06 Oct Many US Women Face Distance Barriers To Abortion Access
MedicalResearch.com Interview with: Jonathan Marc Bearak, PhD Senior Research Scientist Guttmacher Institute New York MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although U.S. women who live farther from abortion clinics are less likely to obtain one, no national study has examined inequality in women’s access to abortion and whether inequality in abortion access has increased as the number of abortion clinics have declined. We found that half of women live within 11 miles of an abortion provider. However, 1 in 5 women would need to travel at least 43 miles. We found substantially greater variation within than across states, because even in relatively rural states, women and clinics were concentrated in urban areas. These disparities have persisted since at least 2000.06 Oct Stepped Care Case-Finding Intervention Can Provide Cost Effective Care For PTSD After a Disaster
MedicalResearch.com Interview with: [caption id="attachment_37442" align="alignleft" width="144"]
Dr. Cohen[/caption]
Gregory H. Cohen, MPhil, MSW
Statistical Analyst
Department of Epidemiology
School of Public Health
Boston University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy.
Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care.
Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective.
06 Oct Employer Health Plans Spend At Least $6 Billion Per Year On Preterm Infant Care
MedicalResearch.com Interview with: [caption id="attachment_37390" align="alignleft" width="180"]
Dr. Scott Grosse[/caption]
Scott D. Grosse, PhD
National Center on Birth Defects and Developmental Disabilities
CDC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The U.S. Institute of Medicine (IOM) in 2007 published estimates of the economic costs associated with preterm birth. That report is publicly available: https://www.ncbi.nlm.nih.gov/pubmed/20669423. The total societal cost over a lifetime of a single year’s cohort of infants born preterm was estimated as $26 billion in 2005 US dollars. The study in Pediatrics sought to provide more current estimates of one component of those costs: medical care between birth and 12 months and to answer two additional questions:
- What costs are specifically incurred by employer-sponsored private health plans?
- How much of the overall cost burden of prematurity is attributable to infants born preterm with major birth defects (congenital malformations and chromosome abnormalities)?
06 Oct How Do Viruses Trigger Cough In Asthmatic Children, Even Without Allergies
MedicalResearch.com Interview with: [caption id="attachment_37385" align="alignleft" width="160"]
Dr. Piedimonte[/caption]
Giovanni Piedimonte, MD
Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education
Professor & Chair of Pediatrics
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers.
If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting.
When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies.
We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child
05 Oct Surgical Delays For Melanoma Patients Are Common
MedicalResearch.com Interview with: Adewole Adamson, MD, MPP Department of Dermatology UNC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgery is the primary intervention for the treatment of melanoma. Little is known about how delays for surgery, defined as the time between diagnosis and surgical treatment, among melanoma patient differ by insurance type. After adjustment of patient-level, provider-level, and tumor-level factors we found that Medicaid patients experience a 36% increased risk of delays in surgery for melanoma. These delays were 19% less likely in patients diagnosed and 18% less likely in patients surgically treated by dermatologists. Non-white patients also had a 38% increased risk of delays.05 Oct Standard or Low Dose Alteplase in Acute Ischemic Stroke–Does It Matter?
MedicalResearch.com Interview with: [caption id="attachment_37265" align="alignleft" width="120"]
Prof. Anderson[/caption]
Craig Anderson | MD PhD FRACP
Executive Director
Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney
Neurologist, Neurology Department, Royal Prince Alfred Hospital
The George Institute for Global Health at Peking University Health Science Center
Haidian District | Beijing, 100088 P.R. China
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is much controversy over the benefits of a lower dose of intravenous alteplase, particularly in Asia, after the Japanese regulatory authorities approved a dose of 0.6 mg/kg 10 years ago compared to the US FDA and other regulatory authorities approving 0.9 mg/kg 20 years ago. The investigator inititiated and conducted ENCHANTED trial aimed to determine the effectiveness and safety of these two doses in an international multicentre pragmatic open design.
