Author Interviews, Neurological Disorders / 23.03.2017

MedicalResearch.com Interview with: Joshua Kim, researcher RIKEN-MIT Center for Neural Circuit Genetics at The Picower Institute for Learning and Memory, Department of Biology and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA Howard Hughes Medical Institute, Massachusetts Institute of Technology Cambridge, MA 02139 MedicalResearch.com: What is the background for this study? Response: We previously identified to populations of neurons in a structure known as the basolateral amygdala, one that is capable of mediated fear-related behaviors and the other reward-related behaviors. Both of these basolateral amygdala populations send projections to a structure known as the central amygdala. For this study, we wanted to examine the function of 7 different populations of central amygdala neurons in regard to fear-related and reward-related function and how each of these 7 populations are connected to the 2 basolateral amygdala populations. (more…)
Author Interviews, Heart Disease, JACC, Lifestyle & Health / 23.03.2017

MedicalResearch.com Interview with: Andrew T. Yan, MD Terrence Donnelly Heart Centre St Michael's Hospital University of Toronto Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: The pathogenesis of aortic stenosis is complex and incompletely understood. Previous experimental data and epidemiologic studies (mostly cross-sectional) have demonstrated an association between conventional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, and aortic sclerosis or stenosis. However, there is a paucity of longitudinal data from large population studies. Therefore, we sought to examine the relationship between conventional cardiovascular risk factors and incident severe aortic stenosis during extended follow-up in a large unselected elderly population in Ontario, Canada. In over 1 million individuals older than 65 who were followed for a median of 13 years, hypertension, diabetes and dyslipidemia were all significantly and independently associated with development of severe aortic stenosis requiring hospitalization or intervention. Furthermore, we observed a positive dose-response relationship between the number and duration of cardiac risk factors, and the risk of aortic stenosis. Together, these risk factors accounted for approximately one third of the incidence of severe aortic stenosis at a population level. (more…)
Author Interviews, Dermatology / 23.03.2017

MedicalResearch.com Interview with: Usha Nagavarapu, PhD Senior director of preclinical drug development BioPharmX MedicalResearch.com: What is the background for this study? What are the main findings? Response: Acne vulgaris is a complex chronic inflammatory disease known to be linked with P. acnes and can have profound social and psychological effects. Though a number of treatments exist, there is promise of a long-term benefit for acne patients. BioPharmX’s in vitro and in vivo studies have revealed that a low-dose, topical 1% minocycline gel (BPX-01) provided a localized and targeted delivery of adequate minocycline to the epidermis and pilosebaceous units that can potentially limit systemic exposure and may reduce treatment related side effects. At the intended clinical dose, toxicity and safety animal studies found that BPX-01 was well tolerated with no significant local or systemic toxic effects. A comparative animal study with oral minocycline demonstrated that topical application of minocycline can limit systemic exposure while delivering sufficient minocycline to the skin to treat acne vulgaris. Along the same lines, a 4-week clinical study with extended release oral minocycline to assess the skin and plasma concentrations of minocycline was conducted. A marked reduction of mean acne lesion counts from baseline was seen with oral minocycline with presence in plasma. On the contrary no minocycline was identified in the skin from periauricular biopsies. Recently, BioPharmX completed a 4-week Phase 2 clinical repeat-dose study of BPX-01. The minocycline gel was well tolerated and over 90% of P. acnes were eliminated. A 12-week Phase 2 dose-finding clinical trial to further assess the efficacy and safety of BPX-01 for the treatment of moderate-to-severe, non-nodular inflammatory acne vulgaris has been initiated. The dose-finding study will provide additional support for the planned Phase 3 clinical trial program with BPX-01. (more…)
Author Interviews, Cancer Research, Education / 22.03.2017

MedicalResearch.com Interview with: Jiemin Ma PhD MHS Strategic Director, Cancer Interventions Surveillance American Cancer Society, Inc. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies have shown that educational disparities are smaller in the elderly than in working-aged Americans. The differences may partly be explained by the higher health insurance coverage among the elderly (near universal coverage through Medicare for adults aged 65), as well as some aging-related changes in lifestyle and social factors (e.g. retirement). Some of the previous studies were limited by the use of proxy-reported educational information, which tended to be inaccurate for the elderly. Our study used self-reported educational attainment to estimate relative differences in educational disparities in mortality rates between adults aged 50–64 and 66–79 years in a national representative cohort from the National Longitudinal Mortality Study (NLMS). We found that educational disparities in all-cause mortality for ages 66–79 years were about 41% and 61% lower than those for ages 50–64 years in non-Hispanic whites and non-Hispanic blacks, respectively. Diminished disparities in the elderly were also found for deaths from cardiovascular disease and cancer among non-Hispanic Americans. (more…)
Author Interviews, Heart Disease / 22.03.2017

