Amit Singal MD MS Assistant Professor of Medicine Medical Director, Liver Tumor Program Dedman Scholar of Clinical Care Division of Digestive and Liver Diseases • MedicalResearch: What are the main findings of the study? • Dr. Singal: We conducted a meta-analysis of current studies to characterize the association between hepatocellular carcinoma surveillance and early detection, curative treatment rates, and overall survival in patients with cirrhosis. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had hepatocellular carcinoma detected by surveillance. Hepatocellular carcinoma surveillance was associated with improved early stage detection (OR 2.08, 95% CI 1.80– 2.37) and curative treatment rates (OR 2.24, 95% CI 1.99–2.52). These associations were robust to several sensitivity analyses, including study design, study location, and study period. Hepatocellular carcinoma surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67– 2.17), which remained significant in the subset of studies adjusting for lead-time bias. Three-year survival rates were 50.8% among patients who underwent surveillance, compared to only 28.2% among hepatocellular carcinoma patients with tumors detected outside of a surveillance program. • MedicalResearch: Were any of the findings unexpected? • Dr. Singal: The lack of randomized data for hepatocellular carcinoma surveillance in patients with cirrhosis has spurred questions regarding its benefit; however, the lack of a randomized trial does not equate to a lack of data supporting its efficacy. There are limitations in current literature, including many studies failing to adequately adjust for lead-time bias. However, the preponderance of data that consistently demonstrate benefits should provide sufficient rationale to recommend hepatocellular carcinoma surveillance, even in the absence of a randomized controlled trial among patients with cirrhosis. Read the rest of the interview on MedicalResearch.com
  35. 35. Cirrhosis: Data Supports Surveillance for Liver Cancer Screening MedicalResearch.com Interview with: Amit Singal MD MS Assistant Professor of Medicine Medical Director, Liver Tumor Program Dedman Scholar of Clinical Care Division of Digestive and Liver Diseases • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Singal: These data support guidelines that recommend hepatocellular carcinoma surveillance in patients with cirrhosis. Efforts must be made to increase hepatocellular carcinoma surveillance rates, given less than 20% of at-risk patients currently undergo hepatocellular carcinoma surveillance. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Singal: We are currently conducting several studies among patients and providers to determine why surveillance for hepatocellular carcinoma is being underutilized. We are also conducting the first randomized controlled trial to compare the effectiveness of interventions to increase hepatocellular carcinoma surveillance rates in patients with cirrhosis. We are hoping these studies will help improve the effectiveness of hepatocellular carcinoma surveillance efforts in the near future. • Citation: • Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis • Amit G. Singal, Anjana Pillai, Jasmin Tiro • PLOS Medicine Published: April 01, 2014 DOI: 10.1371/journal.pmed.1001624 Read the rest of the interview on MedicalResearch.com
  36. 36. Mastectomy: Use of Paravertebral Block for Pain Control MedicalResearch.com Interview with: Judy C. Boughey, MD Chair, Division of Surgery Research Mayo Clinic, Rochester, Minn. • MedicalResearch.com: What are the main findings of the study? • Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Boughey: Using paravertebral blocks in women undergoing mastectomy can improve patient experience by decreasing amount of opioids (strong pain medication) that patients need after surgery and also decrease the number of patients that require any anti-emetic medications against nausea/vomiting. • The greatest benefit was seen in those patients undergoing bilateral mastectomy with immediate tissue expander/implant based reconstruction. • Citation: • Abstract Presented at the American Society of Breast Surgeons April 30-May4 2014 • Paravertebral Block in Patients Undergoing Mastectomy – Improves Pain Control and Decreases Postoperative Nausea and Vomiting • Aodhnait S. Fahy1, Judy C. Boughey1, Nora S. Eldin1, Benzon Dy1, William S. Harmsen3, Hans Sviggum2, James W. Jakub1 • 1Department of Surgery, 2Department of Anesthesia, 3Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota Read the rest of the interview on MedicalResearch.com