The main results did not confirm the low-dose to be statistically ‘non-inferior’ partly due to the primary outcome measure chosen and partly due to the statistical approach, but it did confirm that the lower dose was safer with less risk of the major complication of this treatment, that of major bleeding in the brain. However, it would appear that this safety effect was offset by some reduce efficacy in terms of functional recovery.
The aim of this secondary analysis of the trial data was to examine in more detail the differences between low and standard dose alteplase according to the participants’ age, ethnicity (Asian vs non-Asian) and severity of neurological deficit at the time of treatment. We did this because the popular belief is that a lower dose might be preferred in older people, and Asians, because of the potential for more likelihood of bleeding, and preferentially to use the standard dose in those with more severe strokes potentially due to greater ‘clot burden’ from a blocked artery to the brain.
The results showed that the main findings on the outcome of surviving free of disability were the same according to age, ethnicity and stroke severity – that is, there was no preferential dose in any of these groups. Similarly, the safety benefit of low dose alteplase on brain haemorrhage, did not clearly translate into clinical disability outcomes in any of the patient groups studied.
04 Oct Genetic Testing Reduces Risk Of Side Effects From Anticoagulation After Surgery
Posted at 23:06h
in Author Interviews, Clots - Coagulation, Genetic Research, JAMA, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_37375" align="alignleft" width="140"]
Dr. Bass[/caption]
Anne R. Bass, MD
Associate Professor of Clinical Medicine
Weill Cornell Medical College
Rheumatology Fellowship Program Director
Hospital for Special Surgery
New York, NY 10021
MedicalResearch.com: What is the background for this study?
Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient.
In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors.
04 Oct Appendicitis May Be More Common After Colonoscopy
MedicalResearch.com Interview with: [caption id="attachment_37370" align="alignleft" width="132"]
Dr. Basson[/caption]
Marc D. Basson, MD, PhD, MBA
Professor of Surgery, Pathology, and Biomedical Science
Senior Associate Dean for Medicine and Research
University of North Dakota School of Medicine & Health Sciences
Grand Forks, ND 58202
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: I and other surgeons have previously had the experience of caring for patients with appendicitis who had recently undergone colonoscopy, and wondered if there might be a connection. However, colonoscopy and appendicitis are both common events, and so it would be difficult to tell whether they are linked or just coincidences from scattered occurrences.
After obtaining appropriate regulatory approvals, we identified almost 400,000 veterans from the US Department of Veterans Affairs database who had undergone screening colonoscopy and compared their rates of appendectomy and acute appendicitis in the week following colonoscopy to rates of appendectomy and appendicitis over each of the following 51 weeks. We asked the question in several different ways and verified our results by examining surgical and pathology reports. Depending on how the question was asked and appendicitis or appendectomy defined, rates of appendectomy and appendicitis were clearly 4-9 times higher in the first week after diagnostic colonoscopy. This wasn’t true when we asked whether appendectomy was more common after several other procedures that also required sedation and contact with the medical system.
04 Oct Almost $3 Billion Spent Per Year On Injuries From Firearms
MedicalResearch.com Interview with: Faiz Gani MD Postdoctoral research fellow Department of Surgery Johns Hopkins University School of Medicine Baltimore, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Response: The current study sought to evaluate epidemiological trend in emergency department (ED) visits for firearm-related injuries in the US. In our study, we observed that 25.3 patients per 100,000 presented to the ED for a firearm-related injury. This translated to over 78,000 ED visits per year. Over time, while firearm injuries decreased from 2006-2013, an increase in the incidence of firearm-related injuries was observed in 2014. Additionally, over time injuries among older patients and those injured in an unintentional firearm injury increased. Injuries due to an assault decreased over time. The average ED and inpatient charges were $5,254 and $95,887, respectively, resulting in an overall financial burden of approximately $25 billion over the study or an annual $2.8 billion in ED and inpatients charges.04 Oct Studying Benign Pancreatic Tumors May Lead To Ability To Grow Beta Cells To Reverse Diabetes
MedicalResearch.com Interview with: [caption id="attachment_37356" align="alignleft" width="165"]
Dr. Stewart[/caption]
Andrew F. Stewart MD
Irene and Dr. Arthur M. Fishberg Professor of Medicine
Director, Diabetes, Obesity and Metabolism Institute
Institute at the Icahn School of Medicine at Mount Sinai
New York, NY 10029
MedicalResearch.com: What is the background for this study?
