MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014

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
November 21 2014
For Informational Purposes Only: Not for Specific Medical Advice.

Medical Disclaimer | Terms and Conditions
• The contents of the MedicalResearch.com Site, such as text, graphics, images, and
other material contained on the 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

Over Half US Population Not Healthy Enough To Donate A Kidney
MedicalResearch.com Interview with:
Anthony Bleyer, Jr.
Wake Forest University Class of 2015, Economics President, Club Sports Union
Senior Captain, Wake Forest Men’s Ultimate
• Medical Research: What is the background for this study? What are the main findings?
• Response: There are over 100,000 individuals waiting for a kidney transplant, but each year
only approximately 6,000 individuals have living donors who donate them a kidney; the rest
of the individuals must remain on dialysis until they receive a kidney from an individual who
has died and is a kidney donor. A major limiting factor for kidney donation is that many
individuals are not healthy enough to donate a kidney because they have excessive obesity,
diabetes mellitus, blood pressure that is too high, or they have other health
conditions. While it was known that obesity, hypertension, and other health conditions are
contraindications to kidney transplant, there was no data about what percentage of the US
population would be able to donate a kidney. To study this, we (a team of kidney doctors and
researchers at Wake Forest School of Medicine, Winston-Salem, NC) analyzed data from the
National Health and Nutrition Survey. This study is a population-based sample that is
representative of the US population.
• Based on data from this study, we determined that 55.2% of the U.S. population would not
have met eligibility criteria for kidney donation, often due to preventable health
conditions. 19.2% of the population would have been unable to donate due to hypertension,
15% due to obesity, 11.6% due to excessive alcohol intake, and 11.5% due to diabetes. 60.1%
of individuals with an adjusted family household income (AFHI) <$35,000 did not meet
eligibility criteria vs. 49.3% for an AFHI > $100,000. If one considers non-US citizenship and a
family income below the poverty threshold as exclusion criteria, 68.5% of the US population
would be unable to donate.
Read the rest of the interview on MedicalResearch.com
Content Not Intended as Specific Medical Advice

Over Half US Population Not Healthy Enough To Donate A Kidney
Anthony Bleyer, Jr.
Wake Forest University Class of 2015, Economics President, Club Sports Union
Senior Captain, Wake Forest Men’s Ultimate
• Medical Research: What should clinicians and patients take away from your report?
• Response: Many individuals are unable to donate a kidney because of preventable health
conditions. As obesity increases in our population, less individuals will be able to donate
kidneys.
Future research should concentrate on how we can help people who want to donate a kidney
but cannot afford to miss work. Approximately 35% of the potential living donor population
(who do not have medical obstacles to donating) have an adjusted family household income
<$35,000. These individuals often live paycheck to paycheck and cannot afford to miss work
for several weeks to donate a kidney.
• Citation:
• ASN Kidney Week 2014 abstract
• A Population-Based Based Study of the U.S. Population Shows the Majority of Persons
Cannot Donate due to Preventable Diseases and Socio-Economic Conditions
Abstract FR-OR089

Smart Phone Technology May Improve Medication Adherence
MedicalResearch.comInterview with:
Dr. Frederick Kaskel: MD PhD
Chief, Division of Pediatric Nephrology, Department of Pediatrics
Albert Einstein College of Medicine
• MedicalResearch.com: What is the background for this study? What are the main findings?
• Dr. Frederick Kaskel: Non-adherence to medication and medical regimens is a serious and
common problem in adolescents with various kidney disorders, resulting in increasing
morbidity and mortality. Innovative efforts to engage this at risk population to prevent or
lessen the cycle of non-adherence are needed.
• Employing new smart phone technology has resulted in changes in this targeted population’s
awareness of their conditions and need to be adherent to the medical regimen.
• Texting reminders regarding medication alerts may result in a better participation of the
adolescent in his/her health care governance. Long-term studies are needed in order to
assess outcomes.
• Citation:
• 2014 ASN abstract:
• Utilization of Smart Phones and Medication Adherence in Adolescents with Kidney Disorders

How Accurate Are Home Blood Pressure Monitors?
Swapnil Hiremath, MD, MPH
Assistant Professor Nephrologist, The Ottawa Hospital
Faculty of Medicine at University of Ottawa
• Medical Research: What are the main findings of the study?
• Dr. Hiremath: Our study was a retrospective analysis of the data from the Nephrology Nurse
BP assessment clinic at the Ottawa Hospital. Patients from the nephrology clinic were
referred to this clinic not just for validation of their home BP machines, but also for lifestyle
education and teaching the correct technique. We validated the monitors brought in by
patients using a set protocol (including: confirming equal blood pressure in both arms,
measuring BP simultaneously in both arms by an RN using proper technique, taking three
resting readings and averaging them).
• Firstly, there was a statistically significant difference when we compared the average blood
pressure measurement (both systolic and diastolic) values from the home monitor compared
to the mercury monitor.
• Secondly, when we calculated the proportions of home BP machines that were accurate
(using different thresholds of 3 mm, 5 mm and 10 mm Hg difference between home and
mercury monitors) a significant proportion of home monitors were inaccurate. These findings
have important implications – if clinicians are using data from home monitors to make
therapeutic decisions, then some patients may be undertreated – or over treated needlessly.

How Accurate Are Home Blood Pressure Monitors?
Swapnil Hiremath, MD, MPH
Assistant Professor Nephrologist, The Ottawa Hospital
Faculty of Medicine at University of Ottawa
• Medical Research: What was most surprising about the results?
• Dr. Hiremath: Surprisingly, when we analysed the data this year, we found a high proportion of patients
with discrepancies that would be clinically significant between the office blood pressure monitors (we use
mercury sphygmomanometers) compared to the home BP monitors the patients were bringing in. Looking
at the most conservative threshold (a difference of > 10 mm Hg, higher or lower) about 1 in 10 home BP
monitors had readings which would be classified as being inaccurate. This study does come with certain
caveats, namely that since we had not collected any further details about the monitors themselves (eg
year of purchase, model numbers etc) so we cannot comment on the role of these factors.
• Dr. Hiremath: Our suggestion would be that home monitors be validated, ideally by comparing with the
‘gold standard’ i.e. a validated mercury sphygmomanometer, which will need to be done in a doctor’s
office. This will be quite challenging, however, in terms of feasibility and logistics – and from insurers’
perspectives.
• Medical Research: What recommendations do you have for future research as a result of this study?
• Dr. Hiremath: Though we did find a certain proportion of home BP devices to be inaccurate, we do not yet
know the actual reasons for these devices being inaccurate. Eg One could speculate it is wear-and-tear of
devices, and if so, how long does it take for that to happen? Should devices be checked regularly – if so
how often? The real challenge, of course, is also to show that this matters in terms of real patient centred
outcomes. Like any research study, I think we will raise more questions, than answers.
• Citation:
• 2014 Kidney Week abstract:
Are Home Blood Pressure Monitors Accurate Compared to Validated Devices?

Maternal Obesity Increases Congenital Kidney/Urinary Anomalies in Offspring
Ian R. Macumber MD
Pediatric Nephrology, Seattle Children’s Hospital
Seattle, Washington
• Medical Research: What are the main findings of the study?
• Dr. Macumber: The main finding is that there is a strong association between maternal
obesity and odds of congenital anomalies of the kidney and urinary tract (CAKUT) in
offspring. This relationship remains strong when looking at offspring with renal malformation
(excluding non-renal congenital anomalies of the kidney and urinary tract), or in offspring
with isolated congenital anomalies of the kidney and urinary tract (no congenital anomalies
elsewhere in the body). There is a dose-response relationship to this association, with the
offspring of extremely obese mothers have even higher odds of having congenital anomalies
of the kidney and urinary tract.
• Medical Research: What was most surprising about the results?
• Dr. Macumber: There were no significant effect modifiers. The association between
maternal obesity and congenital anomalies of the kidney and urinary tract was not affected
by maternal diabetes status, maternal age or race, maternal smoking status, socioeconomic
status, or paternal age or race.