  37. 37. MRI Findings as Surrogate Markers for Brain Microinfarcts MedicalResearch.com Interview with: Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 • MedicalResearch: What are the main findings of the study? • Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones. • MedicalResearch: Were any of the findings unexpected? • Dr. Kantarci: An unexpected finding was the absence of a relationship between white matter hyperintensities and microinfarcts. We were expecting a relationship as both are associated with small vessel ischemic disease. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Kantarci: Presence of macroinfarcts on MRI suggest the presence of microinfarcts, but not all cases with microinfarcts have macroinfarcts on MRI. Microinfarcts on MRI are associated with atrophy independent of Alzheimer’s disease which is an important consideration when using volumetric MRI as an outcome measure in clinical trials. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Kantarci: I think there is an ongoing need for imaging markers of microinfarcts. Our study suggests that MRI findings may be valuable surrogates for the presence of microinfarcts and their impact on the brain. • Citation: Antemortem MRI findings associated with microinfarcts at autopsy Mekala R. Raman, BS, Gregory M. Preboske, MS, Scott A. Przybelski, BS, Jeffrey L. Gunter, PhD, Matthew L. Senjem, MS, Prashanthi Vemuri, PhD, Matthew C. Murphy, PhD, Melissa E. Murray, PhD, Bradley F. Boeve, MD, David S. Knopman, MD, Ronald C. Petersen, MD, PhD, Joseph E. Parisi, MD, Dennis W. Dickson, MD, Clifford R. Jack Jr, MD and Kejal Kantarci, MD, MS Published online before print May 2, 2014, doi: 10.1212/WNL.0000000000000471 Neurology Read the rest of the interview on MedicalResearch.com
  38. 38. Pediatric Diabetes Incidence Rises Dramatically in Last Decade MedicalResearch.com Interview with: Dana Dabelea, MD, PhD Professor and Associate Dean, Faculty Affairs Colorado School of Public Health University of Colorado Denver Aurora, CO 80045 • MedicalResearch.com: What are the main findings of the study? • Dr. Dabelea: We found that the proportion of US youth living with Type 1 Diabetes has increased by at least 21% over a period of only 8 years. This increase was seen in both boys and girls, most age-groups and race/ethnic groups. While we do not completely understand the reasons for this increase, since the causes of Type 1 Diabetes are still unclear, it is likely that something has changed in our environment- both in the US and elsewhere in the world- causing more youth to develop the disease, maybe at increasingly younger ages. • We also found that the proportion of youth living with Type 2 Diabetes has increased by approximately 30% over a period of only 8 years. This increase was also seen in both boys and girls, younger and older children, and among White, Black and Hispanic youth. We did not observe an increase in Type 2 Diabetes in American Indian and Asian-Pacific Islander youth, groups that traditionally had – and still have- the highest burden of Type 2 Diabetes in both children and adults. Several reasons for the increasing Type 2 Diabetes prevalence are possible. Most likely are the obesity epidemic, but also the long-term effects of diabetes and obesity during pregnancy, which have also increased over time. Read the rest of the interview on MedicalResearch.com
  39. 39. Pediatric Diabetes Incidence Rises Dramatically in Last Decade MedicalResearch.com Interview with: Dana Dabelea, MD, PhD Professor and Associate Dean, Faculty Affairs Colorado School of Public Health University of Colorado Denver Aurora, CO 80045 • MedicalResearch.com: Were any of the findings unexpected? • Dr. Dabelea: The extent of this increase was somewhat of a surprise. The increase in minorities, especially black and Hispanic youth, coupled with the changing demographics in the US, means that in the future more minority youth will have diabetes. Since minority youth typically have worse glycemic control, more barriers to care, more obesity, and a higher risk of diabetes-related complications, this is particularly worrisome. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Dabelea: These increases draw attention to the seriousness of the public health impact of pediatric diabetes, as they inform the clinical and public health community about care that is or will be needed for the pediatric population living with diabetes. At the individual level, every new case at a young age means a lifetime burden of difficult and costly treatment and higher risk of early serious complications. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Dabelea: The SEARCH study is hoping to continue to monitor temporal trends in the prevalence and incidence of both Type 1 Diabetes and Type 2 Diabetes, as well as in the risk of development of chronic diabetes-related complication, over time. Only by doing so we will understand the impact of potential changes in the environment in which US children are born and raised on the disease risk, the risk of diabetes-related morbidity and mortality, as well as the impact of potential programs that may be implemented – such as encouraging breastfeeding, reducing school exposure to sugar sweetened beverages, new technologies to monitor blood glucose, or even the effects of the affordable care act. • Citation: Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009 • Dabelea D, Mayer-Davis EJ, Saydah S, et al. Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. JAMA. 2014;311(17):1778-1786. doi:10.1001/jama.2014.3201. Read the rest of the interview on MedicalResearch.com
