About Marie Benz MD FAAD

Physician in practice over 30 years. Editor of MedicalResearch.com. All interviews conducted exclusively for MedicalResearch.com by Marie Benz, MD.

Severe Maternal Morbidity Can Be Identified, and Sometimes Prevented

MedicalResearch.com Interview with:

Joel Ray MD, MSc, FRCPC Institute of Health Policy, Management and Evaluation Faculty of Medicine University of Toronto, Toronto

Dr. Ray

Joel Ray MD, MSc, FRCPC
Institute of Health Policy, Management and Evaluation
Faculty of Medicine
University of Toronto, Toronto

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

Response: Many women who die within childbirth or soon thereafter experience rapid onset of morbidity/illness before succumbing. Thus, severe maternal morbidity (SMM) offers a detectable (or set of detectable) conditions that might be dealt with before they progress to a fatality. Even so, severe maternal morbidity alone can be non-fatal, but create disability for a new mother (e.g., a stroke), or prolong separation of mother and newborn.

So, we showed that, as the number of severe maternal morbidity indicators rises, so does the probability of maternal death. This relation was exponential in nature.   Continue reading

Racial and Gender Disparities in CABG Surgery After First Heart Attack

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology

Dr. Yandrapalli

Dr. Srikanth Yandrapalli
New York Medical College
NYMC · Cardiology

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

Response: Selection of coronary artery bypass grafting over percutaneous coronary intervention during an acute myocardial infarction is influenced by the extent of coronary artery disease and patient comorbidities. Prior studies have shown sex and racial differences in coronary artery diseaseburden.

We sought to identify if there are any sex and racial differences in the utilization of  coronary artery bypass grafting over percutaneous coronary intervention during a revascularized first  acute myocardial infarction in the US.

We found that males had a higher coronary artery bypass grafting rate than women, and compared to Whites, Blacks had lower coronary artery bypass grafting rate and Asians had higher coronary artery bypass grafting at the time of a first myocardial infarction.

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Electronic Decision Support Facilitates Home Discharge of Some PE Patients From ER

Dr-David R Vinson

Dr. Vinson

MedicalResearch.com Interview with:
David R. Vinson, MD
Department of Emergency Medicine
Kaiser Permanente Sacramento Medical Center Sacramento, CA

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

Response: At least one-third of emergency department (ED) patients with acute blood clots in the lung, or pulmonary embolism (PE), are eligible for expedited discharged to home, either directly from the ED or after a short (<24 hour) period of observation. Yet in in most hospitals in the U.S. and around the world nearly all ED patients with acute PE are hospitalized. These unnecessary hospitalizations are a poor use of health care resources, tie up inpatient beds, and expose patients to the cost, inconvenience, and risk of inpatient care. The better-performing medical centers have two characteristics in common: they help their physicians identify which PE patients are candidates for outpatient care and they facilitate timely post-discharge follow-up. At Kaiser Permanente Northern California (KPNC), we have had the follow-up system in place for some time, but didn’t have a way to help our physicians sort out which patients with acute PE would benefit from home management.

To correct this, we designed a secure, web-based clinical decision support system that was integrated with the electronic health record. When activated, it presented to the emergency physician the validated PE Severity Index, which uses patient demographics, vital signs, examination findings, and past medical history to classify patients into different risk strata, correlated with eligibility for home care. To make use of the PE Severity Index easier and more streamlined for the physician, the tool drew in information from the patient’s comprehensive medical records to accurately auto-populate the PE Severity Index. The tool then calculated for the physician the patient’s risk score and estimated 30-day mortality, and also offered a site-of-care recommendation, for example, “outpatient management is often possible.” The tool also reminded the physician of relative contraindications to outpatient management. At the time, only 10 EDs in KPNC had an on-site physician researcher, who for this study served as physician educator, study promotor, and enrollment auditor to provide physician-specific feedback. These 10 EDs functioned as the intervention sites, while the other 11 EDs within KPNC served as concurrent controls. Our primary outcome was the percentage of eligible ED patients with acute PE who had an expedited discharge to home, as defined above.