Response: Diabetes results ultimately from an inadequate number of insulin-producing “beta” cell in the pancreas. Ideally, these would regenerate when they are lost or damaged, but unfortunately inducing them to regenerate or proliferate has proven impossible until recently.
In 2015 and others we identified the first class of drugs – the harmine analogues - that are able to induce human beta cells to proliferate. In this study, we wanted to identify additional pathways that can lead to human beta cell proliferation at higher rates than we had been able to induce with harmine. For this we turned to a rare type of benign (i.e., not malignant, not cancer) tumor of the beta cells in the pancreas called “insulinomas”. These tiny tumors overproduce insulin and cause hypoglycemia (low blood glucose) which in turn causes seizures, loss of consciousness and confusion. Once they are discovered, then can easily be removed via laparoscopic surgery, and the person is cured. Since they are so rare, and since they are benign and easily cured, insulinomas have not been included in large genome sequencing studies of patients wit cancer. However, we reasoned that they must hold the genomic recipe or wiring diagram for inducing human beta cells to replicate, so we perfumed next-generation DNA and RNA sequencing on a large series (38) of insulinomas.
04 Oct Adulterated Proprietary Chinese Medicines Pose Serious Health Hazards
MedicalResearch.com Interview with:
Tony Wing Lai Mak , MBChB, MBA, FRCPath, FRCPA, FHKCPath, FHKAM(Path
Hospital Authority Toxicology Reference Laboratory
Princess Margaret Hospital, Hong Kong
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Proprietary Chinese medicines (pCMs) and health products are generally believed to be natural and safe. However, the safety of pCMs and health products has been compromised by the illicit practice of adulteration with undeclared drugs. Such adulteration can have serious and even fatal consequences. Previous reports of pCM and health product adulteration were mainly routine surveillance data or case reports/series with a small number of affected patients.
The present study in Hong Kong, to our knowledge, is the largest case series that reports an overview of the use of various adulterated Proprietary Chinese medicine and health products and the resulting adverse effects. From 2005 to 2015, we have identified 404 cases involving the use of 487 adulterated pCMs or health products with a total of 1234 adulterants detected. The adulterants consisted of approved drugs, banned drugs, drug analogues and animal thyroid tissue.
The six most common categories of adulterants detected were nonsteroidal ant-inflammatory drugs (18%), anorectics (15%), corticosteroids (14%), diuretics and laxatives (11%), oral antidiabetic agents (10%), and erectile dysfunction drugs (6%). Sibutramine, an anorectic that has been withdrawn from the market owing to its association with increased cardiovascular events and strokes, was the most common adulterant identified. A significant proportion of patients (65.1%) had adverse effects that were attributable to these illicit products, including 14 severe and two fatal cases. These illicit Proprietary Chinese medicine and health products pose severe health hazards to the public.
04 Oct Is RICE Best After Injury? Study Suggests Rest Prolongs Recovery
MedicalResearch.com Interview with: [caption id="attachment_37336" align="alignleft" width="116"]
Dr. Bayer[/caption]
Monika Bayer PhD.
Institute of Sports Medicine Copenhagen
Bispebjerg Hospital
Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Acute muscle strain injuries display a major clinical problem with a high incidence rate for both professional and amateur athletes and are associated with substantial risk for recurrence. Common clinical practice advices to follow the RICE (Rest – Ice – Compression – Elevation) principle after strain injuries but it has not been investigated whether patients really benefit from a period of rest or whether an early of loading following the injury would improve recovery.