  40. 40. Preconception Maternal Diet Linked to Birth Outcomes MedicalResearch.com Interview with: Jessica A. Grieger (BSc(hons), R Nutr, PhD) Post-doctoral research fellow Robinson Research Institute, University of Adelaide • MedicalResearch: What are the main findings of the study? Dr. Grieger: The study aimed to identify associations between maternal dietary patterns in the 12 months before conception on fetal growth and preterm delivery. We report that a one standard deviation increase in the scores on the high-protein/fruit pattern was associated with decreased likelihood for preterm birth, whereas a one standard deviation increase on the high-fat/sugar/takeaway pattern was associated with increased likelihood for preterm birth as well as shorter gestation and birth length. • MedicalResearch: What should clinicians and patients take away from your report? Dr. Grieger: Our results suggest that preconception diet is an important factor relevant to perinatal outcomes. In particular, a diet mainly consisting of discretionary items such as take- away foods, potato chips, refined grains and added sugar is associated with preterm birth, whereas a pattern consisting of fish, meat, chicken, fruit and some whole grains was protective. Preterm birth is a leading cause of morbidity and mortality. Our work highlights the importance of promoting a healthy diet before pregnancy to optimise outcomes for both the mother and baby. Read the rest of the interview on MedicalResearch.com
  41. 41. Preconception Maternal Diet Linked to Birth Outcomes MedicalResearch.com Interview with: Jessica A. Grieger (BSc(hons), R Nutr, PhD) Post-doctoral research fellow Robinson Research Institute, University of Adelaide • MedicalResearch: What recommendations do you have for future research as a result of this study? Dr. Grieger: Larger dietary pattern studies are required to support our results. Our sample was a group of women living in a region of low socioeconomic status, therefore subsequent analyses could be assessed in women of higher socioeconomic status to understand whether similar associations exist. Behaviour-change strategies might be a necessary component to assist women in adopting a healthier dietary pattern both before and during pregnancy. Citation: • Preconception Dietary Patterns in Human Pregnancies Are Associated with Preterm Delivery. Jessica A. Grieger, Luke E. Grzeskowiak, and Vicki L. Clifton J. Nutr. 2014 jn.114.190686; first published online April 30, 2014. doi:10.3945/jn.114.190686 Read the rest of the interview on MedicalResearch.com
  42. 42. Recurrent Glioblastoma: Treatment with Cytomegalovirus Immunotherapy MedicalResearch.com Interview with: Dr Andrea Schuessler QIMR Berghofer Medical Research Institute Herston, Queensland 4006 • MedicalResearch.com: What are the main findings of the study? • Dr . Schuessler: Recurrent glioblastoma is a very aggressive brain cancer and most patients do not survive much longer than 6 months. Our study has assessed a novel immunotherapy and treated 10 patients with late stage cancer. The treatment did not have any serious side effects and most of the patients have survived much longer than the expected 6 months. Importantly, four of the 10 patients have not shown signs of disease progression during the study period with one of them still being cancer free four years after the treatment. MedicalResearch.com: Were any of the findings unexpected? • Dr . Schuessler: Recurrent glioblastoma has a very dismal prognosis and standard treatments often fail to extend patient survival. The finding that 4 out of 10 patients remained cancer free during the study period is a better outcome than we anticipated and encourages further study. • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schuessler: While the findings are still preliminary, immunotherapy is a promising new treatment option with minimal side effects. Pending further clinical testing, this treatment may become widely available in the future. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr . Schuessler: This study has shown promising results in patients with recurrent glioblastoma. Further trials will aim to assess the effect of immunotherapy in patients at an earlier stage of the disease. Hopefully, the treatment can be effective in delaying cancer relapse and extending survival. Citation: • Autologous T cell Therapy for Cytomegalovirus as a Consolidative Treatment for Recurrent Glioblastoma • Andrea Schuessler, Corey Smith, Leone Beagley, Glen M Boyle, Sweera Rehan, Katherine Matthews, Linda Jones, Tania Crough, Vijayendra Dasari, Kerenaftali Klein, Amy Smalley, Hamish Alexander, David G Walker, and Rajiv Khanna • Cancer Res canres.0296.2014; Published OnlineFirst May 4, 2014; doi:10.1158/0008-5472.CAN-14-0296 Read the rest of the interview on MedicalResearch.com