Maternal Obesity Increases Congenital Kidney/Urinary Anomalies in Offspring
Ian R. Macumber MD
Pediatric Nephrology, Seattle Children’s Hospital
Seattle, Washington
• Dr. Macumber: This research further adds to the public health importance of obesity,
especially as potentially modifiable risk factor.
• Medical Research: What recommendations do you have for future research as a result of
this study?
• Dr. Macumber: Further studies will need to be conducted to discover the mechanism behind
the association between maternal obesity and offspring congenital anomalies of the kidney
and urinary tract.
• Citation:
• ASN 2014 abstract:
• The Association of Maternal Obesity with Infant Congenital Abnormalities of the Kidney and
Urinary Tract in Washington State

Many Dialysis Patients Have Limited Disaster Preparedness
MedicalResearch.comInterview with:AnuWadhwa, M.D.
Assistant Professor of Medicine
Division of Nephrology and Hypertension
Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153
• Medical Research: What is the background for this study?
• Dr. Wadhwa: Patients with end stage renal disease rely on dialysis treatments to survive.
Hence this population is very vulnerable during emergencies or disaster situations. We
believe that patient education on an individual level is the cornerstone of a successful
disaster plan. In this quality improvement study, we assessed disaster preparedness in our
dialysis patients and evaluated multidisciplinary approach to disseminate this information.
Multidisciplinary team of physicians, nurses, dieticians and social workers reviewed
preparedness-relevant topics with the patients. Patients were provided purple cards (created
by KCER) with emergency information to carry with them at all times. A simple yes/no
questionnaire asking disaster preparedness relevant questions was given to the patients
before and after this education was provided. Disaster preparedness was defined as
perceived preparedness (survey question) and a positive response to at least three key
questions-having a plan they have had discussed with a family member or dialysis unit,
knowledge of backup dialysis facility and familiarity with emergency diet plan.

• Medical Research: What are the main findings?
• Dr. Wadhwa: While 60% of the patients thought they were prepared for an emergency
(perceived), based on our defining criteria (listed above): 80% of patients were not prepared
for an emergency. About 50% of them did not have a plan or know about a backup facility.
35% were unaware of an emergency diet plan. 95% of the patients were interested in
learning about emergency preparedness and 99% found the information provided during the
project useful. Using similar criteria for preparedness, follow up survey showed 80% of the
patients felt they were better prepared for a disaster or emergency situation.
• Dr. Wadhwa: Emergency preparedness in dialysis patients was lacking, but they were willing
to learn. This study highlights that a multidisciplinary approach in an outpatient dialysis unit
setting is feasible and effective in educating patients about disaster preparedness.

this study?
• Dr. Wadhwa: Since this is a single center experience, it would be interesting to see the
impact of this education if/when implemented on a wider scale. Another important aspect
will be to identify a reasonable interval/timing (annual/seasonal..) to continue providing this
education.
• Citation:
• 2014 American Society Nephrology (ASN) abstract:
• Dialysis Preparedness in Dialysis Patients via Multidisciplinary Approach

Effect of Second Generation Drug Eluting Stents on Cardiovascular Events
Marco Valgimigli, MD, PhD
Associate Professor of Medicine
Erasmus MC, Thoraxcenter, RotterdamThe Netherlands
• Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to
Bare Metal Stents. We have pooled all available datasets comparing a specific second generation
Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal
Stents and found that cardiac mortality along with all other non-fatal endpoints investigated,
including myocardial infarction or stent thrombosis were reduced after co-Cr EES.
Medical Research: What should clinicians and patients take away from your report?
• Dr. Valgimigli: That Drug-Eluting Stents do not necessarily mean a more thrombogenic device than
Bare Metal Stents.
• Medical Research: What recommendations do you have for future research as a result of this
study?
• Dr. Valgimigli:We should further investigate if Drug-Eluting Stents can tolerate a short or very short
of dual anti-platelet therapy similar to Bare Metal Stents.
• Citation:
• Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal
cardiovascular events: patient level meta-analysis
• BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6427 (Published 05 November 2014) Cite this
as: BMJ 2014;349:g6427
•

Acute Coronary Syndrome: How Do Patients Without Critical Stenosis Do?
Dr. Marc-Alexander Ohlow, MD,
Adjunct Professor of Medicine Cardiology Department
Zentralklinik Bad Berka, Germany
• MedicalResearch.com: What are the main findings of the study?
• Dr. Ohlow: This paper reports the finding of a retrospective study including 4.311 consecutive
patients with suspected acute coronary syndrome (ACS). Out of them 272 patients with acute
onset of chest pain and elevated levels of cardiac necrosis markers did not have significant
(≥50% diameter stenosis) coronary artery stenosis on coronary angiography. Aim of this study
was to provide further information and understanding of the clinical characteristics and
outcome of patients with acute coronary syndrome without critical stenosis, and comparing
those with a consecutive series of patients with ACS requiring percutaneous coronary
intervention (non-ST-elevation myocardial infarction patients).
• Patients presenting without significant coronary stenosis, but with chest pain and elevated
troponin level were younger, had less severe angina symptoms, were more likely to be
women, had lower level of myocardial necrosis markers (troponin and creatine kinase), and
had higher left ventricular ejection fraction compared to patients undergoing angioplasty due
to significant coronary obstruction.

• MedicalResearch.com: Were any of the findings unexpected?
• Dr. Ohlow: The term false-positive has been used to describe the situation in which acute
onset of chest pain is associated with an elevated troponin level, but no significant coronary
disease is found at coronary angiography. As expected, the prognosis of patients with acute
coronary syndrome undergoing angioplasty due to significant coronary artery stenosis is
worse than in patients with troponin-positive chest pain and absence significant obstruction
(hazard ratio 2.44). However, a significant event-rate of 28.8% over a period of 86 months
was found in patients with troponin-positive chest pain and absence significant coronary
obstruction. This translates in an annual event-rate of 4%, which is higher than the 2.4% of a
healthy population of comparable age. Taking this into account, troponin-positive ACS
without relevant coronary artery stenosis does not seem to be a benign condition and may
warrant a more aggressive medical therapy in such patients. Interestingly, higher levels of
cardiac troponin (more than 1.9 ng/ml at admission) are associated with a worse prognosis in
patients with troponin-positive chest pain and absence significant coronary obstruction.

• MedicalResearch.com: What should clinicians and patients take away from your report?
• Dr. Ohlow: Approximately 6% of all patients admitted for acute onset of chest pain and
elevated markers of myocardial necrosis do not show significant (≥50%) coronary stenosis at
angiography. The use of several different clinical variables did not help to differentiate
patients with and without significant coronary stenosis. The composite outcome (cardiac
death, re-infarction and re-hospitalization) of patients undergoing angioplasty due to
coronary artery disease is worse than that of patients without significant coronary stenosis
and inversely related to troponin levels.

• MedicalResearch.com: What recommendations do you have for future research as a result
of this study?
• Dr. Ohlow: As troponin-positive ACS without relevant coronary artery stenosis does not seem
to be a benign condition it would be interesting to evaluate, which type of long term
treatment might be the best option for such patients. Whether a treatment similar to acute
coronary syndrome with relevant coronary artery stenosis (e.g. dual platelet inhibition for 12
months, and statin medication) can significantly reduce adverse events during follow-up
needs to be prospectively investigated in further studies.
• Citation:
• Acute coronary syndrome without critical epicardial coronary disease: prevalence,
characteristics, and outcome
The American Journal of Emergency Medicine
• Marc-Alexander Ohlow, MD, PhD et al
• Published Online: November 08, 2014
• DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.048

Short Term Sugar Sweetened Drinks May Not Be Detrimental To Adolescent Health
Jill Kanaley, PhD
Professor and associate chair
Department of Nutrition and Exercise Physiology University of Missouri
• Abstract: Background: Adolescents consume more sugar-sweetened beverages than do individuals in any
other age group, but it is unknown how the type of sugar-sweetened beverage affects metabolic health in
this population.
• Objective: The objective was to compare the metabolic health effects of short-term (2-wk) consumption of
high-fructose (HF) and high-glucose (HG)–sweetened beverages in adolescents (15–20 y of age).
• Design: In a counterbalanced, single-blind fashion, 40 male and female adolescents completed two 2-wk
trials that included 1) an HF trial in which they consumed 710 mL of a sugar-sweetened beverage/d
(equivalent to 50 g fructose/d and 15 g glucose/d) for 2 wk and 2) an HG trial in which they consumed 710
mL of a sugar-sweetened beverage/d (equivalent to 50 g glucose/d and 15 g fructose/ d) for 2 wk in
addition to their normal ad libitum diet. In addition, the participants maintained similar physical activity
levels during each trial. The day after each trial, insulin sensitivity and resistance [assessed via
Quantitative Insulin Sensitivity Check Index (QUICKI) and homeostatic model assessment of insulin
resistance (HOMA-IR) index] and fasting and postprandial glucose, lactate, lipid, cholesterol, insulin, C-peptide,
insulin secretion, and clearance responses to HF or HG mixed meals were assessed.
• Results: Body weight, QUICKI (whole-body insulin sensitivity), HOMA-IR (hepatic insulin resistance), and
fasting lipids, cholesterol, glucose, lactate, and insulin secretion or clearance were not different between
trials. Fasting HDL- and HDL3-cholesterol concentrations were w10–31% greater (P , 0.05) in female
adolescents than in male adolescents. Postprandial triacylglycerol, HDL-cholesterol, HDL3-cholesterol, and
glucose concentrations were not different between HF and HG trials. The lactate incremental area under
the curve was w3.7-fold greater during the HF trial (P , 0.05), whereas insulin secretion was 19% greater
during the HG trial (P , 0.05).
• Conclusions: Moderate amounts of HF- or HG-sweetened beverages for 2 wk did not have differential
effects on fasting or postprandial cholesterol, triacylglycerol, glucose, or hepatic insulin clearance in
weight-stable, physically active adolescents.