During the 16-month study period (8-month pre-intervention and 8-months post-intervention), we cared for 1,703 eligible ED patients with acute PE. Adjusted home discharge increased at intervention sites from 17% to 28%, a greater than 60% relative increase. There were no changes in home discharge observed at the control sites (about 15% throughout the 16-month study). The increase in home discharge was not associated with an increase in short-term return visits or major complications.  Continue reading

Disparities Remain But Blacks Experience Greatest All-Cause Mortality Reductions

MedicalResearch.com Interview with:

Katie Hastings MPH Stanford Medicine 

Kate Hastings

Katie Hastings MPH
Stanford University School of Medicine
Stanford, California

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

Response: Heart disease has been the leading cause of death since the early 1900s, but recent data has suggested cancer will surpass heart disease in the upcoming decades. To date, this is the first study to examine the transition from heart disease to cancer mortality as the leading cause of death by U.S. county and sociodemographic characteristics using national mortality records from 2003 to 2015.

Our main findings are:

  • Epidemiologic transition is occurring earlier in high compared to low income U.S. counties, and occurs earlier for Asian Americans, Hispanics, and NHWs compared to blacks and American Indians/Alaska Natives.
  • Data may suggest that this shift arises from larger reductions in heart disease than cancer mortality over the study period, particularly in the highest income counties.
  • Continued disparities in heart disease and cancer mortality between blacks and other racial/ethnic groups, even in the highest income quintiles. While blacks continue to have the highest overall mortality than any other group, we do show this population experienced the greatest overall improvements in mortality (i.e. mortality rate reductions over time) for all-cause, heart disease, and cancer compared to all other racial/ethnic groups (except for heart disease in Hispanics). 

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Panel of Salivary RNA Biomarkers Could Identify Autism

MedicalResearch.com Interview with:

Steven D. Hicks, M.D.,Ph.D Department of Pediatrics Penn State College of Medicine Hershey, PA

Dr. Hicks

Steven D. Hicks, M.D.,Ph.D
Department of Pediatrics
Penn State College of Medicine
Hershey, PA

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

Response: Since autism has both genetic and environmental underpinnings, my colleagues and I suspected that transcriptional elements (e.g. regulatory RNA molecules) might be different in the saliva of children with autism compared to peers without autism. We used a non-biased approach to analyze saliva from 372 children, and allowed machine learning techniques to inform which RNA elements best predicted autism status. To our surprise, microbial RNA levels and human RNA levels were equally powerful in predicting which children had autism. This may be because some children with autism eat restricted diets, resist tooth brushing, or put foreign objects in their mouths. The end result was a panel of 32 RNAs (20 human and 12 bacterial) that identified autism with 87% accuracy. Interestingly, when we tested the panel in a completely separate set of 84 children (including children from a different geographic region) the accuracy remained 88%. 

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Lower SNAP Participation by Immigrant Mothers With Young Children

MedicalResearch.com Interview with:
Allison Bovell-Ammon, M.Div. Deputy Director of Policy Strategy Children's HealthWatchAllison Bovell-Ammon, M.Div.
Deputy Director of Policy Strategy
Children’s HealthWatch

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

Response: Children’s HealthWatch was founded in 1998 by pediatric providers treating children with failure to thrive in six US cities across the country. They began their research on the health impacts of economic hardships like food insecurity in response to the 1996 welfare reform legislation after witnessing deteriorating health among young children in their clinics as a result of welfare sanctions on families.

Over the years, the scope of the research has expanded to include research on food insecurity, housing instability, energy insecurity, health care hardships, and child care constraints. Through our current network of pediatricians and public health researchers in five US cities (Boston, Baltimore, Little Rock, Minneapolis, and Philadelphia), we seek to improve the health and well-being of children under age 4 and their families by informing policies that address and alleviate economic hardships. Our ongoing data collection in emergency departments and primary care clinics enables us to rapidly respond to emerging public health issues as policies and economic conditions change. While we have produced other papers and analyses specifically addressing health and economic disparities relevant to immigrant families, we were specifically interested in exploring this topic because the clinicians in our group as well as national media began anecdotally reporting that immigrants were forgoing accessing critical public health programs like SNAP out of fear.