  43. 43. Hepatitis C: Successful Treatment Without Interferon for HCV 3 MedicalResearch.com Interview with: Stefan Zeuzem, M.D. Professor of Medicine, Chief Department of Medicine JW Goethe University Hospital Frankfurt Germany • MedicalResearch.com: What are the main findings of the study? • Dr. Zeuzem: Main finding is that also patients infected with HCV 3 can be cured with an IFN-free regimen. However, duration of therapy must be prolonged to 24 weeks. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Zeuzem: Treatment prolongation from 12 to 16 weeks already suggested that longer treatment duration will increase sustained virologic response (SVR) rates. The magnitude of sustained virologic response rates with 24 wks SOF + RBV in HCV3 was unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Zeuzem: Standard of care for patients infected with HCV 2 is now confirmed to be 12 wks SOF + RBV, for HCV 3 infected patients an IFN-free regimen with chances of SVR > 90% is now also available. These options have already been included in the European label. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Zeuzem: The sustained virologic response rates for treatment-experienced patients with HCV 3 and liver cirrhosis are still “only” 60%. Here, further improvement is needed, likely by addition of another direct antiviral agent with a different mechanism of action and HCV3 activity. • Citation: • Sofosbuvir and Ribavirin in HCV Genotypes 2 and 3 • Stefan Zeuzem, M.D., Geoffrey M. Dusheiko, M.D., Riina Salupere, M.D., Ph.D., Alessandra Mangia, M.D., Robert Flisiak, M.D., Ph.D., Robert H. Hyland, D.Phil., Ari Illeperuma, M.S., Evguenia Svarovskaia, Ph.D., Diana M. Brainard, M.D., William T. Symonds, Pharm.D., G. Mani Subramanian, M.D., Ph.D., John G. McHutchison, M.D., Ola Weiland, M.D., Hendrik W. Reesink, M.D., Ph.D., Peter Ferenci, M.D., Christophe Hézode, M.D., and Rafael Esteban, M.D. for the VALENCE Investigators • May 4, 2014DOI: 10.1056/NEJMoa1316145 Read the rest of the interview on MedicalResearch.com
  44. 44. Coffee Consumption and Risk of Type 2 Diabetes MedicalResearch.com Interview with: Dr. Frank B. Hu MD MPH PhD Professor of Nutrition and Epidemiology From the Departments of Nutrition and Epidemiology Harvard School of Public Health, Boston, MA • MedicalResearch.com: What are the main findings of the study? • Dr. Hu: We found that people who increased the amount of coffee they drank each day by more than one cup over a four-year period had a 11% lower risk for type 2 diabetes than those who made no changes to their coffee consumption, but those who decreased their coffee consumption by more than a cup per day increased their type 2 diabetes risk by 17%. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hu: No, because previous studies have consistently found benefits of coffee on diabetes, but this is the first time to look at whether changes in coffee consumption is associated with subsequent risk of diabetes. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hu: For individuals who drink coffee regularly, they should enjoy it and there is no reason to stop or reduce consumption for health reasons. However, coffee is only one of many factors that influence diabetes risk. More importantly, individuals should watch their weight and be physically active.” • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hu: More prospective studies are needed to confirm our findings and explore potential mechanisms for the benefits of coffee on diabetes. • Citation: • Changes in coffee intake and subsequent risk of type 2 diabetes: three large cohorts of US men and women Shilpa N. Bhupathiraju & An Pan & JoAnn E. Manson & Walter C. Willett & Rob M. van Dam & Frank B. Hu Diabetologia DOI 10.1007/s00125-014-3235-7 Read the rest of the interview on MedicalResearch.com
  45. 45. Dietary Fiber: Potential Mechanism of Appetite Suppression Discovered MedicalResearch.com Interview with: Professor Gary Frost PhD RD Head of the Nutrition and Dietetic Research Group NIHR Senior Investigator Division of Diabetes, Endocrinology and Metabolism Faculty of Medicine Imperial College Hammersmith Campus London W12 ONN • MedicalResearch.com: What are the main findings of the study? • Prof. Frost: That acetate that is derived from the fermentation of dietary fiber in the colon by the microbiota is taken up by the hypothalamus in the brain. In the hypothalamus the way the cells metabolize acetate creates a signal that suppresses appetite MedicalResearch.com: Were any of the findings unexpected? • Prof. Frost: No, most people thought that acetate from the colon did not reach the brain it was all metabolised by the liver. Also other scientist have shown that the fermentation of dietary fiber leads to an increase release of hormones from the colon that make you feal full (PYY and GLP-1). What we are beginning to see is that dietary fiber has many ways of working. • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Frost: It is to early, we need to translate these observation to humans. We need to understand how much fiber you would need to eat to have these effects. What we do know is if you eat large amounts of fiber it makes you feel full but you need to eat about double the recommendation (30g) • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Prof. Frost: At the moment we are working with humans to see if the results are the same. If they are then we can start to develop targeted dietary methods to suppress appetite • Citation: • The short-chain fatty acid acetate reduces appetite via a central homeostatic mechanism Gary Frost et al • Nature Communications5, Article number: 3611 doi:10.1038/ncomms4611Received 16 July 2013 Accepted 11 March 2014 Published 29 April 2014 Read the rest of the interview on MedicalResearch.com