MedicalResearch.com Interview with: Alec Vishnevsky, MD Cardiology Fellow and First Author Thomas Jefferson University Hospital Michael P. Savage, MD FACC FSCAI FACP Ralph J. Roberts Professor of Cardiology Sidney Kimmel Medical College at Thomas Jefferson University Director, Cardiac Catheterization Laboratory MedicalResearch.com: What is the background for this study? What are the main findings? Response: Percutaneous coronary intervention (PCI) has been a mainstay treatment for patients with symptomatic coronary artery disease. While current guidelines emphasize the importance of periprocedural antithrombotic medications, they fail to mention the use of nitroglycerin prior to PCI to rule out coronary artery spasm as the etiology of a stenosis seen on coronary angiography. This distinction is paramount as it can avoid unnecessary stenting procedures. In this case series, we described a series of patients presenting with chest pain and angiographically significant stenoses that resolved with administration of intracoronary nitroglycerin (IC NTG) prior to planned PCI. The study group consisted of 6 patients with a mean age of 52, all of whom had anginal symptoms and significant stenoses seen on coronary angiogram.  In each case, giving intracoronary nitroglycerin resulted in resolution of the stenosis, and all 6 patients were successfully managed medically without stenting. (more…)
Accidents & Violence, Author Interviews, Autism, Columbia / 22.03.2017

MedicalResearch.com Interview with: Joseph Guan MPH Candidate in Epidemiology, Certificate in Chronic Diseases Epidemiology Columbia University Mailman School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: The prevalence of autism has been increasing especially in the past two decades. With an estimate of more than 3.5 million people living with autism in the US, approximately 500,000 of them are children under 15 years old. Current studies show that males are approximately four times as likely than females to be diagnosed with autism. There is also evidence that people with autism are at a heightened risk of injury. However, the research on the relationship between autism and injury is understudied. We found that 28% of deaths in individuals with autism were due to injury, compared to 7% of deaths in the general population. Injury deaths in individuals with autism occurred at a much younger age (29.1 years) on average compared to injury deaths in the general population (54.7 years). Our study show that drowning was the leading cause of injury death among individuals with autism, followed by suffocation and asphyxiation. Children under the age of 15 years were 160 times more likely to die from drowning. (more…)
Abuse and Neglect, Author Interviews, Diabetes, JAMA, Ophthalmology, Technology / 21.03.2017

MedicalResearch.com Interview with: José Cunha-Vaz, M.D., Ph.D. Emeritus Professor of Ophthalmology University of Coimbra, Portugal President of AIBILI Association for Innovation and Biomedical Research on Light and Image Editor-in-Chief of Ophthalmic Research Coordinator, Diabetic Retinopathy and Retinal Vascular Diseases, European Vision Institute Clinical Research Network (EVICR.net)  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study, we evaluated the clinical utility of quantitative measures of microvasculature in optical coherence tomographic angiography (OCTA). Although several studies have demonstrated the potential value of measures of microvasculature in the management of diabetic retinopathy (DR), our study uses the ROC curve to compare the overall value of different approaches. In this age matched population with a range of disease, the mean vessel density measured in the SRL had the highest AUC, indicating that it is best among the methods tested at differentiating normal eyes from eyes with diabetic retinopathy. (more…)
Author Interviews, CDC, Smoking, Tobacco, Tobacco Research / 21.03.2017

MedicalResearch.com Interview with: Kristy Marynak, Master of Public Health Public Health Analyst at Centers for Disease Control and Prevention Centers for Disease Control and Prevention Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for our study is that in recent years, self-reported cigarette smoking has declined among youth and adults, while electronic cigarette (e-cigarette) use has increased. However, sales trends for these products are less certain. Our study assessed national and state patterns of U.S. cigarette and e-cigarette unit sales using retail scanner data from convenience and grocery stores; mass merchandisers like Walmart; drug, dollar, and club stores; and military commissaries. (more…)
Author Interviews / 21.03.2017