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Brain Metastases: Stereotactic Radiation vs Surgery Compared

MedicalResearch.com Interview with:

Dr. Stephanie E. Weiss MD FASTRO Chief, Division of Neurologic Oncology Associate Professor, Department of Radiation Oncology Director, Radiation Oncology Residency and Fellowship Training Program Fox Chase Cancer Center Philadelphia, Pennsylvania

Dr. Weiss

Dr. Stephanie E. Weiss MD FASTRO
Chief, Division of Neurologic Oncology
Associate Professor, Department of Radiation Oncology
Director, Radiation Oncology Residency and Fellowship Training Program
Fox Chase Cancer Center
Philadelphia, Pennsylvania

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

Response: Brain metastasis are the most common form of brain tumor.

Historically all patients received whole brain radiation as the primary therapy. Patients required neurosurgery to remove lesions if there was a question of diagnosis, what the diagnosis is and if there was a mass effect not relieved with steroids. Surgery was also indicated for patients with a single brain lesion because this offers a survival benefit over just receiving whole brain radiotherapy.

In 2003 a randomized trial proved that radiosurgery offers a similar benefit. So the question taxing patients and doctors at tumor boards since has been: which is better? If neurosurgery is superior, we are under-treating a lot of patients with radiosurgery. If radiosurgery is superior, we are subjecting a lot of patients to unnecessary brain surgery. Attempts to study this in a head-to-head randomized trial have failed. Patient and physician preference for one treatment or the other has proven to be a barrier to randomization and accrual. The EORTC 22952-2600 trial was originally designed to compare outcomes with and without whole brain radiation for patients receiving surgery or radiosurgery for brain metastasis.

We used this as the highest-quality source data available to compare local control of brain metastasis after surgery or radiosurgery, adjusted for by receipt or not of whole brain radiation.   Continue reading

Spring Daylight Savings Time Linked to More AFib Admissions

MedicalResearch.com Interview with:
sunset copyright American Heart AssociationJay Chudow, M.D.

Montefiore Medical Center
Bronx, New York

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

  • Others found associations between daylight saving time transitions and sleep duration, sleep quality, workplace injuries and traffic accidents. Regarding cardiovascular health, studies in Europe and the United States have found an increased incidence of acute myocardial infarction and ischemic stroke in the days following daylight saving time transitions.
  • Our study found a significant increase in admissions for atrial fibrillation following the daylight saving time spring transition compared to the yearly average (average of 3.13 vs 2.56 admissions per day over the Monday to Thursday period). No significant difference was found following the autumn transition.
  • These findings add atrial fibrillation as a known condition associated with daylight saving time transitions. It adds to the knowledge base of negative health consequences of daylight saving time. 

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Over 8% of Americans Expressed Distress About Having Difficulty Controlling Their Sexual Urges and Behaviors

MedicalResearch.com Interview with:
"Sex in stone" by Nagarjun Kandukuru is licensed under CC BY 2.0Janna A Dickenson, PhD

Doug Braun-Harvey Postdoctoral Fellow
Program in Human Sexuality
Department of Family Medicine
University of Minnesota Medical School

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

Response: Researchers and clinicians have contested the term “sex addiction” in favor of alternative definitions and symptom presentations. Recently, the ICD-11 has characterized compulsive sexual behavior disorder (CSBD) as a persistent pattern that involves failing to control intense sexual urges or sexual behaviors that results in significant levels of distress and/or impairment in one’s functioning.

Researchers estimate that CSBD affects 2-6% of the population and is much more common among cisgender men than cisgender. Using a randomized national sample, we assessed the prevalence of a key feature of CSBD that researchers and clinicians agree upon: distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors.

We performed this assessment with a screening tool called the Compulsive Sexual Behavior Inventory (CSBI). Of the 2,325 adults, 8.6 percent overall (10.3 percent of individuals who identified as men and 7 percent of individuals who identified as women) met the clinical threshold of the CSBI; meaning that 8.6% of people expressed difficulty controlling their sexual feelings, urges and behaviors and experienced distress and/or impairment as a result. To be clear, this does not mean the 8.6% of the sample endorsed CSBD, but that 8.6% of our sample exhibited significant distress or impairment related to difficulty controlling one’s sexual behaviors.