  46. 46. Chest Pain in the Emergency Room: Clinical Decision Strategy MedicalResearch.com Interview with: Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK • MedicalResearch.com: What are the main findings of the study? • Dr. Body: This paper actually reports the findings of two consecutive, separate studies. We aimed to derive and then externally validate a clinical decision rule to risk stratify patients with suspected acute coronary syndromes in the Emergency Department (ED). This rule could then be used to reduce unnecessary hospital admissions while also making judicious use of specialist high dependency resources. • In the first study we derived a clinical decision rule that incorporates 8 variables: high sensitivity troponin T, heart-type fatty acid binding protein; ECG ischaemia; worsening angina; hypotension (systolic blood pressure <100mmHg on arrival); sweating observed in the ED; pain associated with vomiting; and pain radiating to the right arm or shoulder. When we validated the rule at a different centre, we found that its use could have avoided hospital admission for over a quarter of patients while effectively risk stratifying others. Of the 10% of patients who were identified as ‘high risk’, approximately 95% had a major adverse cardiac event within 30 days. The findings suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule could be used to ‘rule in’ and ‘rule out’ acute coronary syndromes immediately, using information gathered at the time of initial presentation to the ED. Before clinical implementation, we recommend that effect of using the MACS rule in practice should first be evaluated in a trial setting. This will enable us to determine: (a) whether physicians and patients are likely to comply with (and be satisfied with) the MACS rule; (b) the safety of the MACS rule when used in practice; and (c) whether use of the MACS rule leads to cost savings for the health service. Read the rest of the interview on MedicalResearch.com
  47. 47. Chest Pain in the Emergency Room: Clinical Decision Strategy MedicalResearch.com Interview with: Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK • MedicalResearch.com: Were any of the findings unexpected? • Dr. Body: When we first started out we suspected that the most useful biomarkers may be markers of the earliest stages in the disease process such as plaque rupture, rather than markers of myocardial necrosis. However, the markers of plaque rupture that we evaluated had relatively disappointing performance. In contrast, we found that high sensitivity troponin T and heart-type fatty acid binding protein are excellent markers with independent predictive value. Both were found to be useful additions to the decision rule. • The other finding that was perhaps unexpected was the inclusion of pain radiating to the right arm or shoulder, which we would normally consider as an ‘atypical’ symptom of an acute coronary syndrome. However, we found that this feature helped to differentiate those with acute myocardial infarction (AMI) from those without, which is actually consistent with other reports in the literature. • This doesn’t mean that pain radiating to the right arm or shoulder should now be considered as more ‘typical’ than, for example, pain radiating to the left arm or shoulder. In our derivation study, approximately a third of patients with AMI had pain radiating to the left arm or shoulder. However, the same proportion of patients who did not have acute myocardial infarction also reported pain radiating to the left arm or shoulder, so this feature just didn’t help to differentiate between the two groups. Pain radiating to the right arm or shoulder was less common among patients with AMI. A little more than 1 in 5 patients with acute myocardial infarction had this symptom compared to less than 1 in 10 patients who did not have AMI. As such, this symptom helped to differentiate patients with acute myocardial infarction from those without. When we ran the multivariate analysis, this symptom was found to have independent predictive value, hence its inclusion in the rule. Read the rest of the interview on MedicalResearch.com
  48. 48. Chest Pain in the Emergency Room: Clinical Decision Strategy MedicalResearch.com Interview with: Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Body: First and foremost, what we’ve described is a really promising strategy for use in patients presenting to the Emergency Department with suspected cardiac chest pain. Using the MACS rule, it may be possible to immediately ‘rule out’ an acute coronary syndrome (ACS) and safely discharge more than 1 in 4 patients, to ‘rule in’ ACS for 1 in 10 patients, and to effectively risk stratify the remaining patients who still need further tests. This does need further evaluation as part of a trial and we’re looking for potential sites, both in the UK and internationally, to participate. • Second, we’ve described a fairly novel approach to interpreting biomarker levels. We considered troponin and H-FABP as continuous variables, i.e. we didn’t artificially dichotomise the levels at an arbitrary level such as the 99th percentile in a healthy reference population. The higher the level of these biomarkers, the greater the risk. By using a computer model, we were able to retain the richness of diagnostic information and optimise the risk stratification. Potentially this method could be effectively applied in other situations. Read the rest of the interview on MedicalResearch.com
