Profound Disparities By Race in Delivery of Care to Stroke Patients

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MedicalResearch.com Interview with:

Romanus Roland Faigle, M.D., Ph.D. Assistant Professor of Neurology The Johns Hopkins Hospital

Dr. Roland Faigle

Romanus Roland Faigle, M.D., Ph.D.
Assistant Professor of Neurology
The Johns Hopkins Hospital

MedicalResearch.com: What is the background for this study?

Response: Stroke care entails a variety of procedures and interventions, which generally fall into one of the two following categories: 1) curative/preventative procedures (such as IV thrombolysis and carotid revascularization), which intent to prevent injury and restore function; and 2) life-sustaining procedures (such as gastrostomy, mechanical ventilation, tracheostomy, and hemicraniectomy), which intent to address complications from a stroke and to prevent death. The use of curative/preventative procedures is supported by excellent evidence and is guided by well-defined criteria, while those are largely lacking for life-sustaining procedures. Therefore, curative/preventative are desirable for eligible patients, while life-sustaining procedures indicate the need to address undesired complications and in itself have questionable utility. We wanted to determine whether race differences in the use of the individual stroke-related procedures exist, and whether presence and directionality of differences by race follow a pattern unique to each of the 2 procedure groups.

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Shorter Course of Antibiotics May Be Enough For Community Acquired Pneumonia

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MedicalResearch.com Interview with:
Dr. Ane Uranga MD
Department of Pneumology, Galdakao-Usansolo Hospital
Galdakao, Bizkaia, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite clear benefits of shorter antibiotic treatments, reducing the duration of treatment remains challenging in daily clinical practice. Actually, IDSA/ATS recommendations for Community Acquired Pneumonia (CAP) suggested a minimum of 5 days of treatment based on clinical stability criteria. However, in our study the median of duration of antibiotic treatment in the control group was as high as 10 days.

The main finding is that receiving 5 days antibiotic treatment in hospitalized patients suffering from CAP is not inferior to arbitrary treatment schedules in terms of clinical success.

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What is Risk of Hypoglycemia When Adding Sulphonylurea to Metformin for Diabetes Control?

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MedicalResearch.com Interview with:

Stig Ejdrup Andersen MD, PhD Clinical Pharmacology Unit Zealand University Hospital Roskilde Denmark

Dr. Andersen

Stig Ejdrup Andersen MD, PhD
Clinical Pharmacology Unit
Zealand University Hospital
Roskilde Denmark

MedicalResearch.com: What is the background for this study?

Response: For decades, we have used sulphonylurea derivates in the medical treatment of type 2 diabetes. Although several newer drugs have become available, adding an SU is still a recommended and acceptable strategy when metformin monotherapy fails. The SUs are among the cheapest glucose lowering drugs on the marked but the risk of hypoglycaemia make clinicians prefer a newer oral drug such as a DPP-IV inhibitor or a SGLT-2 inhibitor to ansulphonylurea because even mild hypoglycaemia may affect the patients’ quality of life negatively.

Several meta-analyses have examined the effectiveness and safety of noninsulin antidiabetic drug, all of which have considered the SUs a homogenous drug class. Pharmacologically, however, the SU agents are quite different. In 2004, a randomized controlled trial by Shernthaner et al. indicated that in comparison with glimepiride, gliclazide MR is equally effective and is associated with fewer hypoglycaemic episodes. Still, head-to-head comparisons of the SU-agents as add-on to metformin are few. In the absence of robust designed comparative trials, we decided to compare the relative risk of hypoglycaemia among the newer SU-agents in a network meta-analysis.

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Breastfeeding May Correct Metabolic Abnormalities Linked To Diabetes

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MedicalResearch.com Interview with:
Dr. Sandra Hummel and Dr. Daniela Much
Institute of Diabetes Research
Helmholtz Center Munich
German Research Center for Environmental Health
Munich

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Gestational diabetes mellitus is associated with a seven-fold increased risk of developing type 2 diabetes postpartum. In 2012, we published that type 2 diabetes risk was markedly reduced up to 15 years after delivery in women with gestational diabetes if they breastfed for more than 3 months. However the underlying biological mechanisms are still unclear to date.