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Age-Related Hearing Loss Linked to Dementia, Depression, Heart Attacks and Stroke

MedicalResearch.com Interview with:

David Loughrey PhD Atlantic Fellow for Equity in Brain Health Global Brain Health Institute DeafHear Research Partner NEIL Programme Trinity College Institute of Neuroscience

Dr. Loughrey

David Loughrey PhD
Atlantic Fellow for Equity in Brain Health
Global Brain Health Institute
DeafHear Research Partner
NEIL Programme
Trinity College Institute of Neuroscience

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

Response: The World Organisation (WHO) estimate that one-third of older adults aged 65 and over have a disabling hearing loss. Increasingly, research is finding that age-related hearing loss (ARHL) may be associated with other negative health outcomes, including dementia which currently affects 50 million people worldwide.

A study recently published in The Lancet reported that of nine possible modifiable risk factors, addressing age-related hearing loss (ARHL) could potentially lead to the largest reduction in the prevalence of dementia globally.

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Should Patients with Hypertrophic Cardiomyopathy Ride Roller Coasters?

MedicalResearch.com Interview with:

Nikolaos Papoutsidakis, M.D., Ph.D. Associate Research Scientist, Yale University School of Medicine New Haven, CT 

Dr. Papoutsidakis

Nikolaos Papoutsidakis, M.D., Ph.D.
Associate Research Scientist,
Yale University School of Medicine
New Haven, CT 

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

Response: Lifestyle education is a significant part of Hypertrophic Cardiomyopathy management. HCM patients, who frequently have to abstain from intense athletics, often ask if such restrictions extend to thrill-seeking activities they previously enjoyed, such as rollercoaster rides. Werealized there is very little data on this topic, which prompted us to set up this study.

We found that for Hypertrophic Cardiomyopathy patients who elected to participate in thrill-seeking activities, adverse events (defined as losing consciousness or experiencing a shock from an implantable cardioverter-defibrillator) were rare. We also asked patients (participating and non participating) about advice received from their physician on this topic. We found that, probably due to the lack of data, physicians often avoid providing advice or provide conflicting advice regarding participation in thrill seeking activities.  Continue reading

Estrogen Receptors More Versatile and Widespread Than Previously Recognized

MedicalResearch.com Interview with:
"Mammogram" by slgckgc is licensed under CC BY 2.0Prof. Cathrin Brisken MD, PhD

ISREC, School of Life Sciences
Ecole Polytechnique Fédérale (EPFL)
CH-1015 Lausanne, Switzerland 

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

Response: Estrogen receptor signaling has been well characterized in various in vitro models, like breast cancer cell lines.  Understanding estrogen receptor action in complex in vivo context is much more challenging.

We obtained elegant mouse models in which either all estrogen receptor function or specifically either the hormone dependent (AF-2) or the hormone independent (AF-1) function were ablated. Using the mammary glands from these mice we performed tissue recombination studies to discern the role of the different aspects of estrogen receptor signaling in the mouse mammary epithelium and its different cell populations.

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Is Social Media Making You Depressed and Lonely?

MedicalResearch.com Interview with:
Melissa G. Hunt, Ph.D. Diplomate - Academy of Cognitive Therapy Chair - PENDELDOT Associate Director of Clinical Training Department of Psychology University of PennsylvaniaMelissa G. Hunt, Ph.D.

Diplomate – Academy of Cognitive Therapy
Chair – PENDELDOT
Associate Director of Clinical Training
Department of Psychology
University of Pennsylvania


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

Response: Lots of prior research has established a correlation, or association, between social media use and depression.  Ours is the first study to establish an actual causal relationship between using more social media, and feeling more depressed.   Continue reading

Eat Carbs in the Morning, Fat at Night?

MedicalResearch.com Interview with:
"Compare-the-Use-of-Carbohydrates-and-Lipids-in-Energy-Storage" by Zappys Technology Solutions is licensed under CC BY 2.0Kirsi-Marja Zitting, Ph.D.

Instructor in Medicine, Harvard Medical School
Division of Sleep and Circadian Disorders
Departments of Medicine and Neurology
Brigham and Women’s Hospital
Boston, MA 02115

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

Response: This study is a follow-up study to our previous study where we found that chronic insufficient sleep together with chronic jet lag is associated with adverse changes in metabolism, including increase in blood sugar levels (Buxton et al. Science Translational Medicine, 2012). The present study focuses on the influence of the time of day on metabolism, which has not been investigated in humans independent of the effects of sleep, physical activity and diet.