MedicalResearch.com Interview with: Mitch Rothschild MA, MBA Co-founder of Vitals MedicalResearch.com: What is the background for this study? What are the main findings? Response: There’s so much in the news about health care today. It’s on people’s mind more than ever before due to rising costs and deductibles and, of course, the repeal debate. With that in mind, we wanted to see how the current landscape affects two things: 1) People’s trust in the health system in general; and 2) Their attitude towards the doctor-patient relationship. It shouldn’t be surprising that different generations had different perceptions. But we were amazed by how some generational stereotypes held true when it came to doctor-patient relationships and the health care attitudes. Millennials – Health Care Idealists Being in their 20s and 30s, Millennials are young and in general a healthy bunch. For the most part, they’ve utilized less health care services than other generations. Only 35 percent have a primary care provider, and one in four say they use an alternative care facility, like an urgent care center, when they are sick. Often characterized as optimistic and idealistic, those traits may help explain why they have a high degree of trust in the system and in their doctors. They’re the least likely to question their doctor’s authority or their integrity when it comes to fessing up to medical mistakes. Confident and idealistic, Millennials are often labeled as over-sharers for their habits both on social media and in the real world. But this translates into an open doctor-patient relationship. Millennials are more likely than other generations to say they can tell their doctor “anything.” Perhaps a byproduct of their parents raising them to believe their voice matters, Millennials have an expectation that they can and should engage authority. Yet, that collaborative and open dialogue leads to another positive: They’re the most likely to follow their doctor’s medical advice. Millennials have grown up as digital natives. As such, they’re the most likely to use online reviews to “check up” on a new doctor. Yet, their familiarity with technology leads them to be the least suspicious of pitfalls. More than other generations, Millennials trust health facilities with their personal health information. (more…)
Aging, Alzheimer's - Dementia, Author Interviews, JAMA, Supplements / 21.03.2017

MedicalResearch.com Interview with: Richard J. Kryscio, Ph.D. Statistics and Chair, Biostatistics and Sanders-Brown Center on Aging Sanders-Brown Center on Aging University of Kentucky  MedicalResearch.com: What is the background for this study? Response: At the time the trial was initiated (2002), there was ample evidence that oxidative stress is an important mechanism in brain aging. Research showed that protein oxidation is linked to the brain’s response to the abnormal proteins seen in Alzheimer disease (amyloid beta plaques in particular) leading to inflammation, DNA repair problems, reduced energy production, and other cellular changes that are identified mechanisms in the Alzheimer brain. Both vitamin E and selenium are antioxidants. Antioxidants, either through food or supplements, are believed to reduce oxidative stress throughout the body. In the brain, they may reduce the formation of amyloid beta plaques, reduce brain inflammation, and improve other brain processes. Studies in humans support these hypotheses. The Rotterdam study in the Netherlands, as an example, showed that initial blood levels of vitamin E could predict dementia risk. Those people with higher vitamin E levels were 25% less likely to develop dementia. Also, selenium deficiency results in cognitive difficulties and several population-based studies have shown an association between selenium level and cognitive decline (lower selenium levels are linked to thinking changes in the elderly). (more…)
Author Interviews, Mental Health Research / 21.03.2017

MedicalResearch.com Interview with: Dr. Melanie Ullrich PhD Universität Würzburg Physiologisches Institut Würzburg MedicalResearch.com: What is the background for this study? Response: Shortly after the first description of SPRED proteins in 2001, their in vivo functions, especially that of SPRED2, were completely unexplored. Thus we generated a mouse model which lacks functional SPRED2 expression. In our previous study, we identified SPRED2 as a critical regulator of stress hormone release from the hypothalamic-pituitary-adrenal (HPA) axis. In SPRED2 KO mice levels of corticotropin-releasing hormone, adrenocorticotropic hormone, and corticosterone are elevated, a feature often associated with obsessive-compulsive disorders (OCD) in humans. In fact SPRED2 KO mice showed clear signs of OCD-like behavior demonstrated by excessive self-grooming up to the level of self-inflicted lesions. Treatment with the selective serotonin reuptake inhibitor (SSRI) fluoxetine alleviated excessive grooming, confirming the OCD-like nature of the disease. Therefore, the first main finding of our study is that mutations in the SPRED2 gene have to be considered as a possible risk factor for the development of OCD-like diseases. (more…)
Author Interviews, Heart Disease, JAMA / 21.03.2017