In this study, amateur athletes were divided into two groups: one group started rehabilitation two days after the trauma, the other group waited for one week and began rehabilitation after nine days. All athletes had a clear structural defect of the muscle-connective tissue unit following explosive movements. We found that protraction of rehabilitation onset caused a three-week delay in pain-free recovery. In all athletes included, only one suffered from a re-injury.
04 Oct Vitamin D May Have a Role In Reducing Risk of Severe Asthma Attacks
MedicalResearch.com Interview with: [caption id="attachment_37294" align="alignleft" width="125"]
Dr. Jolliffe[/caption]
David Jolliffe, PhD
Centre for Primary Care and Public Health
Blizard Institute
Barts and the London School of Medicine and Dentistry
London
MedicalResearch.com: What is the background for this study?
Response: Asthma affects more than 300 million people worldwide and is estimated to cause almost 400,000 deaths annually. Asthma deaths arise primarily during episodes of acute worsening of symptoms, known as attacks or ‘exacerbations’, which are commonly triggered by viral upper respiratory infections. Vitamin D is thought to protect against such attacks by boosting immune responses to respiratory viruses and dampening down harmful airway inflammation.
Several clinical trials have tested whether vitamin D supplementation might protect against asthma attacks, but individually their results are inconclusive. In the current study, we pooled raw data from 955 asthma patients who took part in 7 separate trials, which allowed us to answer two questions:
1, Does vitamin D protects against asthma attacks overall, when data from all trials are pooled?
2, Do people who have lower vitamin D levels to start with particularly benefit from supplementation?
04 Oct MRSA Contamination of Home and Pets May Contribute To Reinfection and Resistance
MedicalResearch.com Interview with: [caption id="attachment_37331" align="alignleft" width="139"]
Mr. Shahbazian[/caption]
Mr. Jonathan Shahbazian, MPH
Johns Hopkins Bloomberg School of Public Health
Baltimore
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study was designed to investigate risk factors for drug resistance in MRSA found in dust on surfaces in the home. We undertook this investigation because we were concerned first that people living in the home could pick up MRSA from these surfaces, and second, that if they picked up drug-resistant MRSA, it would be more difficult to treat them.
Our main finding was that use of antibiotics by either people or pets in the home, as well as use of biocidal cleaning products, was associated with multidrug resistance (MDR) in home MRSA. This study is the first to report that use clindamycin in either humans or domestic animals was not associated with risk of MDR in the home environment.
We also found that mupirocin treatment was associated with a slight increase in mupirocin resistance in the household environment, which could complicate decolonization efforts that rely on use of nasal mupirocin ointment. We found that 100% of our MRSA isolates from rural homes were MDR, suggesting living in a rural household may be a risk factor. We also found the presence of domestic pets was associated with MDR MRSA in the home environment while the presence of unwanted pests, such as mice or cockroaches, was associated with non-MDR MRSA strains at the three-month visit.
03 Oct Drinking Coffee Reduced Mortality in Treated HIV-Hepatitis C Co-Infected Patients
MedicalResearch.com Interview with: [caption id="attachment_37320" align="alignleft" width="200"]
CoffeeWikipedia image[/caption] Patrizia Carrieri PhD INSERM U912 - ORS PACA IHU - Faculté de Médecine Marseille, France MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is based on the longitudinal data of the French ANRS HEPAVIH cohort of patients with HIV and Hepatitis C co-infection. This cohort was set up thanks to a collaboration between INSERM (National Institute of health and medical research) UMR912 in Marseille, the ISPED (public health and epidemiology institute) in Bordeaux and several hospital/university sites. Our INSERM team in Marseille is specialized in the study of the impact of behaviors on HIV and HCV outcomes, including mortality. We could think that HCV cure was enough to reduce mortality in HIV-HCV patients as the mortality risk was 80% lower in those who were cured of (i.e. who “cleared”) Hepatitis C thanks to treatment. However, our study showed that, even after HCV cure, sociobehavioral factors still matter: drinking at least 3 cups of coffee a day was associated with a 50% reduction in mortality risk as well as not smoking which was also associated with a reduced mortality risk. This association between elevated coffee intake and reduced mortality risk is probably due to the properties of polyphenols contained in coffee which can protect the liver and also reduce inflammation.
