Author: Marie Benz MD FAAD
11 Aug Pancreatic Cancer Study Finds Abraxane Superior to Paclitaxel
MedicalResearch.com Interview with: [caption id="attachment_26931" align="alignleft" width="200"]
Dr. Rajesh Kumar NV[/caption]
Rajesh Kumar NV, Ph.D.
Instructor of Oncology and Pathology
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Current Affiliation: Senior Manager, Human Therapeutics Division, Intrexon Corporation, 20358 Seneca Meadows Parkway, Germantown, MD, USA
MedicalResearch.com: What is the background for this study?
Response: Pancreatic cancer remains as one of the most deadly malignancies in the world. Recently, a cremophor-free and albumin-bound formulation of paclitaxel (nab-PTX, Abraxane) in combination with gemcitabine (GEM, Gemzar) is recently approved as a standard of care treatment option for patients with metastatic pancreatic cancer. Majority of the newly diagnosed pancreatic cancer patients use the nab-PTX plus GEM regimen. Currently there are over 100 clinical trials at various stages with this regimen as a backbone to approved medicines or investigational agents. Since widely available cremophor-based paclitaxel (PTX, Taxol) is a key chemotherapy component for the treatment of several human malignancies and the treatment cost of nab-PTX is relatively higher than PTX, patients, clinicians, third party payers and regulatory agencies have a substantial interest in understanding whether these two drugs provide a similar level of therapeutic efficacy in pancreatic cancer.
We utilized orthotopic models of human pancreatic cancer, which were shown to better recapitulate the histologic and metastatic characteristics of disease, and compared the anticancer efficacy, effect on tumor stroma modulation, metastatic spreading to distant organs and survival following GEM, PTX, nab-PTX and combinations of GEM plus PTX or nab-PTX. The preclinical trial used a total of 300 mice with established orthotopic pancreatic tumors. The tumors used for implantation were originally resected from the primary tumors of patients with moderately differentiated and poorly differentiated pancreatic cancer.
11 Aug Pulsed Electric Field Therapy May Reduce Unwanted Scar Formation
MedicalResearch.com Interview with: Alexander Golberg, PhD Senior Lecturer Head of Environmental Bioengineering Laboratory Porter School of Environmental Studies Tel Aviv University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wound care costs the U.S. healthcare system more than $20 billion each year, and care required to combat skin scarring represents an additional $12 billion burden. Hypertrophic scarring after trauma and burn injury remains a major clinical challenge that leads to physical, aesthetic, functional, psychological, and social stresses in thousands of patients. This is a stubborn clinical problem very difficult to solve. Inspired by previous works that pulsed electric fields kill cells precisely in tissue (procedure called irreversible electroporaiton, developed by UC Berkeley group of Boris Rubinsky and Rafael Davalo) and these ablated tissues regenerate with minimal scarring, we decided to test whether pulsed electric fields can reduce the scar formation if we treat the wound during healing. We found that partial irreversible electroporation using 200 pulses of 250 V and 70 µs duration, delivered at 3 Hz every 20 days during a total of five therapy sessions after the initial burn injury resulted in a 57.9% reduction of the scar area in comparison with untreated scars and structural features approaching those of normal skin. Noteworthy, unlike humans, rats do not develop hypertrophic scars. Therefore, the use of a rat animal model is the limiting factor of this work.11 Aug Inflammation is An Important Feature of Uveal Melanoma
MedicalResearch.com Interview with: [caption id="attachment_26912" align="alignleft" width="150"]
Dr. Ulrich Pfeffer[/caption]
Ulrich Pfeffer, PhD
Laboratory of Molecular Pathology
Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The melanoma of the eye or uveal melanoma is well controlled by radiotherapy or surgery but very aggressively growing metastases often develop and therapy has only marginally improved in decades. On the other hand, uveal melanoma is probably the best studied cancer in absolute: we know its development in great detail and we can make very precise prognosis. An important piece of information that is lacking is the effect of a chromosomal alteration, amplification of a part of chromosome 6, that is often encountered in a subset of uveal melanomas that show features of bad prognosis but actually perform better. Many have guessed that the immune system or more generally, inflammation might protect uveal melanomas with this alteration from progression to metastasis. Therefore we have set out to analyze a candidate gene, the putative immunomodulatory BTNL2, that is located on chromosome 6. We found highly variable expression of this gene in uveal melanoma samples where it is expressed by tumor cells and by infiltrating immune cells. The type of infiltrate is strongly associated with the risk to develop metastases. We also analyzed genetic variants of BTNL2 in 209 patients but we could not find a significant association with uveal melanoma risk.