Short Term Sugar Sweetened Drinks May Not Be Detrimental To Adolescent Health
Jill Kanaley, PhD
Professor and associate chair
Department of Nutrition and Exercise Physiology University of Missouri
• Medical Research: What should patients and clinicians take away from this report?
• Dr. Kanaley: Collectively, the data from this study and others (30–33) suggest that fructose or
glucose consumption per se is not detrimental to an adolescent’s health and perhaps factors
other than fructose intake (obesity, physical activity levels) should be modulated to prevent
chronic disease.
• You must also remember this was only for 2 weeks, and we are not encouraging the
consumption of sugar-sweetened beverages because of the empty calories. In addition, we
have done another study in young adults and found that the amount of physical activity is the
key to preventing the deleterious changes.
• Citation:
• D. Heden, Y. Liu, Y.-M. Park, L. M. Nyhoff, N. C. Winn, J. A. Kanaley. Moderate amounts of
fructose- or glucose-sweetened beverages do not differentially alter metabolic health in male
and female adolescents. American Journal of Clinical Nutrition, 2014; 100 (3): 796 DOI:
10.3945/ajcn.113.081232

Oral Sex Can Lead To Oral HPV Infection
MedicalResearch.comInterview with;
Eduardo L. Franco DrPH, FRSC, FCAHS
James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology, Minda de
Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University, Montreal, Quebec,
Canada
• Dr. Franco: Our findings of oral transmission of human papillomavirus (HPV) infection in men
are part of a larger molecular epidemiologic study called ‘HPV Infection and Transmission
among Couples through Heterosexual Activity’ (HITCH) cohort study. The focus of the HITCH
study is to understand how HPV is transmitted within couples via sexual contact and other
behaviors. We measure the presence of this virus using highly-sensitive molecular assays for
HPV DNA in the genital surfaces (vagina and penis), oral cavity, and hands. We also take a
blood sample to look for the presence of antibodies against HPV. We take multiple samples
over a period of two years at pre-scheduled visits. We have previously published results
focused exclusively on genital transmission. The present report is the first in the HITCH study
to look at what happens in terms of characteristics that place male participants to be at risk
of oral HPV infection.
• To our knowledge, this is the first study to show a high risk of oral HPV infection among men
whose female partners had a genital or oral HPV infection, suggesting that transmission may
occur through oral or genital routes. We looked at transmission for 36 individual HPV
genotypes, which improved our ability to study risk determinants. Risk was also significantly
higher among men who had ever smoked, had a high number of lifetime sex partners, or
were in non-monogamous relationships. Our results are largely consistent with previous
studies that have found male sex practices and smoking to be the most significant risk factors
for oral HPV infection.

Oral Sex Can Lead To Oral HPV Infection
MedicalResearch.comInterview with;
Eduardo L. Franco DrPH, FRSC, FCAHS
James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology, Minda de
Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University, Montreal, Quebec,
Canada
• We observed increased prevalence of oral HPV infection among men with a genital HPV-positive partner suggesting oral sex
and possibly deep kissing as modes of transmission to the oral tract. The fact that we examined this association at the HPV
genotype level enhances the credibility that the genital-oral route is truly an efficient form of HPV transmission during sexual
activity. Interestingly, we also found that oral HPV prevalence was higher among men who had a concurrent genital HPV
infection. While auto-inoculation comes to mind to explain these results, we must also consider that that these men
acquired infections at both oral and genital sites from their infected partners. Moreover, increased susceptibility to HPV
infection among some individuals could account for this finding.
• With such strong results (> 100-fold and >20-fold greater risks if female partner had an oral or genital HPV infection,
respectively) for the oral-oral and oro-genital routes it is now clear why condom protection is not as important as we wished
it to be in preventing transmission of HPV infection. This is an important message for clinicians and patients. On the bright
side is the fact that although oral transmission is highly probable via these sexual practices, on average only 7.2% of HITCH
men had an oral HPV infection, which indicates that although HPV is easy to acquire it is also easy for it to be spontaneously
cleared from the oral cavity, perhaps via an immune response. The clinically relevant consequence of HPV infection is a
precancerous lesion and ultimately cancer. Luckily, these are detectable endpoints at an earlier stage and take many years to
develop. There are no clinical guidelines that specify testing exfoliated oral samples for HPV infection , as we did, as part of
best practices in oral healthcare. Clinical examination for flat or verrucous lesions continues to be the main focus of clinical
examination for oral HPV infection. Counselling may also be helpful, keeping in mind the negative psychological
consequences for the couple if the clinical importance of HPV infection is overplayed.
• Vaccination against the main types of HPV that cause cancer or benign warty lesions is already available in most countries.
HITCH couples were beyond the reach of the successful school-based vaccination that is ongoing in Canada. HPV vaccination
is expected to substantially decrease risk of HPV infection by the vaccine-targeted types.
• Citation:
• Sexual Transmission of Oral Human Papillomavirus Infection among Men
• Kristina R. Dahlstrom, Ann N. Burchell, Agnihotram V. Ramanakumar, Allita Rodrigues, Pierre-Paul Tellier, James Hanley,
François Coutlée, and Eduardo L. Franco
• Cancer Epidemiol Biomarkers Prev Published OnlineFirst November 12, 2014; doi:10.1158/1055-9965.EPI-14-0386

Long Term ACEIs May Reduce Risk of ALS
MedicalResearch.comInterview with: Charles Tzu Chi Lee, PhD
Associate Prof., Department of Public Health
Kaohsiung Medical University, Kaohsiung, Taiwan
Sanmin District, Kaohsiung City Taiwan
• Dr. Lee: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease and most
patients die within three to five years after symptoms appear. Studies have suggested angiotensin-converting
enzyme inhibitors (ACEIs) may decrease the risk for developing neurodegenerative
diseases. But there was still no human study discussing ACEIs use and ALS risk in literature. The
study results indicate that when compared with patients who did not use ACEIs, the risk reduction
was 17 percent (adjusted odds ratio of 0.83) for the group prescribed ACEIs lower than 449.5
cumulative defined daily dose (cDDD) and 57 percent (adjusted odds ratio 0.43) for the group
prescribed ACEIs greater than 449.5 cDDD.
• Dr. Lee: The findings in this total population-based case-control study revealed that long-term
exposure to ACEIs was inversely associated with the risk for developing ALS.
study?
• Dr. Lee: This was an observational population-based study, and hence, more animal and clinical
studies are required to assess the possibility of using ACEIs for treating ALS.
• Citation:
• Lin F, Tsai C, Kuang-Wu Lee J, Wu M, Tzu-Chi Lee C. Angiotensin-Converting Enzyme Inhibitors and
Amyotrophic Lateral Sclerosis Risk: A Total Population–Based Case-Control Study. JAMA Neurol.
Published online November 10, 2014. doi:10.1001/jamaneurol.2014.3367.
•

Risk of Ebola Transmission By Airline Passengers Remains
Professor Tom Solomon, FRCP PhD
Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections
Director, Institute of Infection and Global Health, University of Liverpool
• Dr. Solomon: Since the Ebola outbreak began there has been concern about transmission to new
countries by airline passengers who were infected, but didn’t know it. This was underscored by
such transmission to Nigeria, and to USA. Screening for symptoms of Ebola virus disease in airline
passengers whose journeys originated from the three most affected countries—Guinea, Liberia,
and Sierra Leone—has recently been introduced at some airports.
• We examined the current growth rate of the epidemic in West Africa, and airline travel patterns to
predict how many people with Ebola are likely to attempt to fly. Our research showed that we can
expect approximately 29 infected passengers to try and leave West Africa by the end of the year.
Based on the incubation period of the virus, and looking at how long people have symptoms before
they are hospitalised, we estimated ten of these people with Ebola would have symptoms of the
disease as they leave the affected countries, and so would be detected by exit screening. Of the
remaining 19, one to two would be expected to fly to the UK, and up to three to the USA, based on
current airline passenger data. At most one of these passengers would have developed symptoms
by the time they arrive in the UK or USA, and thus would be detected by entry screening
• Dr. Solomon: The risk of Ebola transmission by airline passengers remains, even though exit and
entry screening reduce it. Therefore clinicians need to remain vigilant about febrile illness in those
returning from West Africa.. However it is important to remember that the only people who get
sick from Ebola are those who are caring for ill patients with Ebola. And in the Uk we have robust
systems to care for any such patients without putting others at risk. So even if we do have a case in
the UK, we won’t develop a situation like in West Africa