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Tonsillectomy Often Done When Not Indicated (and vice versa!)

MedicalResearch.com Interview with:

A pair of tonsils after surgical removal Wikipedia image

A pair of tonsils after surgical removal
Wikipedia image

Tom Marshall, MSc, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham, Birmingham, UK

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

Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea).

Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems.

Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.

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Which Questionnaires Best Reflect Dry Eye Symptoms?

MedicalResearch.com Interview with:
Jennifer P. Craig, Associate Professor

Department of Ophthalmology
New Zealand National Eye Centre
Auckland, New Zealand

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

Response: Dry eye disease is a complex multi-factorial condition, which affects between 5% to 50% of the adult population in different parts of the world. The condition can have profound effects on the ocular comfort, visual function, and quality of life of sufferers. In both clinical practice and academic research settings, validated questionnaires are frequently used to screen for dry eye symptomology, before clinical assessment of tear film homeostatic markers is conducted to make an overall diagnosis of dry eye disease.

Although a large number of validated symptomology questionnaires has previously been developed, the recently convened Tear Film and Ocular Surface Dry Eye Workshop II (TFOS DEWS II) identified that the considerable heterogeneities in the study populations, methodologies, and reference standards used in earlier diagnostic accuracy studies introduced significant challenges when trying to compare the diagnostic performance of these screening instruments.

The current study is the first to offer a direct comparison of five commonly used validated questionnaires within the same study population, and uses the global consensus criteria for tear film homeostatic disturbance developed by the TFOS DEWS II as the reference standard.

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South Pacific Island Nation First Country to Ban Environmentally Harmful Sunscreens

MedicalResearch.com Interview with:
"Protect Coral Reefs" by NOAA's National Ocean Service is licensed under CC BY 2.0Ariel Kushmaro and Esti Kramarsky-Winter
Department of Biotechnology Engineering, Ben Gurion University
Beer Sheva, Israel

The Republic of Palau, a South Pacific island nation, became the world’s first country to ban sunscreen products containing environmentally harmful ingredients

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

Response: Coral reefs are important ecosystems that are under threat due to global human driven climate change. In addition to global changes, local hazards such as point pollution by eutrophication, dredging and chemical pollution are exacerbating and promoting reef destruction at local levels. This destruction affects not only island nations that depend on these reefs for protection and livelihood, they affect humanity as a whole as they are an important source for food and novel drugs and new materials.

Our recent studies have shown that chemicals found in most commercial sunscreens and creams used to protect humans from deleterious effects of UV A and UVB wash off into the environment are persistent, have endocrine disruptive effects, and thus deleteriously affect marine organisms including corals.  Continue reading

About 20% of Women With Earlier Stage Breast Cancer Progress to Metastatic Disease Within 20 Years

MedicalResearch.com Interview with:

Angela Mariotto PhD Chief of the Data Analytics Branch  Surveillance Research Program (SRP) Division of Cancer Control and Population Sciences National Cancer Institute 

Dr. Mariotto

Angela Mariotto PhD
Chief of the Data Analytics Branch
Surveillance Research Program (SRP)
Division of Cancer Control and Population Sciences
National Cancer Institute (NCI

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

Response: Progressing to metastatic breast cancer (MBC) is one of the major concerns for women diagnosed with early-stage breast cancer. Before our study there were no reliable numbers on risk of metastatic breast cancer recurrence after a (non-metastatic) breast cancer diagnosis, as registries do not routinely collect this data.

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Cystic Fibrosis Patients May Need Higher Doses of Antibiotics To Clear Lung Infections

MedicalResearch.com Interview with:

Andrea Hahn, M.D., MS Infectious disease specialist and lead study author Children's National Health System

Dr. Hahn

Andrea Hahn, M.D., MS
Infectious disease specialist and lead study author
Children’s National Health System

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

Response: People who have the genetic disease cystic fibrosis have increased sticky secretions in their lungs that put them at risk for repeated bacterial infections. They often will receive courses of intravenous antibiotics to treat more severe or difficult-to-treat infections associated with decreased lung function. However, not all patients fully recover their lung function after antibiotic treatment, despite directing antibiotic therapy toward the specific bacteria thought to be causing the infection. The goal of this study was to determine if the pharmacokinetics of commonly used antibiotics was associated with recovery of lung function.