10 Aug Unsafe levels of toxic chemicals found in drinking water for six million Americans
Posted at 12:51h
in Author Interviews, Brigham & Women's - Harvard, Environmental Risks, Toxin Research
MedicalResearch.com Interview with:
[caption id="attachment_26899" align="alignleft" width="133"]
Dr. Courtney Carignan[/caption]
Courtney C. Carignan PhD
Research Fellow
Department of Environmental Health
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We used mapping technology coupled with drinking water data from EPA to identify military bases, airports, industrial sites, and wastewater treatment plants as major sources of PFOS and PFOA contamination in drinking water. These measurements suggest that at least six million people have drinking water that exceeds the recent EPA health advisorylevels for PFOA and PFOS.
These are chemicals that have been historically manufactured in the US and used widely in consumer products such as stain-proof carpeting, non-stick pans and aqueous firefighting foam. They have been replaced with new generation of shorter-chain fluorinated chemicals, which also do not break down in the environment and may be similarly toxic.
10 Aug Volunteering in Mid and Old Age Linked To Better Mental Health
MedicalResearch.com Interview with: [caption id="attachment_26773" align="alignleft" width="180"]
Dr. Faiza Tabassum[/caption]
Dr. Faiza Tabassum, PhD
Southampton Statistical Sciences Research Institute
University of Southampton
Southampton, UK
MedicalResearch.com: What is the background for this study?
Response: Previous research has shown that volunteering in older age is associated with better mental and physical health, but it’s unclear whether this extends to other age groups. We aimed to examine the association of volunteering with mental health or well-being among the British population across all ages.
The British Household Panel Survey (BHPS) was used which has collected information from 1991 to 2008 from over 5000 households. The published study has analysed over 66,000 responses representing the whole of the UK. The BHPS included a wide range of questions on leisure time activities, which covered the frequency of formal volunteering—from at least once a week through to once a year or less, or never. The BHPS also included a validated proxy for mental health/emotional wellbeing known as the GHQ-12.
10 Aug US Task Force Reviews Lipid Screening For Children and Adolscents
MedicalResearch.com Interview with: [caption id="attachment_26893" align="alignleft" width="142"]
Dr. Paula Lozano[/caption]
Paula Lozano, MD MPH
Associate Medical Director, Research and Translation
Group Health Physicians
Senior Investigator
Group Health Research Institute
Metropolitan Park East
Seattle, WA 98101
MedicalResearch.com: What is the background for this study?
Response: This wasn’t a study, but rather a study of studies, to support the US Preventive Services Task Force in updating its previous recommendation of
I: insufficient to assess the balance of benefits and harms. We conducted two systematic evidence reviews of screening children and adolescents:
1. for familial hypercholesterolemia (FH, a genetic disorder that interferes with the body’s ability to metabolize cholesterol and can result in early coronary heart disease); and
2. for multifactorial dyslipidemia—which we defined as elevated LDL cholesterol or total cholesterol, not caused by familial hypercholesterolemia. LDL and total cholesterol were of interest because they are considered atherogenic.
One of the challenges of lipid screening in youth is that blood levels of these atherogenic lipids are known to fluctuate during the course of childhood and adolescence. It’s sort of a W-shaped curve, with a peak at age 9-11 years. So for a given child, the definition of what’s an elevated LDL or total cholesterol level will change with age. Also, two-thirds of kids identified as having high cholesterol through universal screening would not go on to have high cholesterol as adults.
10 Aug Clinical Course of Diabetic Kidney Disease Has Changed Over Past 30 Years
MedicalResearch.com Interview with: [caption id="attachment_26816" align="alignleft" width="133"]
Dr. Ian de Boer[/caption]
Ian de Boer, MD, MS
Associate Professor of Medicine
Adjunct Associate Professor of Epidemiology
Division of Nephrology and Kidney Research Institute
University of Washington, Seattle, WA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: From the perspective of patients with diabetes, kidney disease can be a devastating complication, leading to end stage renal disease requiring dialysis or kidney transplantation and markedly increasing the risks heart disease, stroke, peripheral vascular disease, and amputation. From a public health perspective, diabetes is the most common cause of end stage renal disease in the US, so understanding, preventing, and treating diabetic kidney disease is critical to reduce the numbers of people needing dialysis and kidney transplants. There have been major changes in the treatment of patients with diabetes over the last 30 years, so we were interested in evaluating how diabetic kidney disease was changing in this context.