Aim of this biomarker study was to identify the mechanism underlying the protective effect of prolonged lactation. At our study site in Munich, we enrolled 197 women with previous gestational diabetes participating in a postpartum assessment of glucose tolerance at a median time of 3.6 years after delivery. By using a targeted metabolomics approach (including a broad spectrum of lipids and amino acids), we identified lactation-associated biochemical changes in maternal plasma samples. Most interestingly, these metabolite signatures have been described with decreased risk for type 2 diabetes previously. Our results indicate that lactation-associated alterations persisted up to 11 years post-lactation.

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Gut and Brain Communicate To Drive Irritable Bowel Syndrome

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MedicalResearch.com Interview with:

Laureate Professor Nicholas J. Talley, MBBS (Hons.)(NSW), MD (NSW), PhD (Syd), MMedSci (Clin Epi)(Newc.), FRACP, FAFPHM, FAHMS, FRCP (Lond. & Edin.), FACP, FACG, AGAF, FAMS, FRCPI (Hon), GAICD Pro Vice-Chancellor, Global Research, University of Newcastle, Australia Professor of Medicine, Faculty of Health and Medicine, University of Newcastle, Australia

Prof. Nicholas Talley

Laureate Professor Nicholas J. Talley, MBBS (Hons.)(NSW), MD (NSW), PhD (Syd), MMedSci (Clin Epi)(Newc.), FRACP, FAFPHM, FAHMS, FRCP (Lond. & Edin.), FACP, FACG, AGAF, FAMS, FRCPI (Hon), GAICD
Pro Vice-Chancellor, Global Research,
University of Newcastle, Australia
Professor of Medicine, Faculty of Health and Medicine, University of Newcastle, Australia
President, Royal Australasian College of Physicians
Chair, Committee of Presidents of Medical Colleges
Hon. Treasurer, Australian Academy of Health and Medical Sciences
Editor-in-Chief, Medical Journal of Australia
Senior Staff Specialist, John Hunter Hospital, Newcastle, Australia
Professor of Medicine and Professor of Epidemiology, Joint Supplemental Consultant Gastroenterology and Health Sciences Research, Mayo Clinic, Rochester, MN, USA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Functional gastrointestinal diseases (FGIDs) like the irritable bowl syndrome (IBS) are very common, cause major distress including pain and psychological dysfunction, impact on quality of life and drive high health care costs. We speculated that there are two distinct types of functional gastrointestinal disease that others have not recognized.

For example, IBS in a subgroup may first begin with gut symptoms (pain, diarrhea, constipation, bloating etc) in those free of psychological distress and only later does new onset anxiety or depression develop, implicating gut disease as the primary driver of the entire symptom complex (a gut-to-brain disease). On the other hand, we speculated there is another quite different subgroup where disease begins with anxiety or depression and only later do new onset gut symptoms develop, and this is likely primarily a central nervous system cause (probably through the stress system), or a brain-to-gut disease. This is exactly what we found, with gut disease occurring first followed by new onset psychological distress in about two thirds of people from the community over a one year follow-up.

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Iron Levels Should Be Checked During Pregnancy

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MedicalResearch.com Interview with:
Kris Poppe, MD, PhD
Co-Head Endocrine Unit
CHU St-Pierre UMC
Université libre de Bruxelles

MedicalResearch.com: What is the background for this study? 

Response: Pregnant women are often referred by gynecologists to my endocrine practice, for altered thyroid function. At that occasion, I often noticed that the women also had low iron/ferritin levels (ferritin is the iron reserve). Searching in literature did not reveal many publications on the association between iron (deficiency) and thyroid function during pregnancy and so that was the background/aim to perform this study.

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Even Light Smoking Elevates Risk of Brain Bleeding From Intracranial Aneurysm

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MedicalResearch.com Interview with:
Joni Valdemar Lindbohm, MD
Department of Public Health
University of Helsinki, Finland

MedicalResearch.com: What is the background for this study?