Risk of Ebola Transmission By Airline Passengers Remains
Professor Tom Solomon, FRCP PhD
Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections
Director, Institute of Infection and Global Health, University of Liverpool
this study?
• Dr. Solomon: We predicted that America was at greatest risk of importing Ebola some weeks
before it actually happened. So it will be interesting to see whether out predictions about the
effects of screening are true. The most important means of controlling the global threat of
Ebola is to get it under control in West Africa.
• Citation:
• Effectiveness of screening for Ebola at airports
• Jonathan M Read,Peter J Diggle,James Chirombo,Tom Solomon,Matthew Baylis
The Lancet – 13 November 2014
DOI: 10.1016/S0140-6736(14)61894-8
• Got 5 minutes? My TEDx Talk “Sex Drugs & Emerging Viruses” is at
https://www.youtube.com/watch?v=tySFXZ-ABZA

Non-Infarct Related Coronary Artery Disease Common in Acute Myocardial Infarction
MedicalResearch.comInterview with: Manesh Patel, MD
Associate Professor of Medicine
Director Interventional Cardiology and Catheterization Labs
Duke University Health System
Duke Clinical Research Institute
• Dr. Patel: In clinical practice, patients with acute myocardial infarction are found to have non-IRA
disease of varying significant and location. The current recommendations are to have patients
recover from the acute myocardial infarction and get non-invasive testing to determine
revascualrization after 4-6 six weeks in uncomplicated patients. These data demonstrate that non-
IRA disease is common (>50% of STEMI patients) and that these patients have an elevated 30-day
mortality.
• Dr. Patel: The data in this area are evolving but generally speaking for patients with multi vessel
disease post STEMI reperfussion, there should be careful follow up and consideration for more
immediate revascularization strategies.
study?
• Dr. Patel: We need large RCTs in patients with STEMI and Non-IRA disease with conservative
medical therapy versus revascularization during the index hospitalization.
• JAMA
• Extent, Location, and Clinical Significance of Non–Infarct-Related Coronary Artery Disease Among
Patients With ST-Elevation Myocardial Infarction
• In addition to Patel, study authors include Duk-Woo Park; Robert M. Clare; Phillip J. Schulte; Karen
S. Pieper; Linda K. Shaw; Robert M. Califf; E. Magnus Ohman; Frans Van de Werf; Sameer Hirji;
Robert A. Harrington; Paul W. Armstrong; Christopher B. Granger; and Myung-Ho Jeong.

MedicalResearch.com Interview with: Matthew L. Springer, Ph.D.
Associate Professor of Medicine Division of Cardiology
Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research
Center for Tobacco Control Research & Education
• Dr. Springer: The general public is aware that cigarette secondhand smoke is harmful. However, many
people who actively avoid tobacco secondhand smoke don’t feel the need to avoid marijuana secondhand
smoke; they don’t consider it harmful because there’s no nicotine and because we who tell them to avoid
tobacco smoke don’t tell them to avoid marijuana smoke. However, secondhand smoke from tobacco and
marijuana is very similar in chemical composition (4000-7000 chemicals depending on whom you ask),
aside from the nicotine and the THC (the psychoactive drug in marijuana).
• We and others have shown that brief exposure to tobacco secondhand smoke, such as 30 minutes, at real-world
levels impairs vascular function in humans. We developed a way to study vascular function
(measured as arterial flow-mediated dilation; FMD) in living rats, and recently published that even one
minute of sidestream smoke from the burning tips of tobacco cigarettes, a well-accepted model for
secondhand smoke, is enough to start detecting impairment of FMD. The main findings of the current
study are that in laboratory rats, FMD was substantially impaired by a 30 minute exposure to marijuana
secondhand smoke, when measured 10 minutes after the end of exposure. Impairment was comparable
to that resulting from exposure to tobacco sidestream smoke, although whereas impairment from tobacco
smoke was temporary and had normalized by 40 minutes later, FMD was still impaired 40 minutes after
the end of exposure to marijuana smoke. Smoke from marijuana lacking THC still impaired FMD, showing
that is not required for this effect. Similarly, the impairment of FMD by marijuana secondhand smoke
confirms that nicotine is not required for smoke to cause this effect.
• A limitation is that we tested at levels that approximated real-world tobacco secondhand smoke
conditions (due to lack of information about ambient levels of marijuana secondhand smoke in social
situations). However, these results support the concept that “smoke is smoke,” and it is notable that we
have already published that even one minute of exposure to tobacco smoke at those levels leads to
detectable impairment of FMD.

MedicalResearch.com Interview with: Matthew L. Springer, Ph.D.
Associate Professor of Medicine Division of Cardiology
Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research
Center for Tobacco Control Research & Education
• Dr. Springer: The impact on clinicians is that they should be aware that at least some
deleterious cardiovascular effects of tobacco secondhand smoke exposure are caused by
marijuana secondhand smoke as well, so physicians should consider advising their patients to
avoid exposure to any smoke, regardless of whether the source is tobacco or marijuana.
• Additional impact for individuals is that they should be aware that exposure to marijuana
secondhand smoke may be as harmful to their vascular health as exposure to tobacco
secondhand smoke, and that especially as marijuana is increasingly legalized, regulations that
protect the public from secondhand smoke exposure should be written broadly enough to
include marijuana secondhand smoke.
• Bottom line: public exposure to secondhand smoke should be avoided whether the source is
tobacco or marijuana.
• Citation:
• AHA14 abstract:
• Secondhand marijuana smoke may damage blood vessels as much as tobacco smoke

Drug Researched To Help Curb Binge Eating
MedicalResearch.comInterview with: Pietro Cottone, Ph.D.
Associate Professor
Departments of Pharmacology and Psychiatry Laboratory of Addictive Disorders
Boston University School of Medicine Boston, MA 02118
• Dr. Cottone: Binge-eating disorder affects over ten million people in the USA and it is characterized
by excessive consumption of junk food within brief periods of time, accompanied by loss of control,
uncomfortable fullness and intense feelings of disgust and embarrassment. Increasing evidence
suggests that binge-eating disorder can be regarded as an addiction behavior.
• Memantine, a neuroprotective drug which blocks the glutamatergic system in the brain, is an
Alzheimer’s disease medication, and it has been shown potential to treat a variety of addictive
disorders.
• We first developed a rodent model of binge eating by providing a sugary, chocolate diet only for
one hour a day, while the control group was given the standard laboratory diet. Rats exposed to the
sugary diet rapidly develop binge eating behavior, observed as a 4 fold increase in food intake
compared to controls. Furthermore, binge eating rats are willing to work to a much greater extent
to obtain just the cue associated with the sugary food (not the actual food), as compared to
controls. In addition, binge eating subjects exhibit compulsive behavior by putting themselves in a
potentially risky situation in order to get to the sugary food, while the control group obviously
avoids that risk.
• We then tested whether administering memantine could reduce binge eating of the sugary diet,
the strength of cues associated with junk food as well as the compulsiveness associated with binge
eating. In addition, we studied which area of the brain was mediating the effects of memantine, by
injecting the drug directly into the brain of binge eating rats.

Associate Professor
• Our data show that memantine was able to block binge eating of the sugary diet, the
willingness to work to obtain a cue associated with junk food, as well as the risky behavior of
rats when the sugary diet was provided in a potentially unsafe environment. When we
injected the drug directly into the nucleus accumbens of rats, they stopped binge eating.
Importantly, the drug had no effects in control rats eating a standard laboratory diet.
• Dr. Cottone: There are no recommendations for clinicians and patients at this point. As all
preclinical studies, also this one requires caution.
• A previous open-label trial performed by Dr. Hudson and his group at McLean Hospital
demonstrated that memantine could successfully reduce the frequency of binge eating
episodes, the severity of the illness and the disinhibition in a relatively small sample of binge-eating
subjects. Clearly, we need more evidence.