  49. 49. Chest Pain in the Emergency Room: Clinical Decision Strategy MedicalResearch.com Interview with: Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Body: It’s imperative that we evaluate use of the MACS rule in practice to ensure that physicians and patients will comply and find the rule acceptable, to verify safety and to evaluate the economic impact for health services. We should also look at ways to refine and build upon the MACS rule. We know that serial troponin testing over 1 to 2 hours may enable exclusion of acute coronary syndromes. Potentially the MACS rule could be used to ‘rule out’ Acute Coronary Syndromes in a proportion of patients. Others may then undergo further testing after 1 to 2 hours, at which stage it may be possible to ‘rule out’ Acute Coronary Syndromes in even more patients. Thus, we would have a ‘staggered’ rule out strategy. This needs to be prospectively evaluated. • • Citation: • The Manchester Acute Coronary Syndromes (MACS) decision rule for suspected cardiac chest pain: derivation and external validation Richard Body, Simon Carley, Garry McDowell, Philip Pemberton, Gillian Burrows, Gary Cook, Philip S Lewis, Alexander Smith, Kevin Mackway- Jones • Heart heartjnl-2014-305564Published Online First: 29 April 2014 doi:10.1136/heartjnl-2014- 305564 Read the rest of the interview on MedicalResearch.com
  50. 50. Prostate Cancer: Mathematical Model Defines Growth of Bone Metastases MedicalResearch.com Interview with: Arturo Araujo, PhD IMO Moffitt Cancer Center Tampa, FL 33612 • MedicalResearch: What are the main findings of the study? • Dr. Araujo: Using in vivo approaches it is often challenging to study the multiple simultaneous interactions occurring at various time points in the setting of bone metastasis. However, integrating biological data with a powerful computational model allowed us to build a tool that could not only mimic the in vivo growth of cancer in bone but also to determine how the disease was behaving at any given time point. The key finding for us was that the computational model demonstrated the phasic or cyclical nature of how the prostate cancers grow in bone. For example, a wave of osteoclast mediated bone resorption would be followed by sustained bone formation by osteoblasts, followed again by bone reposition. We think these findings could provide novel insights into when the best time to apply therapies might be in order to obtain maximum efficiency. • MedicalResearch: Were any of the findings unexpected? • Dr. Araujo: Our model suggests that, if an anti-RANKL therapy was reaching the prostate- bone microenvironment with 100% efficacy, it would be sufficient to eradicate bone metastases by completely preventing osteoclast formation. To get to 100% efficacy is clinically challenging but our model predicts that increasing the efficacy anti-RANKL therapy from 40% to even 80% would significantly impact the growth of the disease. This could be achieved by increasing the dosage but this increase in dosing could also cause unanticipated side-effects. Read the rest of the interview on MedicalResearch.com
  51. 51. Prostate Cancer: Mathematical Model Defines Growth of Bone Metastases MedicalResearch.com Interview with: Arturo Araujo, PhD IMO Moffitt Cancer Center Tampa, FL 33612 • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Araujo: The take away message is that mathematical models can be used in an integrative way with biological models and clinical data to generate powerful tools that will be clinically useful by prolonging the overall survival of patients with prostate to bone metastases. Given the phasic nature of the disease it is possible that, by applying currently used standard of care treatments in different sequences or combinations could greatly enhance the efficacy and in turn, the overall survival for the patients. This kind of models can be used to design powerful combinations of these treatments. There are also implications for the rapid assessment of new inhibitors and how applying them to the computational model could predict whether they will be successful or not. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Araujo: The complexity of cancer heterogeneity is a major challenge facing cancer researchers and we believe that the flexibility of mathematical modeling offers us a real advantage in studying how cancers evolve in response to their microenvironment and importantly to applied therapies. Using patient derived information in regards to genetic mutation, it would be possible to begin tackling this heterogeneity and personalize computational models in a bid to provide better treatment options for each patient. • Citation: • An Integrated Computational Model of the Bone Microenvironment in Bone-Metastatic Prostate Cancer • Arturo Araujo, Leah M. Cook, Conor C. Lynch, and David Basanta Cancer Res May 1, 2014 74:2391-2401; doi:10.1158/0008-5472.CAN-13-2652 Read the rest of the interview on MedicalResearch.com