MedicalResearch.com Interview with: Eric A. Secemsky, MD, MSc Interventional Cardiology Fellow Massachusetts General Hospital Harvard Medical School Baim Institute for Clinical Research  MedicalResearch.com: What is the background for this study?  What are the main findings? Response: We know from previous trials that continuing dual antiplatelet therapy longer than 12 months after coronary stenting decreases ischemic events, including spontaneous myocardial infarction and stent thrombosis. However, extending dual antiplatelet therapy is also associated with some increase in bleeding risk. For instance, in the DAPT Study, more than 25,600 patients were enrolled and received both aspirin and a thienopyridine antiplatelet drug (clopidogrel or prasugrel) for one year after stenting. Of these patients, 11,648 participants who had followed the study protocol and had no serious cardiovascular or bleeding events during that first year were then randomized to either continue with dual therapy or to receive aspirin plus a placebo for another 18 months. The overall findings of the DAPT study were that, compared with switching to aspirin only after one year, continuing dual antiplatelet therapy for a total of 30 months led to a 1.6 percent reduction in major adverse cardiovascular and cerebrovascular events – a composite of death, myocardial infarction, stent thrombosis and ischemic stroke – and a 0.9 percent increase in moderate to severe bleeding events. The prognosis following early ischemic and bleeding events has previously been well described. However, data for events occurring beyond 1 year after PCI are limited. As such, we sought to assess the cumulative incidence of death following ischemic and bleeding events occurring among patients in the DAPT Study beyond 1 year after coronary stenting. (more…)
Author Interviews, JAMA, Mental Health Research, Urology / 21.03.2017

MedicalResearch.com Interview with: Blayne Welk, MD, FRCSC Assistant Professor of Surgery Western University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Concerns have been raised by regulatory agencies and patients about possible serious psychiatric side effects associated with the use of 5 alpha reductase inhibitors. These medications can be used for both enlarged prostates and alopecia. We used administrative data to assess for potential psychiatric side effects associated with finasteride and dutasteride usage in older men with benign prostatic enlargement. In our study we found that there was no increased risk of suicide associated with the use of these medications. However, there was a small increase in both self-harm and new onset depression associated with the use of 5 alpha reductase inhibitors. (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease / 21.03.2017

MedicalResearch.com Interview with: Lia Crotti, MD, PhD Department of Cardiovascular, Neural and Metabolic Sciences San Luca Hospital IRCCS Istituto Auxologico Italiano MedicalResearch.com: What is the background for this study? Response: Sudden cardiac death in one of the major cause of death in Western Countries and among the causes of these deaths in young people under the age of 35, inherited forms of cardiomyopathy have a prominent role. Among these cardiomyopathies, Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) plays a major role. In ARVC, the heart tissue is replaced by fatty and fibrous tissue. This process encourages the development of life-threatening arrhythmias, such as ventricular fibrillation, that causes a cardiac arrest and sudden death in few minutes without a ready device to shock the heart. Intense physical activity favors the progression of the disease and arrhythmias are frequently triggered by adrenergic activation: those are the reason why young athletes with this disease are at high risk. (more…)
Author Interviews, Biomarkers, Breast Cancer, Genetic Research, Journal Clinical Oncology / 21.03.2017

MedicalResearch.com Interview with: Anne Kuijer, MD Departments of Surgery and Radiology University Medical Center Utrecht and Thijs van Dalen, PhD Department of Surgery Netherlands Cancer Institute, Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years it has become evident that clinicopathological factors fail to accurately determine prognosis in hormone receptor positive early stage breast cancer patients at intermediate risk of developing metastases. Gene-expression profiles, such as the 70-gene signature (MammaPrint) are therefore increasingly used for chemotherapy decision-making. In the current multicentre study we assessed the impact of 70-gene signature use on chemotherapy decisions in these patients. We demonstrated that, without the use of the 70-gene signature, half of patients was advised chemotherapy, which reflects the current controversy regarding chemotherapy benefit. Use of the 70-gene signature changed the chemotherapy advice in half of all patients and adherence to the 70-gene signature result was high. (more…)
Author Interviews, Education, Gender Differences / 20.03.2017