First, we found that patients with therapeutic blood levels of beta-lactam antibiotics had better lung recovery than patients with sub-therapeutic levels of these antibiotics.

Second, we found that using higher antibiotic dosing according to Cystic Fibrosis Foundation guidelines was not sufficient to predict which patients would have therapeutically meaningful blood levels of antibiotics. Continue reading

Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions

MedicalResearch.com Interview with:

Nicholas S. Reed, AuD Assistant Professor | Department of Otolaryngology-Head/Neck Surgery Core Faculty  | Cochlear Center for Hearing and Public Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health

Nicholas Reed AuD

Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty  | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health

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

 

Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.

MedicalResearch.com: What are the main findings? 

Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.

Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss.  Continue reading

No Detectable Developmental Issues in Children Exposed to Anesthesia and Surgery

MedicalResearch.com Interview with:
"Anesthesia" by Liran Szeiman is licensed under CC BY-NC-ND 4.0James D. O’Leary, MD

Department of Anesthesia and Pain Medicine,
Child Health Evaluative Sciences
The Hospital for Sick Children
Department of Anesthesia, University of Toronto
Toronto, Ontario, Canada

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

Response: There is substantial evidence from laboratory studies that the developing brain is susceptible to injury from general anesthetic drugs, which culminated in the US Food Drug Administration issuing a safety communication in 2017 stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. Considering the substantial number of children who require general anesthesia every year (almost 3 million in the US annually) even small differences in child development outcomes after surgical procedures that require general anesthesia may have significant public health implications.

Undertaking studies of anesthesia-related neurotoxicity in humans is difficult as adverse child development is a function of the complex interaction between many risk and protective factors. By examining differences between biological siblings in Ontario, Canada, this study seeks to mitigate differences in risk from biological vulnerability and environmental factors, to provide a more accurate estimate of the adverse effects of anesthesia and surgery on child development.

In the current study, young children who had surgical procedures that require general anesthesia were not found to be at increased risk of adverse child development outcomes compared to their biological siblings who did not have surgery. These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes. Continue reading

Daily Drinking is Dangerous

MedicalResearch.com Interview with:
“Alcohol” by Jorge Mejía peralta is licensed under CC BY 2.0Sarah Hartz, MD PhD

Assistant Professor
Department of Psychiatry
Washington University School of Medicine in St. Louis

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

Response: This study is the first to show that daily drinking is dangerous. Specifically, drinking four or more times weekly, even if it’s only 1-2 drinks at a time, increases risk of mortality. This is in line with recent studies published in the Lancet, but we were able to break down their lowest drinking categories (up to 12.5 drinks weekly in one and up to 5.6 drinks weekly in the other) and found that the frequency is important, not just the average number of drinks per week. It looks like the increased mortality is predominantly due to cancer-related deaths.

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TBI: U.S. Territory Veterans Have Greater Mortality Risk Than Mainland Vets

MedicalResearch.com Interview with:
Clara E. Dismuke-Greer, PhD
Health Equity and Rural Outreach Innovation Center
Ralph H. Johnson Department of Veterans Affairs Medical Center
Charleston, SC 29401

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

Response: The background for this study is that previous research we had published had shown that Hispanic U.S. Veterans diagnosed with Traumatic Brain Injury (TBI) had higher risk of mortality than non-Hispanic White U.S. Veterans, even after accounting for the effects of comorbidities as well as socio-demographics. This study sought to investigate further this apparent racial/ethnic disparity.

Using a 10 year cohort followed for up to 14 years, and adjusting for TBI severity as well as comorbidities, socio-demographics and military factors, when we included location (urban vs. rural vs. highly rural vs. U.S. Territory (Puerto Rico, U.S. Virgin Islands, Guam, America Samoa and Mariana Islands), as well as race/ethnicity, we found that the racial/ethnic disparity disappeared, and that it was location which became statistically significant.

Our main findings were that Veterans diagnosed with TBI residing in U.S. Territories have lower survival and higher risk of mortality relative to Veterans residing on the U.S. Mainland , even after statistical adjustment for the factors listed above.