Associate Professor
this study?
• Dr. Cottone: Our results are very encouraging and should be an incentive to open new clinical
trials in larger human subject samples. In addition, we need deeper investigations of the
neurobiological mechanisms which underlie the effects of memantine on binge eating.
• Citation:
• The Uncompetitive N-methyl-D-Aspartate Antagonist Memantine Reduces Binge-Like
Eating, Food-Seeking Behavior and Compulsive Eating: Role of the Nucleus Accumbens
Shell
Karen L Smith1, Rahul R Rao1, Clara Velázquez-Sánchez1, Marta Valenza1, Chiara Giuliano2,
Barry J Everitt2, Valentina Sabino1 and Pietro Cottone
Neuropsychopharmacology accepted article preview 10 November 2014; doi:
10.1038/npp.2014.299

Early PCI Valuable for Out-of-Hospital Cardiac Arrest
Dr Guillaume Geri, MD
Medical Intensive Care Unit
Cochin Hospital Paris, France
• Medical Research: What is the background of the study? What are the main findings?
• Dr. Geri: Culprit coronary artery occlusion is the main cause of out-of-hospital cardiac arrest.
This has been well demonstrated since pioneer study of Spaulding et al in the New England
Journal of Medicine in 1997. Several studies highlighted the favorable prognostic impact of
an immediate successful PCI in cardiac arrest patients but inclusion biases or the lack of data
on in-hospital management limit the generalization of such findings.
• In this large French cohort of out-of-hospital cardiac arrest patients who were admitted after
successful return of spontaneous circulation from 2000 to 2012, those who received
immediate PCI had better short- and long-term survival than those who did not undergo the
procedure, new data presented here concluded.
• The researchers examined the association between immediate PCI and survival at 30 days, 2
years and 10 years, and evaluated other potential predicting factors. Furthermore, they used
a propensity score method to analyze the impact of PCI on 30-day and long-term survival in
matched patients.
• Overall, 1,722 patients (71.5% male; median age, 59.9 years) were analyzed during a median
2 year follow-up. OHCA (out-of-hospital cardiac arrest ) was witnessed in 86.7% of patients,
and occurred in a public space in 32.2% of patients and with an initial shockable rhythm (eg,
ventricular fibrillation/ventricular tachycardia) in 54.6% of cases.

Early PCI Valuable for Out-of-Hospital Cardiac Arrest
Dr Guillaume Geri, MD
Medical Intensive Care Unit
Cochin Hospital Paris, France
• Therapeutic hypothermia was utilized in 71% of patients whereas immediate PCI was
performed in 27.8% of patients.
• At 30 days, survival was higher in the immediate PCI group compared with those who did not
undergo the procedure (43% vs. 27.5%), which remained consistent at 2 years (40.1% vs.
23.4%) and 10 years (38% vs. 20.2%). Immediate PCI also yielded better survival at 30 days
(adjusted OR=0.71; P=.02) and during the long term (adjusted HR=0.44; P<.01).
• Similarly, among the propensity score matched cohort, long-term survival was better in the
PCI arm (adjusted HR=0.29; 95% CI, 0.14-0.61).
• Medical Research: What is the take home message?
• Dr. Geri: Early coronary angiography and PCI if required should be considered in all non-trauma
out of hospital cardiac arrest patients without an obvious extra- cardiac cause.
• Citation:
• American Heart Association 2014 abstract:
• Early PCI Is Associated with Short- and Long-Term Outcome After Out-of-Hospital Cardiac
Arrest

Heart Attack Treated With PCI: Who Gets Acute Kidney Injury?
Dr. Yacov Shacham MD
Department of Cardiology Tel-Aviv SouraskyMedical Center,
Affiliated to the Sackler Faculty of Medicine
Tel-Aviv University, Tel-Aviv, Israel.
• Dr. Shacham: Acute kidney injury (AKI) is a common complication among ST elevation
(STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and it is
associated with poor long-term clinical outcomes. No studies have yet evaluated the
association between cardiac function and the risk of AKI in this patient population. We
conducted a retrospective study of consecutive STEMI patients who underwent primary PCI
and had a full echocardiography study performed within 72 hours of hospital admission. We
evaluated the relation between systolic and diastolic parameters and AKI. We demonstrated
that the occurrence of AKI following primary PCI was associated with worse left ventricular
systolic and diastolic function, however only left ventricular EF emerged as an independent
predictor of AKI.
• For every 1% reduction in EF, the risk of AKI increased (OR 1.1, 95% CI 0.86-0.96; p=0.001)

Heart Attack Treated With PCI: Who Gets Acute Kidney Injury?
Dr. Yacov Shacham MD
Department of Cardiology Tel-Aviv SouraskyMedical Center,
Affiliated to the Sackler Faculty of Medicine
Tel-Aviv University, Tel-Aviv, Israel.
• Dr. Shacham: Among the 8 risk factors of the current, most widely applied score, published by
Mehran et al to estimate the risk of CIN, 3 (hypotension, congestive heart failure, and intra-aortic
balloon pump) are directly related to cardiac pump function, as was also demonstrated in a
previous report by our group. It seem thus, that every effort should be made in order to decrease
time to reperfusion, as the early preservation of left ventricular function may also prevent AKI
complicating the course of STEMI.
• Medical Research:What recommendations do you have for future research as a result of this
study?
• Dr. Shacham: Worsening of renal function among STEMI patients undergoing PCI appears to be a
frequent finding, resulting in a more complicated in hospital course and worse long term outcomes.
Effort should be made trying to find other predictors for this complication, which will allow the
early identification of those at risk, and enable both the use of prophylactic measures and frequent
monitoring of renal function in that patient population.
• Citation:
• Association of Left Ventricular Function and Acute Kidney Injury among ST Elevation Myocardial
Infarction Patients Treated by Primary Percutaneous Intervention
• Shacham, Yacov et al. American Journal of Cardiology
Published Online: November 13, 2014
DOI: http://dx.doi.org/10.1016/j.amjcard.2014.11.002

Mechanical Chest Compressions Did Not Enhance CPR Outcomes
Prof Gavin D. Perkins MD
Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research;
Warwick Medical School and Heart of England NHS Foundation Trust
• Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital
cardiac arrests and less than one in twelve of those returns home alive. Early high quality
Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to
survival. However maintaining high quality chest compressions during resuscitation is difficult
for crews of emergency vehicles, especially if they are on their own, because of fatigue and
the need to perform other actions. Chest compression is particularly difficult in moving
vehicles.
• A number of mechanical devices, suitable for out of hospital use, have been developed over
the years to improve the quality of chest compressions and therefore attempt to improve
patient outcomes. Some NHS organisations decided to purchase devices to use although
there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS
would cost tens of millions of pounds plus costs for on-going training and maintenance. This
prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the
purchase of further mechanical chest compression devices until further research had been
carried out.
• The aim of this trial was to compare the effects of the mechanical chest compressions
(LUCAS-2) device versus standard manual chest compressions (crew using their hands) on
survival.

• Prof. Perkins: The research team found that there was no difference in 30-day survival
between the two types of chest compression; 6.3% of LUCAS-2 patients survived while 6.9%
of manual CPR patients survived. Resuscitation by NHS paramedics delivering manual CPR
was shown to be as effective as resuscitation utilising LUCAS-2 to deliver chest compressions.
A number of important secondary findings were also reported. The results indicate that use
of LUCAS-2 did not improve the percentage of patients:
• · who had return of spontaneous circulation (ROSC) at any point (31.6% LUCAS-2 vs. 31.4%
manual);
· who sustained ROSC to hospital (22.8% LUCAS-2 vs. 23.3% manual);
· with favourable neurologic outcome (4.7% LUCAS-2 vs. 6.0% manual).
• The trial is the largest UK trial conducted in out of hospital cardiac arrest and the largest
randomised trial undertaken of a mechanical chest compression device. The successful
completion of the trial is testament to the great effort and support provided by all
participating ambulance staff. It is a landmark trial in confirming the important role NHS
Ambulance services play in conducting high quality research that is relevant to everyday NHS
and international practice.

Prof. Perkins: The PaRAMeDiC trial confirms manual CPR by NHS Paramedics is as good as LUCAS-2
CPR and emphasises the importance of focusing on the provision of high quality chest
compressions. Increasing bystander CPR, improving access to public access defibrillation and
reducing ambulance response times to cardiac arrest victims remain the key to improving outcomes
for cardiac arrest victims.
study?
• The role of mechanical CPR during in-hospital cardiac arrest.
The role of mechanical CPR as part of a strategy to facilitate rescue percutaneous coronary
intervention during cardiac arrest.
• Citation:
• Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a
pragmatic, cluster randomised controlled trial
Prof Gavin D Perkins MD,Ranjit Lall PhD,Prof Tom Quinn M Phil,Prof Charles D Deakin MD,Prof
Matthew W Cooke PhD,Jessica Horton MSc,Prof Sarah E Lamb DPhil,Anne-Marie Slowther
DPhil,Prof Malcolm Woollard MPH,Andy Carson FRCGP,Mike Smyth MSc,Richard Whitfield
BSc,Amanda Williams MA,Helen Pocock MSc,John J M Black FCEM,John Wright FCEM,Kyee Han
FCEM,Prof Simon Gates PhD,PARAMEDIC trial collaborators
The Lancet – 16 November 2014
DOI: 10.1016/S0140-6736(14)61886-9

Atrial Fibrillation: Over/Under Anticoagulation Increases Risk of Dementia
Dr. T. Jared Bunch, M.D
Medical Director for Heart Rhythm Services
Intermountain Healthcare network.
• Dr. Bunch: Approximately 5 years ago we found that atrial fibrillation was associated with all
forms of dementia, including Alzheimer’s disease. At that time we did not know the
mechanisms behind the association. One hypothesis that we had was brain injury in patients
with atrial fibrillation is in a spectrum, large injuries result in strokes and repetitive small
injuries result in dementia. In this regard, we anticipated that anticoagulation effectiveness
and use may impact dementia risk. Early this year we published in HeartRhythm Journal that
atrial fibrillation patients with no history of dementia that have used warfarin, but had high
percent times outside of the therapeutic range were much more likely to develop
dementia. We gained some insight from this trial in that we saw much higher risks of the
patients were either over or under anticoagulated.
• Amongst our atrial fibrillation patients using warfarin nearly one third are also taking aspirin,
typically due to the presence of coronary artery disease or a prior myocardial infarction. We
hypothesized since these patients were using two agents that increase risk of bleed that over
anticoagulation with warfarin may be an even great risk for dementia. This is was we
found. The patients over anticoagulated greater than 30 percent of the time were nearly 2
and a half times more likely to develop dementia compared to those that were over
anticoagulated less that 10 percent to the time.