We observed that the clinical manifestations of kidney disease have indeed changed among US adults with diabetes over the last 30 years. Albuminuria, or elevated levels of albumin in the urine, has traditionally been thought of as the first evidence of kidney damage for people with diabetes. Reduced GFR, or a reduced ability of the kidneys to filter out waster products, has typically been thought of as a late stage of diabetic kidney disease. But from 1988 to 2014, we saw a significant decrease in the prevalence of albuminuria accompanied by a significant increase in reduced GFR.
10 Aug Counterfeit Xanax Contained Toxic Amounts of Opioid Fentanyl
MedicalResearch.com Interview with: Ann M. Arens, MD California Poison Control Center San Francisco, CA 94110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prescription opioid abuse is a significant public health threat that has garnered the attention of health care providers throughout medicine. With efforts to curb the number of prescriptions for opioid pain medications, users may begin to purchase prescription medications from illegal sources. Our study reports a series of patients in the San Francisco Bay Area who were exposed to counterfeit alprazolam (Xanax®) tablets found to contain large amounts of fentanyl, an opioid 100 times more potent than morphine, and in some cases etizolam, a benzodiazepine. The California Poison Control System – San Francisco division identified eight patients with unexpected serious health effects after exposure to the tablets including respiratory depression requiring mechanical ventilation, pulmonary edema, cardiac arrest, and one fatality. Patients reportedly purchased the tablets from drug dealers, and were unaware of their true contents. In one case, a 7 month-old infant accidentally ingested a counterfeit tablet dropped on the floor by a family member.10 Aug Apical Periodontitis Significantly Associated With Cardiovascular Diseases
MedicalResearch.com Interview with: [caption id="attachment_26880" align="alignleft" width="100"]
Dr. John Liljestrand[/caption]
John Liljestrand, DDS
Department of Oral and Maxillofacial Diseases
University of Helsinki
MedicalResearch.com: What is the background for this study?
Response: There is an increased amount of evidence supporting the hypothesis that oral inflammations increase the risk for cardiovascular diseases (CVDs). The association between marginal periodontitis, a common inflammatory disease in the tooth supporting tissues, and CVDs is well established. The link is thought to depend on transient but repeated bacteremia, endotoxemia and an increased systemic inflammatory burden.
Apical periodontitis is a common manifestation of an endodontic infection, most often caused by dental caries. It is an inflammatory reaction surrounding the root tip of a tooth and it restrains the dental infection from spreading into the bone. Apical periodontitis is similar to marginal periodontitis regarding its microbial profile and ability to increase systemic inflammatory markers. Therefore, it is justified to suggest that apical periodontitis might also increase the risk for CVDs. There is only a minor amount of publications on this topic and further research is still needed.
10 Aug Altruistic Men May Get More Sex
MedicalResearch.com Interview with: [caption id="attachment_26876" align="alignleft" width="205"]
Dr. Steven Arnocky[/caption]
Steven Arnocky, PhD
Associate Professor
Department of Psychology
Nipissing University
North Bay, ON CAN
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our work was based on previous findings from hunter-gatherer populations showing that men who hunt and share meat often enjoy greater reproductive access to women. Research in North America has shown that individuals prefer altruistic partners, especially for long-term mating, and that there may be a sex difference in these preferences such that women exhibit this preference more strongly than men. In line with this, some research has shown that men will sometimes compete with other men in order to make charitable donations to attractive female fundraisers (termed 'competitive altruism'). Taken together, these findings led us to hypothesise that individuals (and perhaps particularly men) who behave altruistically might experience greater mating success.
In Study 1, undergraduate men and women completed a self-report altruism questionnaire (items such as “I have donated blood”), a personality measure, and a sexual history survey. We found that participants who scored higher on a self-report altruism measure reported they were more desirable to the opposite sex, as well as reported having more sex partners, more casual sex partners, and having sex more often within relationships. Moreover, altruism mattered more for men’s number of lifetime and casual sex partners relative to women’s.