MedicalResearch.com Interview with: Tasseli McKay, MPH Violence and Victimization Research Program Center for Justice, Safety and Resilience RTI International MedicalResearch.com: What is the background for this study? Response: Prompted by a mass murder of LGBTQ+ individuals in Orlando in 2016 and a range of pending legislation affecting LGBTQ+ communities, RTI researchers analyzed 20 years’ worth of published studies on violence and LGBTQ+ communities. The systematic review identified patterns of evidence across 102 peer-reviewed studies as well as a few unpublished analyses and non-peer-reviewed papers. With The Henne Group, RTI also carried out a series of focus-group discussions to elicit the perspectives of members of LGBTQ+ communities on the violence and victimization issues identified in the review. These were conducted with LGBTQ+ communities in San Francisco; New York City; Durham, North Carolina; and rural Wyoming. (more…)
Author Interviews, Sugar / 20.03.2017

MedicalResearch.com Interview with: Shu Wen Ng, Ph.D., FTOS Research Associate Professor, Department of Nutrition Gillings School of Global Public Health Fellow, Carolina Population Center Duke-UNC Center for Behavioral Economics and Healthy Food Choice Research University of North Carolina at Chapel Hill MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Mexican government enacted a 1 peso per liter tax on sugar sweetened beverages (SSB) after studies showed that more than 70 percent of the country’s population was overweight or obese, and that in excess of 70 percent of the added sugar calories in the Mexican diet were coming from SSBs. We were interested in learning how purchases of SSBs and other beverages changed in the 2 years after the tax was implemented in Mexico. The Health Affairs study titled “In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax” found that in the two-year period spanning 2014 to 2015, the tax resulted in a 5.5 percent reduction in the first year and continued to decline, averaging 9.7 percent the second year, with lower socioeconomic households, for whom health care costs are most burdensome, lowered their purchases of sweetened beverages the most. Meanwhile, purchases of untaxed beverages such as bottled water increased 2.1 percent. (more…)
Author Interviews, Orthopedics / 20.03.2017

MedicalResearch.com Interview with: Alexis Colvin, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity. We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early. (more…)
Author Interviews, Heart Disease, Pharmacology / 20.03.2017

MedicalResearch.com Interview with: Kathrine Bach Søndergaard MD, Research Fellow Gentofte University Hospital Department of Cardiology Hellerup  MedicalResearch.com: What is the background for this study? Response: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have in previous studies been associated with an increased risk of cardiovascular adverse events, such as myocardial infarction and heart failure. Cardiac arrest is the ultimate adverse event; however, no research exists of the association between cardiac arrest and use of NSAIDs, which we aimed to assess in this study. (more…)
Author Interviews, Heart Disease, Medical Imaging / 20.03.2017

MedicalResearch.com Interview with: Matthias Götberg, MD, PhD Director Cardiac Cath Lab Department of Coronary Heart Disease Skane University Hospital- Lund Lund, Sweden MedicalResearch.com: What is the background for this study? Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely. FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects. iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed. iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking. iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization. RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality. (more…)
Author Interviews, Heart Disease, JACC / 19.03.2017