03 Oct Coordination Program Reduced ER Visits and Readmissions in Medicaid Population
Posted at 20:59h
in Author Interviews, Cost of Health Care, Emergency Care, Health Care Systems, Hospital Readmissions, Primary Care
MedicalResearch.com Interview with:
[caption id="attachment_37314" align="alignleft" width="134"]
Dr. Capp[/caption]
Roberta Capp MD
Assistant Professor
Director for Care Transitions in the Department of Emergency Medicine
University of Colorado School of Medicine
Medical Director of Colorado Access Medicaid
Aurora Colorado
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medicaid clients are at highest risk for utilizing the hospital system due to barriers in accessing outpatient services and social determinants.
We have found that providing care management services improves primary care utilization, which leads to better chronic disease management and reductions in emergency department use and hospital admissions.
03 Oct Circulating Tumor Cells Linked To Poor Prognosis in Early Stage Lung Cancers
MedicalResearch.com Interview with: [caption id="attachment_37310" align="alignleft" width="180"]
Dr. Nagrath[/caption]
Dr. Sunitha Nagrath, PhD
Associate Professor, Chemical Engineering
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Lung cancer is leading cause of cancer-related mortality, and detecting it in earlier stages is crucial to improving outcomes for patients. The motivation for this study lies in understanding the phenotypic and genetic make-up of lung cancer during its early stages, using a blood sample (blood biopsy). We have done this by employing a microfluidic device to capture cancer cells circulating in the blood that is obtained from the peripheral veins and the pulmonary vein (a vein next to the tumor itself) from patients with early stage lung cancers. The idea behind using blood from the pulmonary vein was to obtain a richer yield of these circulating tumor cells, which are rare in the blood.
Through this study, we found that the pulmonary vein does yield a much higher quantity of circulating tumor cells, and also often harbors these cells in large clusters. We further went on to study the significance of these clusters, and found that these clusters indicated aggressive traits such as resistance to treatment, and could also potentially suggest poorer patient outcomes at long term.
03 Oct Gay and Bisexual Men With Less Education and Income At Greater Risk of Suicide
Posted at 19:07h
in Author Interviews, Education, Gender Differences, Mental Health Research, Sexual Health, Social Issues
MedicalResearch.com Interview with:
Oliver Ferlatte PhD
Men's Health Research Program
University of British Columbia
Vancouver , British Columbia , Canada
MedicalResearch.com: What is the background for this study?
Response: Suicide, like many other health inequities, is unevenly distributed among the population, with marginalized groups being most affected. In Canada, suicide has been found to particularly affect gay and bisexual men, aboriginal people and people living in rural and remote communities.
While the populations affected by suicide are not mutually exclusive – for example someone can be a bisexual Aboriginal man living in a remote community – much of the suicide prevention literature tends to treat these groups as such. Moreso, very little attention is given in suicide prevention research to diversity within groups: for example, we know very little about which gay and bisexual men are most at risk of attempting suicide. This situation creates a vacuum of knowledge about suicide among gay and bisexual and deprives us of critical information for the development of effective suicide prevention activities.
We therefore investigated in a survey of Canadian gay and bisexual men (Sex Now Survey), which gay and bisexual men are at increased risk of reporting a recent suicide attempt. The large sample of gay and bisexual men with 8493 participants allows for this unique analysis focused on the multiple, intersecting identities of the survey participants.