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New Drug Class Holds Promise Against Antibiotic Resistant Gonorrhea

MedicalResearch.com Interview with:

Intracellular Gram-negative, Neisseria gonorrhoeae diplococcal bacteria, - CDC image

Intracellular Gram-negative, Neisseria gonorrhoeae diplococcal bacteria, – CDC image

Edward W. Hook, III, MD
University of Alabama at Birmingham
Medicine / Infectious Diseases
Birmingham, AL

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

Response: Zoliflodacin represents a new class of antibiotics (spiropyrimidinetriones) with in vitro activity against Neisseria gonorrhoeae, as well as other STD  pathogens (Chlamydia trachomatis and Mycoplasma genitalium).  Because of this promising data and the fact that the manufacturer (Entasis Pharmaceuticals) was willing to pursue the possibility of using this drug to treat gonorrhea, a Phase II trial was conducted which showed he drug to be 96% effective for genital or rectal infections.  The drug was well tolerated as well making it a promising drug for gonorrhea treatment which might help to combat the increasing problem of antibiotic resistant gonorrhea.  Continue reading

For Most Patients, Tennis Elbow is Self-Limiting

MedicalResearch.com Interview with:

Amin Mohamadi, MD, MPH Research Fellow Harvard Medical School Center for Advanced Orthopaedic Studies Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Mohamadi

Amin Mohamadi, MD, MPH
Research Fellow
Harvard Medical School
Center for Advanced Orthopaedic Studies
Beth Israel Deaconess Medical Center
Boston, MA 02215 

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

Response:  “Tennis elbow” is a painful conditions caused by overuse of the tendons in the forearm, typically in a patient’s dominant arm. Overuses syndromes are resulted from repetitive stress injury without signs of inflammation. Tennis elbow afflicts more than 200,000 new patients in the United States every year, which is not only limited to athletes, but also laborers, food industry workers, manufacturers and office workers – anyone who uses the hands and wrists for hours each day. In addition, many clinicians and scientists believe that tennis elbow is a self-limited condition in which, the majority of patients will be symptom-free after a period of time. However, no meta-analysis has evaluated this notion.

Numerous treatments are available for patients to alleviate their pain and restore their pain-free grip strength but few high quality trials and meta-analyses have compared these treatments. In this largest meta-analysis to date, we compared results of 11 different treatment modalities evaluated in 36 randomized to identify if any of these treatments are more effective and safer than the others. Overall,  2746 patients were evaluated in our meta-analysis and we found that all of the evaluated treatments only showed a modest effect, at best , on pain relief and strength of grip. While there was only modest effect for some treatments, all of interventions increased risk of adverse events in comparison with placebo and none of them seemed to be safer than others.

In the next step we were curious to find out what will be outcome of patients who were treated with only placebo, a pill or injection without effective medication or sham treatment— when the therapeutic device was not turned on. Interestingly, we found that across all of clinical trials,  totally 92% of patients experienced substantial pain relief after a month of receiving only placebo or sham treatment. 

MedicalResearch.com: What should readers take away from your report?

Response: Our results imply that for most patients, tennis elbow is a self-limiting condition.  Based on this analysis, our overall recommendation is “wait and see”. However, for some groups “wait and see” may not be a feasible option, so we recommend for these groups an intervention that is most effective in short-term. Because almost all patients reported only minimal pain after the first four weeks, clinicians treating patients with tennis elbow may consider opting for a pain relief regimen to manage symptoms on a patient-to-patient basis. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should investigate the outcome rest in comparison with those who continued their actives with same intensity. There are also some evidence showing particular exercises may be beneficial and finally future research can identify if any particular patients group are at higher risk for none pain resolutions.  

MedicalResearch.com: Is there anything else you would like to add?

Response: We evaluated almost all of the non-surgical treatments available for tennis elbow and showed that they provide only minimal effect over placebo. For example corticosteroids were more effective than placebo within the first 4 weeks but this effect was transient and did not seem to be effective after 4 weeks. In addition, 47 patients would be needed to get corticosteroid injections so that only 1 less patient suffer from pain compared with those who received placebo.

Citation:

Jayson Lian, Amin Mohamadi, Jimmy J. Chan, Phillip Hanna, David Hemmati, Aron Lechtig, Ara Nazarian. Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. The American Journal of Sports Medicine, 2018; 036354651880191 DOI: 10.1177/0363546518801914 

Nov 7, 2018 @ 9:28 pm

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