  52. 52. Psychological Distress Increases Risk of Diabetes in Pre-Diabetics MedicalResearch.com Interview with: Marianna Virtanen PhD Finnish Institute of Occupational Health Helsinki, Finland • MedicalResearch: What are the main findings of the study? • Dr. Virtanen: We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. We used a clinical type 2 diabetes risk score to assess future diabetes risk and in addition, participants’ prediabetes status. We found that psychological distress did not predict future type 2 diabetes among participants who were normoglycemic and among those with prediabetes combined with a low diabetes risk score. However, psychological distress doubled the risk of type 2 diabetes among participants with prediabetes and a high diabetes risk score. • MedicalResearch: Were any of the findings unexpected? • Dr. Virtanen: Not exactly. We already knew that there was not consistent evidence on stress or psychological distress predicting onset of type 2 diabetes. In this study we sought to find a subgroup where distress might have a particularly strong effect. • MedicalResearch: What should clinicians and patients take away from your report? • Dr. Virtanen: Psychological symptoms among patients who have prediabetes and many diabetes risk factors (such as overweight or obesity, dyslipidemia, hypertension or familial diabetes) are at an even more increased risk of developing type 2 diabetes if they have psychological distress symptoms. • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Virtanen: It would be important to study whether interventions aiming at reduce distress prevent development of type 2 diabetes among high-risk populations. • Citation: • Psychological Distress and Incidence of Type 2 Diabetes in High-Risk and Low-Risk Populations: The Whitehall II Cohort Study • Marianna Virtanen, Jane E. Ferrie, Adam G. Tabak, Tasnime N. Akbaraly, Jussi Vahtera, Archana Singh- Manoux, and Mika Kivimäki • The Whitehall II Cohort Study Diabetes Care published ahead of print May 1, 2014, doi:10.2337/dc13-2725 Read the rest of the interview on MedicalResearch.com
  53. 53. Organ Transplantation: What is the Risk of Cancer Transmission? MedicalResearch.com Interview with: Rajeev Desai SpR Gastroenterology, City Hospital Birmingham Honorary Clinical Research Fellow University Hospital Birmingham / NHS Blood and Transplant, Bristol • MedicalResearch: What are the main findings of the study? • Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non- transplantation. • MedicalResearch: Were any of the findings unexpected? • Dr. Desai: Current guidelines for assessment of donors suggest exclusion of all donors with a history of certain types of cancers, as such organs are considered to pose high risk of transmission of cancer. The findings of our study show that some such donors, following careful selection, can be a valuable source additional organs • MedicalResearch: What recommendations do you have for future research as a result of this study? • Dr. Desai: In our study, in spite of a large donor cohort, the number of donors with individual cancers was small. Experience from such donors should be studied from larger transplant programmes to produce additional evidence which explores the risks and benefits of accepting organs from donors with past cancer. • Citation: • Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry • Desai, R., Collett, D., Watson, C. J. E., Johnson, P., Evans, T. and Neuberger, J. (2014), Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry. Br J Surg. doi: 10.1002/bjs.9460 Read the rest of the interview on MedicalResearch.com
  54. 54. Follow Your Heart Program Reduced Hospital Readmissions Following Heart Surgery MedicalResearch.com Interview with: Michael H. Hall, MD North Shore-LIJ Health System • MedicalResearch: What are the key points of your research? • Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary. • Their efforts resulted in a marked improvement in continuity in patient care and a reduction in 30 day readmission to 3.85% for the intervention group compared to 11.54% for the concurrent usual care group. The Follow Your Heart program was effective across all socio-economic groups. It resulted in a decrease in adverse events such as readmission within 30 days of discharge and provided a substantial cost savings in readmissions averted as well. It is clear that appropriately trained and experienced NPs can provide a transitional care service that is clinically and financially more effective. Hospital based NPs are better equipped to know the patients and their families since they typically spend most of their time at the bedside of the patients in the hospital. Read the rest of the interview on MedicalResearch.com