03 Oct Hematuria, and Early Cancer Detection, Not Uncommon With Anticoagulation Medications
MedicalResearch.com Interview with: [caption id="attachment_37252" align="alignleft" width="132"]
Dr. Nam[/caption]
Robert Nam, MD, FRCSC
Ajmera Family Chair in Urologic Oncology
Professor of Surgery
University of Toronto
Head, Genitourinary Cancer Site
Odette Cancer Centre
Sunnybrook Health Sciences Centre
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The well known potentially lethal complications of anti-thrombotic medications of cerebral and gastrointestinal bleeding complications are well known. However, more common bleeding related complications are not well described . In particular, gross hematuria is a well known complication of these medications but its frequency and severity is unknown. We sought to characterize this association among a large population-based cohort consisting of over 2.5 million patients from the Province of Ontario, Canada, using hematuria-related complications was endpoints. These were defined as undergoing invasive urologic procedures, hospital admissions or emergency visits for gross hematuria.
03 Oct Treating Iron Deficiency In Infants Has Beneficial Brain and Behavioral Effects In Children
MedicalResearch.com Interview with: [caption id="attachment_37300" align="alignleft" width="125"]
Dr. Berglund[/caption]
Staffan Berglund MD PhD
Umeå University
Sweden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Iron deficiency has been associated with impaired neurodevelopment and iron supplementation is recommended to those at risk. While it is well known that very low birth weight infants are at risk of iron deficiency, less has been known regarding the large subgroup of children born with only marginally low birth weight (2000-2500g). In the present study, we previously showed that this relatively common group of otherwise healthy children is at risk of iron deficiency during infancy (Berglund Pediatrics 2010;126).
In the study published this week, we now also found that supplementation during the first six months of life had long term positive effects on their behavioral profile, with significant reduction of externalizing behavioral problems.
03 Oct Does Brand Name 17P Work Better Than Generic In Reducing Preterm Births?
Posted at 11:55h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, OBGYNE
MedicalResearch.com Interview with:
[caption id="attachment_37260" align="alignleft" width="125"]
Dr. Beam[/caption]
Andrew L. Beam, PhD
Instructor in Biomedical Informatics
Department of Biomedical Informatics
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study is one piece of a larger story regarding the use of 17-alpha-hydroxyprogesterone caproate (17P) to treat recurrent preterm birth. This drug was originally only available in a compounded form, but since receiving an orphan drug designation in 2011, a branded and manufactured form was marketed under the name "Makena". This branded form was then sold for a much higher price than the compounded version, but a study that provided concrete data on pricing and outcomes had not been done.
03 Oct TDAP Vaccine During Pregnancy Prevents Whooping Cough In Young Babies
MedicalResearch.com Interview with:
Tami H Skoff
Centers for Disease Control and Prevention
Atlanta, Georgia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Infants are at greatest risk for severe pertussis (whooping cough) morbidity and mortality, especially during the first months of life before infant immunizations begin. CDC and the Advisory Committee on Immunization Practices (ACIP) currently recommend that women receive a dose of Tdap during the third trimester of each pregnancy. This recommendation has been in place since 2012. By getting Tdap, pregnant women pass critical short-term protection to their unborn babies. This helps protect babies until they are old enough to start getting their own whooping cough vaccines at 2 months of age.
The purpose of our study was to evaluate the effectiveness of maternal Tdap during pregnancy at preventing whooping cough in infants <2 months of age.
In our evaluation, Tdap administration during the third trimester of pregnancy prevented more than 3 in 4 (78%) infant cases. Additionally, Tdap vaccination during pregnancy was even more effective (90%) at preventing whooping cough serious enough that the baby had to get treatment in a hospital.