Given the possibility that in any survey research, there is a chance individual’s may report their altruism of sexual history in what they view to be a more positive light (who doesn’t want to think of themselves as altruistic!), in Study 2, we used a behavioral measure of altruism (each participant was entered onto a draw for $100, and at the end of the survey was given the choice to keep their winnings or to donate to a charity). Participants again reported on their sexual histories, as well as completed a personality measure, a scale to capture socially-desirable responding, and a measure of narcissism. Results showed that even when controlling for these potentially confounding variables, that altruists reported having more lifetime sex partners, more casual sex partners, and more sex partners over the past year. Men who were willing to donate also reported having more lifetime dating partners.
10 Aug Abnormal Microbiome Found in Preterm Infants Who Develop Chronic Lung Disease
[caption id="attachment_26871" align="alignleft" width="139"] Dr. Lal[/caption] MedicalResearch.com Interview with: Charitharth ‘Vivek' Lal, MD Assistant Professor, Division of Neonatal-Perinatal Medicine, Departments of Pediatrics University of Alabama at Birmingham Birmingham, AL 35249-7335 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Airway microbiome of neonates, at birth, has not been studied. Also, association of airway...
09 Aug Preconception Counselling Resource Improves Pregnancy Care in Women With Diabetes
MedicalResearch.com Interview with: [caption id="attachment_26855" align="alignleft" width="174"]
Dr. Valerie Holmes[/caption]
Dr Valerie Holmes
Senior Lecturer
Centre for Public Health
School of Medicine, Dentistry and Biomedical Science
Queen's University Belfast
Belfast
MedicalResearch.com: What is the background for this study?
Response: Women with diabetes, type 1 diabetes and type 2 diabetes, are advised to plan for pregnancy as there are higher risks of complications for both the mother and baby when compared to the general maternity population. Careful planning in partnership with diabetes care teams, especially in relation to achieving optimum blood glucose control and taking folic acid can significantly reduce the risks. However, while most women know that they should plan for pregnancy, they are unaware as to why this is important or how to engage with the process, and thus the majority of women (up to two thirds of women) enter pregnancy unprepared. This study describes the implementation of a regional preconception counsellng resource, in the format of a DVD, into routine care in Northern Ireland to raise awareness of pregnancy planning. The authors assessed if the introduction of this resource improved pregnancy planning among women with diabetes in the region.
09 Aug Interventions To Decrease Frequent ED Use May Be Effective But Best Strategies Not Clear
MedicalResearch.com Interview with: Jessica Moe MD, MA, PGY5 FRCPC Emergency Medicine, University of Alberta MSc (Candidate) Clinical Epidemiology MedicalResearch.com: What is the background for this study? What are the main findings? Response: Frequent visitors are common in many urban emergency departments (ED). They represent high resource-utilizing patients; additionally, existing literature demonstrates that they experience higher mortality and adverse health outcomes than non-frequent ED users. Interventions targeting frequent ED users therefore may potentially prevent adverse outcomes in this high risk patient group. The purpose of this study was to provide an up-to-date review of the existing literature on the effectiveness of interventions for adult frequent ED users. This systematic review summarizes evidence from 31 interventional studies. The majority evaluated case management and care plans; a smaller number of studies examined diversion strategies, printout case notes, and social work visits. Overall, the studies were considered to have moderate to high risk of bias; however, 84% of before-after studies found that ED visits significantly decreased after the intervention. Additionally, studies examining interventions for homelessness consistently found that interventions improved stable housing. Overall, effects on hospital admissions and outpatient visits were unclear. In summary, the available evidence is encouraging and suggests interventions targeted towards frequent ED users may be effective in decreasing ED visit frequency and improving housing stability.09 Aug Young Children At High Risk of Chemical Eye Burns
[caption id="attachment_26785" align="alignleft" width="142"]
Dr. R. Sterling Haring[/caption]
MedicalResearch.com Interview with:
R. Sterling Haring, DO, MPH
Center for Healthcare Quality and Patient Safety
University of Lugano, Switzerland
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Chemical burns of the eye are among the most serious and emergent of eye injuries. In the worst cases, corrosive chemicals can eat into the eye and damage internal structures, rendering the individual with little or no vision in the affected eye. Given the proximity of the eyes to one another, it is not uncommon for these injuries to be bilateral, further complicating the clinical picture.