Response: Approximately 1-6% percent of people carry an unruptured intracranial aneurysm but most of these never rupture during lifetime and cause subarachnoid hemorrhage (SAH). In SAH, the rupture of an aneurysm causes bleeding into the lining between the brain’s surface and underlying tissue. Despite advances in operative techniques, SAH can lead to death in up to 45% of the cases. Because life style risk factors are critical in development of subarachnoid hemorrhage, it is important to characterize the risk factor profile of those with an elevated risk.

Widely accepted risk factors for SAH are increasing age, smoking, hypertension and female sex. However, the reasons for an elevated risk in women have remained uncovered and the effect of smoking habits are not well understood.

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Behavioural Activation Therapy Offers Lower-Cost, Effective Treatment for Depression

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MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School University of Exeter St Luke's Campus Exeter United Kingdom MedicalResearch.com: What is the background for this study? Response: Depression is a common mental health disorder affecting around 350 million people worldwide. Untreated depression is expected to cost the global economy US$5.36 trillion between 2011 and 2030. Many patients request psychological therapy, but the best-evidenced therapy—cognitive behavioural therapy (CBT)—is complex and costly. A simpler therapy—behavioural activation (BA)—might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression. MedicalResearch.com: What are the main findings? Response: We found that behavioural activation, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals MedicalResearch.com: What should readers take away from your report? Response: Our findings have substantial implications given the increasing global pressure for cost containment across health systems in high-income countries and the need to develop accessible, scalable interventions in low-income and middle-income countries. Such countries might choose to investigate the training and employment of junior workers over expensive groups of psychological professionals. Our results, therefore, offer hope to many societies, cultures, and communities worldwide, rich and poor, struggling with the effect of depression on the health of their people and economies. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Research into these and other potential strengths of behavioural activation in the context of implementation science is necessary for the hope and promise offered by the COBRA trial to be fulfilled. Now that we have support for BA as a treatment that is clinically effective and cost-effective, we can shift our efforts to focus on what is necessary to produce sustainable large-scale behavioural activation implementation across diverse geographical and cultural settings. MedicalResearch.com: Is there anything else you would like to add? Response: Although many obstacles exist to successful dissemination in addition to training of Mental Health Workers, our findings suggest that health services globally could reduce the need for costly professional training and infrastructure, reduce waiting times, and increase access to psychological therapies. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Lancet Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Prof. David Richards

MedicalResearch.com Interview with:
Professor David A. Richards, PhD
Professor of Mental Health Services Research and NIHR Senior Investigator
University of Exeter Medical School
University of Exeter
St Luke’s Campus
Exeter United Kingdom

MedicalResearch.com: What is the background for this study?

Response: Depression is a common mental health disorder affecting around 350 million people worldwide. Untreated depression is expected to cost the global economy US$5.36 trillion between 2011 and 2030.

Many patients request psychological therapy, but the best-evidenced therapy—cognitive behavioural therapy (CBT)—is complex and costly. A simpler therapy—behavioural activation (BA)—might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression.

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The Emergence of New HIV Strains That May Infect Humans Never Ends

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MedicalResearch.com Interview with:

Zhe Yuan MS. MS. PhD Candidate Nebraska Center for Virology University of Nebraska-Lincoln

Dr. Zhe Yuan

Zhe Yuan MS. MS. PhD Candidate
Nebraska Center for Virology
University of Nebraska-Lincoln

MedicalResearch.com: What is the background for this study?

Response: AIDS causes millions of infections and deaths each year. Human immunodeficiency virus (HIV) is the cause of this detrimental disease of humans. Just like Ebola and Zika, AIDS is also a zoonotic disease at the beginning. For the origins of HIV, people believed that HIV originated from simian immunodeficiency virus from wild chimpanzees (SIVcpz). But until now, there has been no direct in vivo evidence for this assumption. Further, people cannot explain why only certain SIVcpz strains are thought to be the ancestors of already discovered HIV strains in humans. There is also a need to clarify what transmission risks might exist for those SIVcpz strains that have not already been found to infect humans. The answers to these questions are essential for a better understanding of cross-species transmission and predicting the likelihood of additional cross-species transmission events of SIV into humans.