03 Oct Lymph Node Staging of Potentially Curable Lung Cancer Needs Improvement
MedicalResearch.com Interview with: [caption id="attachment_37287" align="alignleft" width="120"]
Dr. Osarogiagbon[/caption]
Raymond U. Osarogiagbon, MBBS, FACP
Translational Lung Cancer Research
Multidisciplinary Thoracic Oncology Program
Baptist Centers for Cancer Care
Memphis, TN
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Most long-term survivors of lung cancer are among the patients who were fortunate enough to be identified early enough to undergo curative-intent surgery. In the US, 60,000 individuals undergo curative-intent surgery for lung cancer every year. This number is likely to increase over the next few years as lung cancer screening becomes more widely adopted. Unfortunately, fewer than 50% of patients who undergo curative-intent surgery actually survive up to 5 years.
We show that the quality of surgery, especially the quality of pathologic nodal staging is a powerful driver of survival differences between groups of patients. In general, pathologic nodal staging (important as it is stratifying patients into risk groups so those at high risk can be offered additional treatments to increase the chances of cure while those at truly low risk can be left alone without exposure to cost and side-effects of additional treatments) is very poorly done. We show how the percentage of patients whose pathologic staging met sequentially more stringently-define thoroughness of staging metrics falls off sharply, while the survival sequentially increases.
02 Oct Half of Menopausal Women Report Getting Insufficient Quality Sleep
MedicalResearch.com Interview with:Dr. Anjel Vahratian PhD MPH
Maternal and Child Health Epidemiologist
Branch Chief at the National Center For Health Statistics
Centers for Disease Control and Prevention
MedicalResearch.com: Why did you conduct this study?
Response: Our research focuses on the health of women as they age and transition from the childbearing period. During this time, women may be at increased risk for chronic health conditions such as diabetes and cardiovascular disease.
As insufficient sleep is a modifiable behavior that is associated with these chronic health conditions, we wanted to examine how sleep duration and quality varies by menopausal status.
02 Oct Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits
Posted at 19:13h
in Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hospital Readmissions
MedicalResearch.com Interview with:
[caption id="attachment_37278" align="alignleft" width="125"]
Dr. Lapointe-Shaw[/caption]
Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto
MedicalResearch.com: What is the background for this study?
Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.
02 Oct Women Tend To Manage Their Cardiac Risk Factors Less Well Than Men
MedicalResearch.com Interview with: Min Zhao PhD student Julius Center for Health Sciences and Primary Care, Clinical Epidemiology University Medical Center Utrech MedicalResearch.com: What is the background for this study? Response: Heart disease is still one of leading causes of deaths and disability worldwide. Management of modifiable risk factors, including both medical treatment target and healthy lifestyle, reduce the chance of new heart attack among those who survived a previous heart attack (so-called secondary prevention). Previous studies have demonstrated that the secondary prevention of heart disease is poorer among women than men. However, most studies were performed in Western populations. We aimed to assess whether sex differences exist on risk factor management and to investigate geographic variations of any such sex differences. Our study is a large-scale international clinical audit performed during routine clinic visit. We recruited over 10,000 patients who had survived a previous heart attack from 11 countries in Europe, Asia, and the Middle East.02 Oct Does Pre-Hospital Advanced Life Support Improve Survival in Out-of-Hospital Cardiac Arrest?
Posted at 15:16h
in Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease
MedicalResearch.com Interview with:
Alexis Cournoyer MD
Université de Montréal
Hôpital du Sacré-Cœur de Montréal
Institut de Cardiologie de Montréal,
Montréal, Québec, Canada.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Out-of-hospital advanced cardiac life support (ACLS) is frequently provided to patients suffering from cardiac arrest. This was shown to improve rates of return of spontaneous circulation, but there was no good evidence that it improved any patient-oriented outcomes. Given the progress of post-resuscitation care, it was important to reassess if ACLS improved survival in out-of-hospital cardiac arrest. Also, with the advent of extracorporeal resuscitation, a promising technique that needs to be performed relatively early in the course of the resuscitation and which seems to improve patients' outcome, we wanted to evaluate if prolonged prehospital resuscitation with ACLS was effective in extracorporeal resuscitation candidates.