Working-age individuals, particularly men, are known to be a high-risk group for these types of injuries. In the first nationwide study on this issue, we found that 1-year old infants were at substantially higher (1.5x) risk of these injuries than the highest-risk age group among adults; 2-year-olds were a close second. These injuries tapered off as children grew older, such that the risk among 1-year-old infants was 13 times higher than that of 7-year-old children. Across all ages, injuries occurred most frequently among lower-income households.
09 Aug CareSkore Allows Hospitals To Do Risk Analysis and Care Planning in Real Time
MedicalResearch.com Interview with:
CareSkore co-founders:
Dr. Puneet Dhillon Grewal MD
CareSkore co-founder and Chief Medical Officer
Dr. Grewal is an Internal Medicine physician and Cardiologist. She had completed her residency from Rosalind Franklin University of Medical Science, and is currently a Cardiology Fellow at the same institution and
Jaspinder Grewal, MBA CareSkore co-founder and Chief Executive Officer,
a graduate from the University of Chicago Booth School of Business and a computer engineer. He has 13 years of experience working with large health systems , managing technology and operations.
MedicalResearch.com: What is the background for the CareSkore company? What is its mission and objectives?
Response: The Affordable Care Act, through penalties and bundled payments, requires hospitals and providers to be accountable for the quality of care they provide. For example, if a patient is readmitted to the hospital within 30-days after discharge, hospital reimbursement is reduced, and in many cases not paid at all.
In order to improve the quality of care, hospitals need to understand the clinical risk of patients, so that they can focus efforts on the patient most likely to face adverse events. The three biggest areas of improvement are readmissions, over utilization of services, and hospital acquired conditions (such as pneumonia and surgical site infections).
09 Aug ACEI and ARBs Had Similar Outcomes in Study of PD Dialysis Patients
MedicalResearch.com Interview with: [caption id="attachment_26841" align="alignleft" width="200"]
Dr. Jenny Shen[/caption]
Jenny Shen, MD, MS
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
Los Angeles Biomedical Institute at Harbor-UCLA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With cardiovascular disease being the No. 1 cause of death in end-stage kidney disease patients on peritoneal dialysis, we examined two classes of medications commonly prescribed to prevent cardiovascular events in these patients and found no significant difference in outcomes.
The two classes of medications, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB), have slightly different mechanisms and could theoretically have differing outcomes. Previous studies had suggested that ACEI may lead to a kinin-mediated increase in insulin sensitivity not seen with ARB. This could potentially lower the cardiovascular risk in patients on peritoneal dialysis because they are exposed to high glucose loads in their dialysate that may lead to insulin resistance and its associated cardiovascular risk.
Using a national database, the U.S. Renal Data System, we surveyed records for all patients enrolled in Medicare Part D who initiated maintenance peritoneal dialysis from 2007 to 2011. Of those, we found 1,892 patients using either drug class. Surveying their medical records, we found no difference in cardiovascular events or deaths between the users for each class of medication.
09 Aug Walk-In Appointments Improved Access To Psychiatric Care
Posted at 00:57h
in Author Interviews, Brigham & Women's - Harvard, Mental Health Research, Primary Care
MedicalResearch.com Interview with:
[caption id="attachment_26837" align="alignleft" width="120"]
Dr. David Kroll[/caption]
David S. Kroll, MD
Harvard Medical School
Department of Psychiatry
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our primary care clinic has the capacity to provide 9 psychiatry evaluations per week, but before we started this project nearly half of the evaluation appointments went unused due to no-shows, and meanwhile the waiting time was two months. We had tried appointment reminders but this had very little impact on the problem—it turns out that forgetting is only a small part of why patients miss their appointments and that instead they have competing obligations—family, housing, legal, etc. Since the traditional model of scheduling and keeping appointments wasn’t working for so many patients, we implemented a referral-based walk-in clinic instead and found that this significantly increased the number of patients who were seen while virtually eliminating our wait list.
08 Aug Vitamin D Levels Fall When Estrogen-Containing Birth Control Pills Stopped
MedicalResearch.com Interview with: [caption id="attachment_26830" align="alignleft" width="100"]
Dr. Quaker Harmon[/caption]
Quaker Harmon M.D., Ph.D.