  55. 55. Follow Your Heart Program Reduced Hospital Readmissions Following Heart Surgery MedicalResearch.com Interview with: Michael H. Hall, MD North Shore-LIJ Health System • MedicalResearch: What should practicing clinicians and the public take home from your study? • Dr. Hall: Unfortunately, simply having health insurance is not enough to guarantee high quality health care. The problem of fragmentation of health care delivery has to be solved. This program is one important step in that direction. Patients should consider the transitional care opportunities and continuity of care in their locale and seek care in hospitals that appreciate the need for better continuity across all potential care transitions. This new iteration of the doctor-patient relationship is a family affair provided by a team of hospital providers who can effectively deal with patients as individuals, not numbers, and provide them with safe and personal high quality transitional care back to their community. • MedicalResearch: Were any of the findings unexpected? • Dr. Hall: What we have learned is that all the training, instructions, office appointments, prescriptions and reams of sheets with directions and phone numbers provided by a hospital may not be enough if patients do not have adequate support systems in place at home. We found patients sometimes were not obtaining new medications because of cost issues, taking old meds with the mistaken belief that they were just as good and appropriate, failing to see community physicians because of lack of transportation, failing to follow appropriate diets because of lack of understanding or inability to go grocery shopping by themselves, or seeing community providers who did not have adequate communication from hospital providers who took care of the patient. All of these issues and more could easily be solved by our NPs. Read the rest of the interview on MedicalResearch.com
  56. 56. Follow Your Heart Program Reduced Hospital Readmissions Following Heart Surgery MedicalResearch.com Interview with: Michael H. Hall, MD North Shore-LIJ Health System • MedicalResearch: What further questions remain to be answered and what further research is indicated? • Dr. Hall: This continuity of care with our NPs acting as the communications hub brought community-based providers up to speed and reinforced family responsibility to help the patient make the right health care decisions. The patient was more likely to feel capable of dealing with their health problems at the end of the day because their care was no longer fragmented. The current utility of the program in three system hospitals is helping us learn how to maximize benefits in a very diverse urban population. Further research is being done to expand the concept to other disease processes, such as congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and cardiac arrhythmias, all of which were favorably impacted in our study group. Further research needs to be done with the concept in more rural areas, although use of NPs for home visits has already been incorporated into some rural family practices across the country. • Citation: • Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions • Michael H. Hall, Rick A. Esposito, Renee Pekmezaris, Martin Lesser, Donna Moravick, Lynda Jahn, Robert Blenderman, Meredith Akerman, Christian N. Nouryan, Alan R. Hartman • Published online: March 5, 2014 The Annals of Thoracic Surgery, p1488–1495 Read the rest of the interview on MedicalResearch.com
  57. 57. Breast Cancer: Pre-Operative Axillary Ultrasound Useful Despite Obesity MedicalResearch.com Interview with: Tina Hieken, M.D. Associate Professor of Surgery Mayo Clinic,Rochester, Minn • MedicalResearch.com: What are the main findings of the study? • Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hieken: We thought that axillary ultrasound might be less accurate in obese patients, because of theoretical concerns regarding technical challenges reported with other soft tissue ultrasound applications in these patients and because of obesity-related alterations in lymph nodes that may complicate imaging findings. However, axillary ultrasound was actually slightly better, largely because a negative axillary ultrasound (normal appearing lymph nodes) was more often associated with negative axillary sentinel nodes at operation in obese than in normal weight patients. Read the rest of the interview on MedicalResearch.com
  58. 58. Breast Cancer: Pre-Operative Axillary Ultrasound Useful Despite Obesity MedicalResearch.com Interview with: Tina Hieken, M.D. Associate Professor of Surgery Mayo Clinic,Rochester, Minn • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hieken: Clinicians should be reassured that preoperative axillary ultrasound in newly diagnosed breast cancer patients is an accurate test for preoperative lymph node staging in normal, overweight and obese breast cancer patients. This can help frame patient expectations regarding the likelihood and extent of involved lymph nodes at operation and help with collaborative decision-making regarding selection of treatment options. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hieken: Validation of our findings in a prospective analysis. Further work to improve the overall accuracy for all patients of preoperative imaging to stage the axilla for breast cancer patients. • Citation: Abstract Presented at: • American Society of Breast Surgeons annual meeting 2014 ‎’

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