Author: Marie Benz MD FAAD
21 Mar Diabetic Retinopathy: OCTA May Improve Staging, Diagnosis and Monitoring
MedicalResearch.com Interview with: [caption id="attachment_33226" align="alignleft" width="133"]
Dr. Cunha-Vaz[/caption]
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.
21 Mar Cigarettes Continue To Vastly Outweigh Sales Of E-Cigarettes
MedicalResearch.com Interview with: [caption id="attachment_33206" align="alignleft" width="200"]
Kristy Marynak[/caption]
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.
21 Mar Health Care Attitudes: How Do The Generations Compare?
Posted at 22:18h
in Author Interviews
MedicalResearch.com Interview with:
[caption id="attachment_33196" align="alignleft" width="200"]
Mitch Rothschild[/caption]
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.
21 Mar Neither Vitamin E or Selenium Found To Prevent Dementia
MedicalResearch.com Interview with: [caption id="attachment_33184" align="alignleft" width="140"]
Dr. Richard Kryscio[/caption]
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).
21 Mar Critical Neural Pathways Identified in OCD Behavior
MedicalResearch.com Interview with: [caption id="attachment_33190" align="alignleft" width="133"]
Dr. Ullrich[/caption]
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.
21 Mar High risks of mortality following bleeding and ischemic events occurring 1 year after coronary stenting
MedicalResearch.com Interview with: [caption id="attachment_33174" align="alignleft" width="120"]
Dr. Eric Secemsky[/caption]
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.
21 Mar Psychiatric Side Effects of 5 Alpha Reductase Inhibitors for BPH
MedicalResearch.com Interview with: [caption id="attachment_33072" align="alignleft" width="115"]
Dr. Blayne Welk[/caption]
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.
21 Mar Discovery of New Gene That Causes Sudden Death in Young Athletes
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.21 Mar 70-Gene Signature Changes 50% of Breast Cancer Chemotherapy Advice
Posted at 00:01h
in Author Interviews, Biomarkers, Breast Cancer, Genetic Research, Journal Clinical Oncology
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.
20 Mar LGBTQ+ Youth Not As Safe At School As We Like To Think
MedicalResearch.com Interview with: [caption id="attachment_33163" align="alignleft" width="200"]
Tasseli McKay[/caption]
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.
20 Mar Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax in Mexico
MedicalResearch.com Interview with: [caption id="attachment_33159" align="alignleft" width="150"]
Dr. Shu Wen Ng[/caption]
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.
20 Mar Patients Can Expect To Return To Normal Function Relatively Quickly After Knee Arthroscopy
MedicalResearch.com Interview with: [caption id="attachment_33141" align="alignleft" width="100"]
Dr. Colvin[/caption]
Alexis Colvin, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
[caption id="attachment_33142" align="alignleft" width="100"]
Dr. Gladstone[/caption]
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.
20 Mar NSAIDS Diclofenac and Ibuprofen Associated with Increased Risk of Cardiac Arrest
MedicalResearch.com Interview with: [caption id="attachment_33131" align="alignleft" width="133"]
Dr. Søndergaard[/caption]
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.
20 Mar Instantaneous Wave-Free Ratio To Evaluate Coronary Artery Disease
MedicalResearch.com Interview with: [caption id="attachment_32970" align="alignleft" width="200"]
Dr. Matthias Götberg[/caption]
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.
19 Mar Valvular Heart Disease: Edoxaban vs Warfarin in the ENGAGE AF-TIMI 48 Trial
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.19 Mar TAVR for Bicuspid Vs. Tricuspid Aortic Valve Stenosis
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.19 Mar iFR Can Assess Need For Coronary Revascularization Without Adenosine
Posted at 23:13h
in Author Interviews, Heart Disease, Imperial College, Medical Imaging, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_33035" align="alignleft" width="149"]
Dr. Davies[/caption]
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.
19 Mar Risk Factors for Unplanned Transfer to the ICU after ED Admission
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.19 Mar Tennis Elbow: Is the Problem the Joint or the Tendon?
MedicalResearch.com Interview with: [caption id="attachment_32956" align="alignleft" width="130"]
Dr. Michael Hausman[/caption]
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.
19 Mar The Opioid Epidemic and Orthopaedic Pain Management
MedicalResearch.com Interview with: [caption id="attachment_32718" align="alignleft" width="196"]
Dr. Sommer Hammoud[/caption]
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.
19 Mar Cannabis Users Have Increased Risk of Stroke and Heart Failure
MedicalResearch.com Interview with: [caption id="attachment_33103" align="alignleft" width="140"]
Dr. Aditi Kalla[/caption]
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.
19 Mar Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RADMatrix Trial
[caption id="attachment_32906" align="alignleft" width="200"]
Dr. Marco Valgimigli[/caption]
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.
19 Mar Evolution of Surgery for Adolescent Idiopathic Scoliosis over 20 Years
MedicalResearch.com Interview with: [caption id="attachment_33134" align="alignleft" width="200"]
Dr. Baron Lonner[/caption]
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.
19 Mar Cardiovascular Procedures That Push the Line: High-Risk or Futility of Care?
MedicalResearch.com Interview with: [caption id="attachment_33090" align="alignleft" width="200"]
Dr. Adam Skolnick[/caption]
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.
19 Mar ST-Segment Elevation and Cardiac MRI in MI With Non-Obstructive Coronary Arteries
MedicalResearch.com Interview with: [caption id="attachment_33084" align="alignleft" width="133"]
Dr. Reynolds[/caption]
Harmony Reynolds, MD
Cardiologist
Saul J. Farber Associate Professor of Medicine
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study?
Response: Some patients with heart attack have open, rather than severely narrowed, coronary arteries when they have a heart attack. This type of heart attack, known as myocardial infarction with non-obstructive coronary arteries or MINOCA, can be caused by a number of different problems. Cardiac MRI is useful because it can help physicians to find the underlying cause of MINOCA.
MINOCA patients with ST elevation on the ECG are at higher risk of death than those without ST elevation but it is not known whether ST elevation correlates with any specific underlying cause of MINOCA.