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With Some Exceptions, Care at Veterans’ Hospitals Comparable to Other Health Systems

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MedicalResearch.com Interview with:
Claire O’Hanlon, MPP
Pardee RAND Graduate School and
Courtney Gidengil, MD, MPH
RAND Corporation

MedicalResearch.com: What is the background for this study?

Response: Providing high-quality health care is central to our nation’s commitment to veterans, but the quality of care provided in Veterans Affairs health care system (VA) is a longstanding area of concern. Part of the 2014 Veterans Access, Choice and Accountability Act (VACAA) mandated an independent assessment of VA’s health care capabilities and resources of the Veterans Health Administration, including a comprehensive evaluation of health care quality. As part of this evaluation we conducted this systematic review of journal articles that compare quality of care at the VA to other settings as an update to a 2009 review on this subject.
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Kaiser Study Reports Clustering of Basal Cell Skin Cancers in Northern California

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MedicalResearch.com Interview with:
G. Thomas (Tom) Ray
Division of Research, Kaiser Permanente
2000 Broadway
Oakland, CA 94612-2304

MedicalResearch.com: What is the background for this study?

Nirmala Pandeya, PhD Post Doctoral Research Fellow Faculty of Medicine and Biomedical Sciences, School of Public Health Herston campus The University of Queensland

Basal cell skin cancer

Response: Basal cell carcinoma (BCC) is the most common cancer in the United States. BCCs tend to develop on sun-exposed areas such as the head and neck and are typically treated with various surgical techniques in an outpatient setting. Although BCCs are rarely fatal, they have been estimated to be among the most costly cancers in the Medicare population due to their high incidence. Yet because these cancers are not tracked by national registries the way, for example, melanoma is, basal cell carcinomas have been difficult to study. Incidence rates in the past have tended to rely on surveys such as those by the National Cancer Institute. And studies using disease codes have, until recently, been difficult because the codes used for basal cell carcinoma and squamous cell carcinoma were the same.

Since 1997, Kaiser Permanente Northern California (KPNC) has had computerized pathology results that allowed us to develop an internal registry of BCC cancers. In addition to having detailed information about basal cell cancer patients, we also had detailed information on the underlying population – KPNC members – which allowed us to determine incidence rates of BCC by age, sex, and most importantly for this study, by geographic location. This is because we know the residential location of all KPNC members at any given time – both those that get basal cell cancer and those who do not. This combination of a validated BCC registry with a well-defined population at-risk gave us the unique ability to investigate the spatial distribution of BCC in Northern California and assess whether there existed geographic clustering of basal cell cancers. Although the investigation of spatial clustering of other cancers is fairly common, no such analyses have been performed for basal cell cancer in the United States.

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New Sunscreens Could Protect Mitochondria From Ultraviolet Light

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MedicalResearch.com Interview with:

AP Commercial Photography C. Pourzand, MSc, MPhil, PhD/DSc Senior lecturer and Associate Professor in Biopharmaceutics Department of Pharmcay and Pharmacology University of Bath Bath, United Kingdom

Dr. Charareh Pourzand

Charareh Pourzand, MSc, MPhil, PhD/DSc
Senior lecturer and Associate Professor in Biopharmaceutics
Department of Pharmcay and Pharmacology
University of Bath
Bath United Kingdom

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Exposure of skin cells to Ultraviolet A (UVA) component of sunlight provokes oxidative damage to the vital subcellular organelles, mitochondria, leading to ATP depletion and necrotic cell death.

The presence of high level of potentially harmful ‘labile’ iron in mitochondria is thought to make these organelles highly susceptible to oxidative damage caused by UVA. Therefore, we designed a highly specific iron trapping compound that could directly target mitochondria and protect the organelles against UVA-induced iron damage and the ensuing cell death. The results of the study demonstrate an unprecedented level of protection afforded by these compounds against damage caused by high doses of solar UVA radiation, equivalent to up to 140 min sun exposure at sea level.

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