MedicalResearch.com Interview with: Raffaele De Caterina MD, PhD Professor of Cardiology and Director of the University Cardiology Division 'G d'Annunzio' University in Chieti MedicalResearch.com: What is the background for this study? What are the main findings? Response: The widely used term “valvular atrial fibrillation” encompasses a variety of conditions in which atrial fibrillation and valvular heart disease coexist. Since most trials of the non-vitamin K antagonist oral anticoagulants (NOACs) have variably excluded “valvular atrial fibrillation”, in more or less restrictive terms, there has been uncertainty whether NOACs can be used in such varied conditions. While atrial fibrillation in the presence of a mechanical valve or rheumatic mitral stenosis has to be a true contraindication (unfavorable data with one NOAC in the former setting; no data in the latter setting), patients with valvular diseases such as mitral insufficiency, aortic stenosis, aortic insufficiency, or with the presence of a bioprosthesis, have been variably included in the phase III trials of NOACs, but had not been extensively and conclusively studied before. (more…)
Author Interviews, Heart Disease, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Sung-Han Yoon MD Clinical Trials, Cardiology, Developmental Biology Cedars-Sinai Medical Center, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) has become the standard treatment in inoperable patients in high surgical risk patients with symptomatic severe aortic stenosis (AS). However, major randomized trials excluded congenital bicuspid AS due to its unique morphological features. The indication of TAVR is expanding into a younger population, in which the frequency of bicuspid AS is higher. Therefore, we will encounter TAVR for bicuspid AS more frequently. However, the experience of TAVR in bicuspid AS is limited to small series. Therefore, we aim to evaluate the clinical outcomes of TAVR in bicuspid AS and compare them to tricuspid AS. (more…)
Author Interviews, Heart Disease, Imperial College, Medical Imaging, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College London MedicalResearch.com: What is the background for this study? Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful. iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care / 19.03.2017

MedicalResearch.com Interview with: Marleen Boerma MD Department of Emergency Medicine Elisabeth-Tweesteden Hospital Tilburg, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED. This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor. (more…)
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: Michael Hausman, MD Chief, Hand and Upper Extremity Surgery Mount Sinai Health System Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lateral epicondylitis has traditionally been thought of as a tendon problem, but tendon pathology has not been well documented. Our study supports our hypothesis that the problem lies within the elbow joint, rather than in the tendon outside the joint. (more…)
Author Interviews, Opiods, Pain Research / 19.03.2017

MedicalResearch.com Interview with: Dr. Sommer Hammoud MD ABOS Board Certified Assistant Professor of Orthopedic Surgery Thomas Jefferson University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients. Our main findings for each of those aims are the following: 1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic 2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and 3) Future research needs to focus on the psychologic aspect of patients' ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain. (more…)
Author Interviews, Cannabis, Heart Disease, Stroke / 19.03.2017

MedicalResearch.com Interview with: Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center Philadelphia MedicalResearch.com: What is the background for this study? Response: As of the recent 2016 election, decriminalization of cannabis passed in several states bringing the total count up to 28 states and D.C. where cannabis is now legal for medicinal and/or recreational purposes. From a physician’s perspective, it is rare that a drug has “hit the market” so to speak without undergoing clinical trials to determine safety and efficacy. Hence, we sought out to study if cannabis had any effects (positive or negative) on the cardiovascular system. (more…)
Author Interviews, Environmental Risks, Heart Disease, Medical Imaging / 19.03.2017

MedicalResearch.com Interview with: Dr. Marco Valgimigli, MD, PhD Interventional Cardiology Sandro Pertini Hospital, ASL RM2, Rome, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Radial access as compared to femoral access reduces bleeding and mortality in patients with acute coronary syndrome (ACS) undergoing invasive management. However, prior studies have raised concerns over the increased risk of radiation exposure for both patients and operators with radial instead of femoral access and it remains still unclear whether radial access increases the risk of operator or patient radiation exposure in contemporary practice when performed by expert operators. The MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial is the largest randomized trial comparing radial versus femoral access in ACS patients undergoing invasive management. In this radiation sub-study (RAD-MATRIX), we collected fluoroscopy time and dose area product (DAP) and equipped radial operators consenting to participate with dedicated dosimeters, each wearing a thorax (primary endpoint), wrist and head (secondary endpoints) lithium fluoride thermo luminescent dosimeter, during study conduct to establish non-inferiority of radial versus femoral access. Among eighteen operators, performing 777 procedures in 767 patients, the non-inferiority primary endpoint was not achieved. Operator equivalent dose at the thorax was significantly higher with radial than femoral access. After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ in the right radial compared to the left radial access. In the overall MATRIX population, fluoroscopy time and DAP were higher with radial as compared to femoral access. (more…)
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: Dr. Baron Lonner MD Professor of Orthopaedic Surgery Mount Sinai Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience. Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients. (more…)
Author Interviews, Heart Disease, NYU, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile.    I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke. We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life.    It is critical to assess a patient's goals of care for a given intervention.   In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient's goals.   When is a procedure high risk, and when is it simply futile?    This is the fine line upon which many cardiologists often find themselves. The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient's goals of care.   We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia. (more…)