Epidemiology Branch
National Institute of Environmental Health Sciences
Research Triangle Park, NC 27709
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Vitamin D is important for bone health. In the United States many women are vitamin D deficient. Vitamin D does not naturally occur in many foods, however some foods are fortified with vitamin D. Supplements and sunshine are the most reliable sources of vitamin D.
Previous studies suggested that women using birth control pills containing estrogen had higher levels of vitamin D. These studies were generally small and were not always able to examine important factors such as time spent outside. We were interested in examining the association between hormonal contraception and vitamin D levels in a larger group of women.
We found that women who use estrogen-containing contraception had a 20% increase in their vitamin D levels. This increase was not due to time spent outside or behaviors related to choice of contraception. The magnitude of increase for hormonal contraception was smaller than for regular use of a supplement containing vitamin D.
08 Aug Health Benefits of Insurance Coverage Under ACA Become More Apparent With Time
MedicalResearch.com Interview with: [caption id="attachment_24380" align="alignleft" width="123"]
Dr. Benjamin D. Sommers[/caption]
Benjamin D. Sommers, M.D., Ph.D
Assistant Professor of Health Policy & Economics Department of Health Policy & Management
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine Division of General Medicine & Primary Care
Brigham & Women’s Hospital / Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches - vs. not expanding at all - in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident - the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).
08 Aug New Anti-Diabetic Compound May Avoid Bone Loss Seen With Current Medications
MedicalResearch.com Interview with: [caption id="attachment_26825" align="alignleft" width="133"]
Dr. Patrick Griffin[/caption]
Patrick Griffin, PhD
Professor
Department of Molecular Therapeutics
The Scripps Research Institute Florida Campus
MedicalResearch.com: What is the background for this study?
Response: Over the past decade, our laboratory and that of TSRI Associate Professor Theodore Kamenecka, have focused on molecules that increase sensitivity to insulin. Using newly discovered information, we have made significant advances in developing a family of drug candidates that target a receptor known as peroxisome proliferator-activated receptors gamma (PPARγ), a key regulator of stem cells controlling bone formation and bone resorption and a master regulator of fat.
08 Aug ICU Care May Lead To More Tests and Costs Without Necessarily Better Outcomes
Posted at 17:47h
in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA
MedicalResearch.com Interview with:
Dong W. Chang, MD, MS
Dong W. Chang, MD, is a lead researcher at LA BioMed, one of the nation’s leading independent nonprofit research institutes. His research interests include improving the delivery of care to patients with a focus on identifying new healthcare models for reducing hospital re-admission. He also is the director of Medical-Respiratory ICU at Harbor-UCLA Medical Center in Torrance
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage. They found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU.
The study, published in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary:diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions.
Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU.
08 Aug Traditional Non-Medicaid Insurance Associated With Earlier Testicular Cancer Diagnosis
Posted at 17:35h
in Author Interviews, Brigham & Women's - Harvard, Cancer Research, Cost of Health Care
MedicalResearch.com Interview with:
Sarah C. Markt, ScD, MPH
Research Associate
Harvard T.H. Chan School of Public Health | Department of Epidemiology
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Response: Age is associated with insurance status, with the greatest proportion of uninsured between the ages of 20 to 34 years. For testicular cancer this is important because the median age of diagnosis is 33 years and the majority of the cases are diagnosed between then ages of 20 and 44 years. Previous studies have shown that people with cancer who are uninsured are more likely to present with worse disease, less likely to receive treatment, and are more likely to die of their disease, compared with those who have private insurance. Furthermore, the associations between Medicaid coverage and cancer outcomes have been conflicting.