Atrial Fibrillation: Over/Under Anticoagulation Increases Risk of Dementia
Dr. T. Jared Bunch, M.D
Medical Director for Heart Rhythm Services
Intermountain Healthcare network.
• Dr. Bunch:
• First, some people use aspirin believing it is heart healthy. In these patients it should be
stopped and only used in patients that have a clear need, such as preventing a second heart
attack.
• Second, in patients that require both agents, physicians need to be extra careful to educate
and monitor them to minimize the time they spend over anticoagulated.
• Finally, in those patients that consistently have marked variation in their warfarin levels,
physicians should consider an alternative approach, although these have not been proven to
reduce dementia. However we have reason to hope the newer blood thinners will reduce
dementia since they reduce strokes and large brain bleeds compared to warfarin.
this study?
• Dr. Bunch: We clearly need to study the new agents and their impact on cognition and
dementia. We also need to look at other risk characteristics of bleeding risks in addition to
aspirin that are very common and often progressive in atrial fibrillation patients such as
kidney dysfunction.
• Citation: AHA14 abstract
• Long-term overtreatment with anti-clotting/antiplatelet drug combo may raise risk of
dementia

“Time-Outs” To Assess Antibiotics Reduce Both Antibiotics Use and Costs
MedicalResearch.com Interview with: Todd Lee MD MPH FRCPC
Consultant in Internal Medicine and Infectious Diseases Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit, McGill University Health Centre
• Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in
terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance,
and increased health care costs. Antimicrobial stewardship is a set of processes which are
employed to improve antibiotic use. Through various techniques, stewardship seeks to ensure the
patient receives the right drug, at the right dose, by the right route, for the right duration of
therapy. Sometimes this means that no antibiotics should be given.
• In implementing antimicrobial stewardship programs, some of the major challenges larger health
care centers face include limitations in the availability of trained human resources to perform
stewardship interventions and the costs of purchasing or developing information technology
solutions.
• Faced with these same challenges, we hypothesized that for one major area of our hospital, our
medical clinical teaching units, we could use our existing resources, namely resident and attending
physicians, to perform “antimicrobial self-stewardship”. This concept tied the CDCs concept of
antibiotic “time outs” (periodic reassessments of antibiotics) to a twice weekly audit using a locally
developed checklist. These audits were performed by our senior resident physicians in the context
of providing their routine clinical care. We also provided local antibiotic guidelines and regular
educational sessions once a rotation.
• We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the
four major classes of antibiotics we targeted as high priority. We estimated we saved between
$140 and $640 in antibiotic expenses per hour of clinician time invested.
• Anecdotally, trainees felt the process to be highly valuable and believed they better understood the
antibiotic use for their patients.

• Dr. Lee: The CDC had previously proposed that clinicians take an antibiotic “time-out” to re-evaluate
antibiotics in their patients. Through building a structured review of all patients on
antibiotics we supported and formalized this process allowing us to achieve reductions in
specific antibiotic use and costs. This was done without the need to engage external human
resources or purchase new information technology solutions.

this study?
• Dr. Lee: Since this study was done on a clinical teaching unit, the long term benefits on
prescribing behavior for our resident physicians and students, if any, will need to be
evaluated.
• Subsequent next steps would be to refine and improve the checklist tool and to demonstrate
that this type of approach could work in other centers and other care settings. Furthermore
we need to evaluate the durability of this type of intervention.
• Citation:
• Antibiotics Self-stewardship: Trainee-led Structured Antibiotics Time-Outs to Improve
Antimicrobial Use
• Lee TC, Frenette C, Jayaraman D, Green L, Pilote L. Antibiotic Self-stewardship: Trainee-Led
Structured Antibiotic Time-outs to Improve Antimicrobial Use. Ann Intern Med.
2014;161:S53-S58. doi:10.7326/M13-3016

More Fast Food Outlets, More Diabetes?
Dr. Patrice Carter
Diabetes, Nutrition & Lifestyle Research Associate
Diabetes Research Centre (Broadleaf) University of Leicester Leicester General Hospital Leicester UK
• Dr. Carter: Type 2 diabetes is a growing concern, worldwide prevalence is expected to
increase to 552million by 2030. Prevalence is closely linked to increasing obesity rates which
are associated to environmental changes that have led to more sedentary lifestyles and poor-quality
dietary intake. Consumption of fast food has previously been linked to the obesity
epidemic and consumption is associated with low adherence to dietary recommendations.
• We analysed data of over 10,000 individuals to investigate the association between screen
detected type 2 diabetes and the number of fast food outlets in their neighbourhood.
• In summary we found the mean number of fast food outlets in areas with high social
deprivation as compared to low social deprivation; mean number of outlets was 3.53 (SD
4.83) and 0.91 (1.89) respectively. The number of fast food outlets was positively associated
with screen-detected type 2 diabetes (OR=1.05; 95% CI 1.04, 1.07; p<0.001). In addition, we
used these data to calculate that for every additional two outlets we would expect to see one
more diabetes case, assuming a 7% prevalence of undiagnosed type 2 diabetes in
neighbourhoods with no outlets and approximately 200 residents in a 500m radius, and
assuming a causal relationship.

More Fast Food Outlets, More Diabetes?
Dr. Patrice Carter
Diabetes, Nutrition & Lifestyle Research Associate
Diabetes Research Centre (Broadleaf) University of Leicester Leicester General Hospital Leicester UK
• Dr. Carter: This study shows how University of Leicester Inter-Departmental Collaboration is leading
to world class research. The geographical analysis of the type 2 diabetes screening data and the
locations of fast food outlets generated a more informative analysis than previous studies and has
had an enormous national and international interest.
• The results have important public health implications for the prevention of diabetes and for those
granting permission for new fast food establishments.
• Clinicians should be aware of the observed association between fast food, obesity and type 2
diabetes, understanding that fast food is high in total fat, trans-fatty acids, salt and can provide over
1000kcal in one meal.
study?
• Dr. Carter: Future research is needed to establish a causal relationship between the number of fast
food outlets and both obesity and type 2 diabetes. In addition it is important to differentiate
between types of fast food, and include convenience stores in the search. Interventions exploring
reducing the number of fast food outlets in a neighbourhood should also be explored.
• Citation:
• Is the number of fast-food outlets in the neighbourhood related to screen-detected type 2 diabetes
mellitus and associated risk factors?
• Bodicoat DH1, Carter P1, Comber A2, Edwardson C1, Gray LJ3, Hill S1, Webb D1, Yates T1, Davies MJ1,
Khunti K1.
Public Health Nutr. 2014 Oct 31:1-8. [Epub ahead of print]

Heart Failure Costs To Increase Due To Aging Population and Improved Medical Therapies
Boback Ziaeian MD
Cardiology Fellow, UCLA Division of Cardiology
PhD Candidate, UCLA Fielding School of Public Health
• Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to
an aging population improved medical therapies that prolong heart failure survival. Spending
for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in
2030. Despite the magnitude of the impact of heart failure on the US population and
economy, our understanding of the factors associated with the highest cost heart failure
hospitalizations is limited.
• Our study provides a descriptive analysis of how certain patient and hospital factors are
associated with increased medical costs nationally. The top 20% of heart failure
hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%.
Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral
vascular disease) have much higher costs associated with hospital care. As expected, sicker
patients receiving more invasive procedures such mechanical ventilation or blood
transfusions incurred higher costs. Certain hospital characteristics were also associated with
higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals.
Hospitals in the Northeast and West Coast of the US were higher in cost compared to the
Midwest and South. The reasons for this disparity in medical costs requires further research
to better understand.