In this study, we observed, as was noted in previous study, that prehospital advanced cardiac life support did not provide a benefit to patients regarding survival to discharge, but increased the rate of prehospital return of spontaneous circulation. It also prolonged the delay before hospital arrival of around 15 minutes. In the patients eligible for extracorporeal resuscitation, we observed the same findings.
02 Oct IPF: Combination of Nintedanib and Pirfenidone May Have Added Benefit With Manageable Side Effects
MedicalResearch.com Interview with: [caption id="attachment_37271" align="alignleft" width="125"]
Prof. Vancheri[/caption]
Professor Carlo Vancheri
Professor of Respiratory Medicine,
University of Catania, Italy and Director of the Regional Referral Centre for Rare Lung Diseases and the Laboratory of Experimental Respiratory Medicine.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The aim of Boehringer Ingelheim’s INJOURNEY trial was to investigate the safety profile of Ofev (nintedanib) in combination with pirfenidone in treating patients with idiopathic pulmonary fibrosis (IPF). Nintedanib and pirfenidone, the only two FDA-approved drugs for the treatment of IPF, are able to slow down the progression of the disease, reducing the forced vital capacity (FVC) decline of about 50%, but this is not a cure. The target for the future is to have even more effective treatments. In the meanwhile, it is necessary to optimize the use of the available drugs. The medical treatment of other pulmonary diseases such as COPD, asthma or pulmonary hypertension is already based on different combinations of drugs.
This 12-week, open-label, randomized study was designed to evaluate the safety, tolerability and pharmacokinetics of nintedanib with add-on pirfenidone, compared with nintedanib alone in patients with IPF. Change in FVC, the established efficacy endpoint in IPF trials, was evaluated as an exploratory endpoint.
The primary endpoint of the INJOURNEY trial was the percentage of patients with on-treatment gastrointestinal adverse events from baseline to week 12 of randomized treatment, and the results showed that the combination of nintedanib and add-on pirfenidone resulted in a manageable safety and tolerability profile, similar to the profile of each drug individually in the majority of patients. Results also indicated there may be a slower decline in FVC in patients treated with pirfenidone along with nintedanib compared with nintedanib alone, suggesting a potential benefit of the combination. However, further research will be necessary to fully evaluate the efficacy of the combination.
02 Oct Radiation Therapy Plus Checkpoint Inhibitors Did Not Increase Adverse Events in Metastatic Lung Cancer
MedicalResearch.com Interview with: [caption id="attachment_37256" align="alignleft" width="97"]
Dr. Keane[/caption]
Florence K Keane MD
Resident, Radiation Oncology
Harvard Radiation Oncology Program
Boston, Massachusetts
MedicalResearch.com: What is the background for this study?
Response: Checkpoint inhibitors (CPIs) have recently transformed the management of patients with metastatic lung cancer, demonstrating significant improvements in overall and progression-free survival in both the first-line setting in patients with increased expression of PD-L1 (≥50%) and in patients with previously treated NSCLC who have progressed on chemotherapy. CPIs are also moving into the treatment of patients with localized lung cancer, with the recently published PACIFIC trial demonstrating a significant improvement in progression-free survival in patients with inoperable stage III NSCLC treated with adjuvant durvalumab after definitive chemoradiotherapy.
However, CPIs are associated with unique toxicities as compared to cytotoxic chemotherapy, including pulmonary, endocrine, neurologic, gastrointestinal, and dermatologic adverse events, which may be fatal in some cases. The risk of autoimmune pneumonitis with checkpoint inhibitors is estimated to be on the order of 5%. Many patients with lung cancer will require radiotherapy for palliation of symptoms. Thoracic radiotherapy (TRT) is also a risk factor for pneumonitis, with a dose- and volume-dependent impact on risk. However, it is unknown whether treatment with CPIs and TRT is associated with increased risk of toxicity.