08 Aug Sickle Cell Trait Not Associated With Increased Mortality in Military Population
MedicalResearch.com Interview with: D. Alan Nelson, MPAS, PhD Postdoctoral research fellow Stanford Medicine MedicalResearch.com: What is the background for this study? Response: The study was inspired by the uncertainty surrounding sickle cell trait (SCT) and its association with serious exertional collapse events and mortality in active populations. I conducted initial, exploratory analyses on these topics in 2014-15 while examining a range of military readiness predictors and outcomes. The early work indicated that the risk of mortality, rhabdomyolysis and other exertional events arising from SCT might be substantially lower than that suggested by prior work in the research literature. Dr. Lianne Kurina and I decided to conduct further, focused study at the Stanford University School of Medicine to confirm or refute these findings. In considering best approaches, we noted that there was an absence of prior research in which the sickle cell trait status of an entire, large, physically-active study population was known. This limitation could introduce bias to inflate the apparent impact of a theorized predictive factor. Aside from the challenges in studying the impact of SCT on exertional outcomes, with respect to prevention, a further concern is that sickle cell trait is a non-modifiable trait. If it were a serious risk factor for rhabdomyolysis and/or mortality, despite careful exertional injury precautions such as those employed by the Army, this might present great challenges for prevention efforts. To maximize the potential for new research to provide actionable prevention information, our interests included examining a range of modifiable risk factors for rhabdomyolysis. Dr. Kurina and I have employed large, longitudinal military datasets for about five years to examine critical military health outcomes, making this study a natural progression of our joint work. The research proceeded with the support of the Uniformed Services University of the Health Sciences, and in cooperation with a distinguished group of experts who co-authored the paper and advised the project. The study was conducted using de-identified records of all SCT-tested African American US Army soldiers on active duty during 2011 - 2014 (N = 47,944).08 Aug Newly Diagnosed Brugada Syndrome Have a Different Prognosis
MedicalResearch.com Interview with: Ruben Casado-Arroyo, MD, PhD Heart Rhythm Management Center Cardiovascular Division, UZ Brussel–Vrije Universiteit Brussel, Cardiology Department, Arrhythmia Section Erasmus Hospital, Université Libre de Bruxelles Brussels, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study is to evaluate the evolution of the presentation of Brugada Syndrome (BrS) during the last 30 years. Only the first diagnosed patient of each family was included. The database was divided in two periods (early and latter group) in relation to the consensus conference of 2002. Aborted sudden death as the first manifestation of the disease occurred most frequently in the earlier period 12.1% versus 4.6% of the latter group. Inducibility (induction of ventricular fibrillation) during programmed electrical stimulation was achieved in 34.4% (earlier) and 19.2% (latter) of patients, respectively. A spontaneous type 1 electrocardiogram pattern that is a coved type ST elevation with at least 2 mm (0.2 mV) J-point elevation a gradually descending ST segment followed by a negative T-wave was presented at diagnosis 50.3% (earlier) versus 26.2% (latter patients). Early group patients had a higher probability of a recurrent arrhythmia (sudden cardiac death or ventricular arrhythmias) during follow-up (19%) than those of the latter group (5%). All these difference were significative. Overall, the predictors of recurrent arrhythmias were previous sudden cardiac death and inducibility. In the latter period, only previous sudden cardiac death was a predictor of arrhythmic events.06 Aug EKG Plus Framingham Score Improves Risk of Cardiovascular Disease
MedicalResearch.com Interview with: [caption id="attachment_26683" align="alignleft" width="133"]
Dr. Amit Shah[/caption]
Dr. Amit J. Shah MD MSCR
Research Assistant Professor
Assistant Professor of Epidemiology
Rollins School of Public Health
Emory University
Adjunct appointment in Medicine (Cardiology)
Atlanta VA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Nearly ½ of sudden cardiac deaths occur in individuals who were not aware that they had heart disease; this increases the need for primary prevention. We studied whether the electrocardiogram could be a useful tool in helping to measure risk of cardiovascular disease in approximately 10,000 community-based adults aged 40-74 with a simple risk equation that is based on age, sex, and 3 numbers from the ECG: heart rate, T-axis, and QT interval. We found that such an equation estimates risk as well as the Framingham risk equation, which is the standard of care (based on traditional risk factors like smoking and diabetes). When combining both the Framingham and ECG risk assessments together, the accuracy improved significantly, with a net 25% improvement in the risk classification of cardiovascular death compared to using the Framingham equation alone.