Heart Failure Costs To Increase Due To Aging Population and Improved Medical Therapies
Boback Ziaeian MD
Cardiology Fellow, UCLA Division of Cardiology
PhD Candidate, UCLA Fielding School of Public Health
• Dr. Ziaeian: We know that heart failure is a costly condition and the best way to improve
health and reduce costs is to proactively prevent hospitalizations from the beginning. For
physicians, our paper provides a set of risk factors associated with patients at risk for
prolonged and complicated hospitalizations. These patients may require closer attention in
clinic to mitigate the risk of hospitalization.
this study?
• Dr. Ziaeian: More research is needed to understand variations in heart failure outcomes,
quality of care, and expenditures between health systems. In researching these issues,
controlling for the disease burden and socioeconomic condition of the population serviced by
each health system remains the largest challenge.
• Citation:
• Factors Associated With Variations in Hospital Expenditures for Acute Heart Failure in the
United States
• Boback Ziaeian, MD, Puza P. Sharma, MBBS, MPH, PhD, Tzy-Chyi Yu, MHA PhD, Katherine
Waltman Johnson, Pharm, Gregg C. Fonarow, MD
• American Heart Journal Published Online: November 14, 2014
• DOI: http://dx.doi.org/10.1016/j.ahj.2014.11.007

Elderly: Who Should and Shouldn’t Take Statins?
Dr. Mike Miedema MD, MPH
Minneapolis Heart Institute
• Dr. Miedema: ” Released in November 2013, the ACC/AHA guidelines for the treatment of
blood cholesterol attempt to target individuals that are most likely to benefit from
cholesterol-lowering statin therapy. These guidelines are a significant change from prior
guidelines that relied heavily on levels of bad cholesterol to determine who to treat. Instead,
the new guidelines recommend focusing statin therapy on the individuals that are at the
highest risk for heart attack and stroke, even if their cholesterol levels are within normal
limits. In addition to recommending statin therapy for individuals with known cardiovascular
disease, diabetes, or markedly elevated cholesterol levels, they also recommend statin
therapy for individuals without these conditions but with an elevated estimated risk of a
heart attack or stroke in the next 10-year based on a risk calculator that factors in an
individual’s age, gender, race, and risk factors. Patients with an estimated 10-year risk > 7.5%
are recommended to consider statin therapy. While I believe the scientific evidence supports
this “risk-based” approach, one potential concern is that the risk-calculator relies heavily on
age to determine an individual’s risk, so we wanted to examine the implications for these
guidelines in an older sample of adults.”

Elderly: Who Should and Shouldn’t Take Statins?
Dr. Mike Miedema MD, MPH
Minneapolis Heart Institute
• Medical Research: What should clinicians and patients take away from this report?
• Dr. Miedema: ” We studied 6,088 black and white adults age 66 to 90 in the Atherosclerosis Risk in
Communities (ARIC) Study, a longitudinal study of cardiovascular disease sponsored by the National
Heart, Lung, and Blood Institute that has been following participants for ~25 years. The ARIC cohort
was reassessed in 2013 and the study analyzed the volume of statin-eligible participants based on
the previous Adult Treatment Panel (ATP) III cholesterol guidelines compared to the newer
ACC/AHA guidelines. Based on the prior ATP III guidelines, we found that just over 70% of the ARIC
participants were eligible for statin therapy. In contrast, 97 percent were statin eligible by ACC/AHA
criteria. For men 66-75 years old, the qualification rate was 100 percent. While half of the cohort
was older than age 75, the ACC/AHA guidelines do not provide a recommendation for or against
statin therapy. We don’t have great data on the efficacy of statin medications in the elderly so the
guidelines drew a cut-off for the recommendations at age 75. This is understandable but it kind of
leaves clinicians in the dark as to what to do with healthy elderly patients, who are often at high
risk for heart attacks and strokes.”
• Medical Research: What future research do you recommend as a result of this study:
• Dr. Miedema: “We clearly need more research looking at the best way to determine who should
and should not take a statin as well as the risks and benefits of statin therapy in elderly patients.
• Citation:
• Miedema MD, Lopez FL, Blaha MJ, et al. Eligibility for Statin Therapy According to New Cholesterol
Guidelines and Prevalent Use of Medication to Lower Lipid Levels in an Older US Cohort: The
Atherosclerosis Risk in Communities Study Cohort. JAMA Intern Med. Published online November
17, 2014. doi:10.1001/jamainternmed.2014.6288.
•

Improved School Nutrition Standards May Lower Adolescent Obesity
Yvonne M. Terry-McElrath, MSA
Research Associate, Survey Research Center, Institute of Social Research
University of Michigan Tobacco Research Center
• Dr. Terry-McElrath: The United States Department of Agriculture (USDA) recently improved
nutrition standards for federally-reimbursable school lunch and breakfast programs. Most lunch
standards were implemented at the beginning of the 2012-13 school year and changes in breakfast
began with the 2013-14 school year. Beginning in 2014, schools participating in federally-reimbursable
meal programs were also required to improve nutrition standards for foods and
beverages sold in vending machines, stores/snack bars/carts, and à la carte cafeteria lines. The new
standards limit fats, sodium, sugar, and calories; and will eventually remove candy; regular-fat salty
snacks/sugary treats; higher-fat milks; high-fat, high-calorie savory foods; and sugar-sweetened
beverages, like regular soda, fruit drinks and high calorie sports drinks. They were developed in
response to rising overweight/obesity among US children and adolescents.
• This study uses five years of data from nationally-representative samples of middle and high school
students—and their school administrators—to examine three research questions: What percentage
of US secondary students attended schools in 2008-2012 where foods and beverages met at least
some of the USDA standards that were to begin phased implementation starting in 2012-13? Is
there evidence that those standards were associated with student overweight/obesity? Is there
evidence of the effect of those standards on racial/ethnic minorities and students from lower
income families? Using data from schools even before the new USDA standards went into effect can
indicate potential effect of the standards once they have been in effect for several years. The
research was conducted through two studies: The Monitoring the Future study, supported by a
grant from the National Institute on Drug Abuse, and the Youth, Education and Society study, part
of a larger research initiative funded by the Robert Wood Johnson Foundation, titled “Bridging the
Gap: Research Informing Policy and Practice for Healthy Youth Behavior.”

• Study findings show that from 2008-2012, few middle or high school students attended
schools where food and beverage standards would be judged to meet at least some of the
USDA school nutrition standards that began to be implemented in 2012-13. Significant
increases in the number of standards over time were seen for middle but not high school
students. Among high school students, having fruits and vegetables available wherever foods
were sold, the absence of higher-fat milks, and increasing the number of positive nutrition
standards were associated with significantly lower odds of overweight/obesity. Not having
sugar-sweetened beverages was associated with lower overweight/obesity for middle and
high school minority students.
• Dr. Terry-McElrath: The USDA school meal and competitive venue standards – if
implemented fully and monitored for compliance – have the potential to significantly
improve the current U.S. school nutritional environment. Such improvements may then lead
to improved student nutritional intake and lowered risk for overweight and obesity.

this study?
• Dr. Terry-McElrath: Future research will be needed to monitor both implementation of and
compliance with USDA standards for school meals and competitive venues. Especially need
will be research that examines how student nutrition and overweight/obesity associates with
changes in the school nutrition environment both overall and within groups at higher risk for
poor nutrition-related outcomes.
• Citation:
• Terry-McElrath YM, O’Malley PM, Johnston LD. Potential Impact of National School
Nutritional Environment Policies: Cross-sectional Associations With US Secondary Student
Overweight/Obesity, 2008-2012. JAMA Pediatr. Published online November 17, 2014.
doi:10.1001/jamapediatrics.2014.2048.
•

Cannabis Extracts Enhance Anti-Tumor Radiation Effects
DrWai Liu
Senior Research Fellow
St George’s University of London London, SW17
• Dr. Liu: It has been known for some time that certain chemicals called cannabinoids that are
isolated from the cannabis plant possess anticancer action through the ability to
enhance/engage apoptosis and autophagy. These effects are both dependent and
independent upon the cognate receptors. These are found at relatively high levels in brain
cells. Brain tumors tend to express these at high levels and so we felt these would be good
candidates.
• The main findings of the current study is the ability that combining the cannabinoids THC and
CBD with irradiation can cause a reduction in tumor that is greater than the sum of the
individual treatments. That is, when using doses of irradiation or cannabinoids individually,
the effects were minimal; however, if they were used simultaneously, the effect was
synergistic, and tumor growth was significantly impeded.

Cannabis Extracts Enhance Anti-Tumor Radiation Effects
DrWai Liu
Senior Research Fellow
St George’s University of London London, SW17
• Medical Research: What should clinicians and patients take away from this report?
• Dr. Liu: Clinicians should take from the study the beneficial synergy seen when irradiation and
cannabinoids are used together. We should investigate the benefits in patients now.
• THC and CBD are already being trialed in patients with glioma. This however is looking at
safety when used with a chemotherapy called temozolomide. I wonder if the data supports
the used of cannabinoids with irradiation?
• Citation:
• Katherine A. Scott, Angus G. Dalgleish, and Wai M. Liu. The Combination of Cannabidiol and
Δ9-Tetrahydrocannabinol Enhances the Anticancer Effects of Radiation in an Orthotopic
Murine Glioma Model. Molecular Cancer Therapeutics, 2014; DOI: 10.1158/1535-7163.MCT-
14-0402

Early Use of Caffeine In Premature Infants
Dr. Abhay Lodha, MBBS, MD, DM, MSC
Assistant Professor, Department of Pediatrics and Community Health Sciences, University of Calgary,
Staff Neonatologist and Clinical Epidemiologist, Section of Neonatology, Alberta Health Services, Chairman, CME
Foothills Medical Centre, Calgary, Alberta, Canada
• Dr. Lodha: Apneic episodes (cessation of breathing) occur in the premature infants. Caffeine is the most
commonly used medication for apnea of prematurity. Normally caffeine started on day 3 of life for apnea.
However, there is no strong evidence that starting caffeine on day 1 or 2 life has some extra advantages in
premature infants. Our study has a large number of premature infants. Our study determined the
association of early initiation of caffeine therapy in very preterm neonates and neonatal outcomes.
• The main finding of our study was that early use of caffeine was associated with a reduction in the rate of
death or bronchopulmonary dysplasia and patent ductus arteriosus. We did not find any adverse impact
on any other outcomes.
• Dr. Lodha: Early use of caffeine (within the first 2 days after birth) in premature infants has no harmful
effects on neonatal outcomes. Early use of caffeine is associated with a reduction in the rate of mortality
or bronchopulmonary dysplasia and patent ductus arteriosus.
• Dr. Lodha: We recommend a randomised controlled trial study comparing the role of early versus late
caffeine therapy in very preterm infants and also to determine the long-term outcome in very premature
infants.
• Citation:
• Lodha A, Seshia M, McMillan DD, et al. Association of Early Caffeine Administration and Neonatal
Outcomes in Very Preterm Neonates. JAMA Pediatr. Published online November 17, 2014.
doi:10.1001/jamapediatrics.2014.2223.

Cystic Fibrosis Survival Improved By Decades
Anne Stephenson MD, PhD Division of Respirology
The Toronto Adult Cystic Fibrosis Centre
St. Michael’s Hospital Toronto, ON
• Dr. Stephenson: Cystic Fibrosis is progressive genetic disease that results in very thick
secretions in various organs such as the lungs, pancreas, and digestive tract. Over time, these
thick secretions damage organs in particular, the lungs, which results in respiratory failure
due to recurrent chest infections. Cystic Fibrosis patients are also at high risk for malnutrition
due to the inability to absorb food which is associated with poor survival. In the 1960s,
people with Cystic Fibrosis died at a very young age and in fact, parents who had a child born
with Cystic Fibrosis at that time were told that there was a 50% chance their child would not
live to attend kindergarten. Over the last several decades, we have seen a significant increase
in the survival of individuals with CF. Individuals born with Cystic Fibrosis today can expect to
not only attend kindergarten, but complete high school, perhaps attend college or university,
have a career, get married or have children as people are living well into adulthood with this
disease. The median age of survival in Cystic Fibrosis today is approximately 50 years of age in
Canada which is quite remarkable.

Dr. Stephenson: The demographics of the CF population are changing. Individuals with Cystic
Fibrosis are living well into adulthood and Cystic Fibrosis is no longer a paediatric disease. In
addition, fewer people with CF are malnourished compared to 20 years ago and currently
almost 60% of the Cystic Fibrosis population is over the age of 18 years. CF patients are
dealing with more complications such as diabetes, anxiety, depression etc than previously
seen because they are living longer.
• There are many reasons for improved survival such as preventing malnutrition, aggressive
treatment of infections, implementing infection control measure to prevent infection and in
the case of end-stage lung disease, the availability of lung transplantation.
• Despite these improvements, every year people with Cystic Fibrosis die and in 2012 the
median age of death was 32 years. This means that half of the patients who died in 2012,
died before their 32nd birthday.

this study?
• Dr. Stephenson: We have made significant advances in Cystic Fibrosis care that have
improved survival but we need to do more research to increase our understanding about the
factors that are associated with mortality, morbidity and quality of life. Recent medications
have been developed to correct the underlying cause of Cystic Fibrosis and we need to
continue our goal of finding a cure for the this devastating disease.
• Citation:
• Anne L. Stephenson, Melissa Tom, Yves Berthiaume, Lianne G. Singer, Shawn D. Aaron, G.a.
Whitmore, and Sanja Stanojevic. A contemporary survival analysis of individuals with cystic
fibrosis: a cohort study. European Respiratory Journal, November 2014 DOI:
10.1183/09031936.00119714

Beta Blockers May Reduce Mortality In Heart Failure with Preserved Ejection Fraction
Dr. Lars H. Lund
Department of Medicine, Karolinska Institutet
Department of Cardiology, Karolinska University Hospital Stockholm, Sweden
• Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and
there is no therapy.
• Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that
they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction.
• Dr. Lund:We confirmed the hypothesis that beta blockers are associated with reduced mortality in Heart
Failure and Preserved Ejection Fraction.
• Dr. Lund: This is by no means proof of a beneficial effect, but it provides a rationale for performing future
randomized trials.
• Dr. Lund: Beta blockers are generic and inexpensive and will not be studied by industry: Instead, we are
seeking public funding to perform so called registry randomized clinical trials – RRCTs, where we use the
registry platoform to perform the functions of a randomized trial. we encourage patients and clinicians to
participate in these and other studies in Heart Failure and Preserved Ejection Fraction.
• Citation:
• Lund LH, Benson L, Dahlström U, Edner M, Friberg L. Association Between Use of β-Blockers and Outcomes
in Patients With Heart Failure and Preserved Ejection Fraction. JAMA. 2014;312(19):2008-2018.
doi:10.1001/jama.2014.15241.

Cardiovascular Health in Youth Limits Functional Disability Later in Life
Thanh Huyen T Vu MD, PhD
Research Assistant Professor Preventive Medicine-Epidemiology
Northwestern University Feinberg School of Medicine
• Response: Ideal levels of all major cardiovascular disease (CVD) risk factors (RF), i.e., low risk
(LR), in younger age are associated with lower subsequent CVD morbidity and mortality in
older age. However, data are limited on the long-term relationships of LR profile in younger
age with functional disability in older age.
Medical Research: What are the main findings?
• Response: With average follow-up 32 years, 11% of the cohort reported having IADL
disabilities and 7% ADL disabilities. Age adjusted prevalence of IADL and ADL were lowest
among the low risk group and increased with number of RFs (p-trends <0.001).
With multivariate-adjustment, low risk was associated with the lowest likelihood of having
any ADL or IADL disabilities; e.g. compared to those with ≥2 RFs, the odds of having any ADL
disabilities vs. no disability in persons with baseline low risk , 0 RF, and 1RF were lower by
60%, 50%, and 40%, respectively.

Cardiovascular Health in Youth Limits Functional Disability Later in Life
Thanh Huyen T Vu MD, PhD
Research Assistant Professor Preventive Medicine-Epidemiology
Northwestern University Feinberg School of Medicine
• Medical Research: What is the take home message?
• Response: For clinicians: our results highlight the importance of having favorable levels of
CVD risk factors at younger ages in preventing functional limitations later in life.
Since healthy lifestyle has been shown to be associated with favorable levels of CVD risk
factors, it is important that health care providers promote a healthy lifestyle for their patients
early in life so they can achieve an ideal CVD RF profile, thus reducing the risk of functional
disability later in life.
• For patients: People should adopt and maintain a healthy lifestyle at all ages. They should try
to stay healthy and avoid the development of CVD risk factors.
this study?
• Response: This study provides more evidence on the benefit of having favorable levels of
CVD risk factors and support the Strategic Impact Goal Through 2020 developed by the AHA
which aims to improve the cardiovascular health for all Americans by 20%. Future research
on how to improve CVD health are needed.
• Citation:
• 2014 AHA meeting abstract:
Ideal Cardiovascular Health in Younger Age and Functional Disability in Older Age – The
Chicago Heart Association Detection Project in Industry (CHA) 32 Year Follow-up Health
Survey

MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014

MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014

Similar to MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014 (20)

More from Marie Benz MD FAAD

More from Marie Benz MD FAAD (17)

Recently uploaded

Recently uploaded (20)

MedicalResearch.com: Medical Research Exclusive Interviews November 21 2014