06 Aug Optune as Standard Treatment Option for Newly Diagnosed Glioblastoma
Novocure is the developer of Optune, which uses Tumor Treating Fields to treat cancer. Tumor Treating Fields, or TTFields, are low intensity, alternating electric fields within the intermediate frequency range. TTFields disrupt cell division through physical interactions with key molecules during mitosis. This non-invasive treatment targets solid tumors. MedicalResearch.com: What is the background for this study? What are the main findings? Response: The National Comprehensive Cancer Network (NCCN) has recommended Optune as a standard treatment option for newly diagnosed glioblastoma (GBM) in its Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Central Nervous System Cancers. NCCN panel members designated Optune together with temozolomide as a category 2A treatment for newly diagnosed GBM for patients with good performance status, indicating uniform consensus among panel members to add Optune to the guidelines for newly diagnosed GBM. Optune has been included in the NCCN Guidelines as a category 2B treatment option for recurrent GBM since 2015. The recommendation follows the publication of Novocure’s EF-14 phase 3 pivotal trial data in The Journal of the American Medical Association (JAMA) in December, 2015. The EF-14 phase 3 pivotal trial demonstrated that adding TTFields to maintenance temozolomide chemotherapy significantly prolonged progression-free and overall survival in newly diagnosed GBM. Glioblastoma, also called glioblastoma multiforme, or GBM, is a type of primary brain cancer. Approximately 12,500 GBM tumors, or tumors that may transform into GBM, are diagnosed in the U.S. each year. GBM is the most common type of primary brain cancer in adults. It is more likely to appear in older adults and to affect men than women. GBM is one of the deadliest forms of cancer, with patients typically not surviving beyond 15 months after diagnosis.06 Aug IV Iron Administered Post-Op May Improve Surgical Outcomes
MedicalResearch.com Interview with: Clinical Professor Alhossain A.Khalafallah Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Senior Staff Specialist Launceston General Hospital, Australia MedicalResearch.com: What is the background for this study? Response: 1. Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting up to one third of the population worldwide. 2. Prevalence of anaemia in orthopaedic surgery ranges between 10-20% with the main cause of anaemia identified as nutritional deficiency. 3. New intravenous iron preparations have been developed at a higher purchase price than oral iron. Iron carboxymaltose, as one example, remains underutilised in the treatment of perioperative anaemia. 4. To our knowledge, this study is the first to compare the efficacy, safety and long term effect on iron stores and length of hospital stay in the postoperative anaemia setting.06 Aug Before Children Enter Kindergarten, They Need To Know How to Count
MedicalResearch.com Interview with: [caption id="attachment_26788" align="alignleft" width="133"]
Dr. David Geary[/caption]
David C. Geary, Ph.D.
Curators’ Distinguished Professor
Thomas Jefferson Fellow
Department of Psychological Sciences
Interdisciplinary Neuroscience Program
University of Missouri
Columbia, MO
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In an earlier study, we found that children’s understanding of numbers and the relations among them (e.g., that 6 = 5 + 1 & 4 + 2 & 3 + 3…) at the beginning of 1st grade predicted their performance on math measures in adolescence, controlling IQ, working memory, family background and other factors. These are measures that predict employability and wages in young adults and thus is practically important. We were interested in understanding the very early quantitative knowledge that predicts children’s later number knowledge. We tested children on a variety of quantitative measures 2 years before they entered kindergarten and in kindergarten gave them the same type of number test that we used in the first study. We found that 3 year olds' cardinal knowledge was critical to their later understanding of number relations, controlling IQ and many other factors. Cardinal knowledge is their understanding of the quantities associated with number words. So, if you ask a child to give you 3 toys, and they give you a handful, they do not understand what ‘three’ means. Young children with poor knowledge of number words, we at risk for poor math outcomes in kindergarten, controlling other factors.
06 Aug Obesity Linked To Prematurely Aged Brains
MedicalResearch.com Interview with: [caption id="attachment_26781" align="alignleft" width="153"]
Dr. Lisa Ronan[/caption]
Dr. Lisa Ronan, PhD
Department of Psychiatry
University of Cambridge Neuroscience
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A growing body of literature relates common markers of aging to those observed in obesity and supports the hypothesis that obesity may accelerate or advance the onset of brain aging. To investigate this relationship at a population level we analysed the white matter volume of the brain in 473 adult subjects ages 20 - 87 years and contrasted these volumes between subjects who were lean (BMI between 18.5 - 25) and those who were overweight / obese (BMI > 25).
Our results suggest that the latter group had significantly smaller white matter volumes when compared to their lean age-matched counterparts. We found that this difference in volume equated to a brain-age increase of 10 years in the overweight / obese group. We found no evidence that obesity impacted on cognitive ability.