Author: Marie Benz MD FAAD
03 Nov Vitamin D and May Improve Exercise Performance
MedicalResearch.com Interview with:
Dr Emad Al-Dujaili
Reader in Biochemistry and Nutrition,
Queen Margaret University
Department of Health Science
Queen Margaret University
Medical Research: What is the background for this study? What are the main findings?
Dr. Al-Dujaili: Recent studies have implicated vitamin D deficiency as a risk factor for Cardiovascular disease and its deficiency is a potential biological predictor of increased rates of CVD. We have done 2 earlier studies investigating the effects of Vitamin D intake on Blood pressure and the stress hormone level cortisol and found that people taking the supplement of Vitamin D had reduced systolic and diastolic blood pressure compared to those who took the placebo. Vitamin D deficiency has also been associated with hypertension, obesity, diabetes mellitus and oxidative stress and reduced exercise performance. For instance, the Framingham offspring study proved that low levels of vitamin D are independently related to Cardiovascular disease incidence. In this placebo-controlled study, We have observed that people given 50ug of Vitamin D daily for 2 weeks showed a significantly reduced systolic and diastolic blood pressure, reduced urinary free cortisol (the hormone that produces stress and high blood pressure if its levels are high. Moreover, the distance cycled in 20 minutes significantly increased by 30% with slightly less efforts compared with that before Vitamin D supplement.
03 Nov Diners Ignoring Calorie Counts At Fast Food Restaurants
[caption id="attachment_19026" align="alignleft" width="144"]
Dr. Brian Elbel[/caption]
MedicalResearch.com Interview with:
Brian Elbel, PhD MPH
Associate professor, Department of Population Health
NYU Langone Medical Center and at
NYU’s Wagner Graduate School of Public Service
Medical Research: What is the background for this study? What are the main findings?
Dr. Elbel: Since New York City implemented in 2008 its mandatory calorie counts in all chain restaurants, including in fast-food eateries, public health officials and the general public have wondered what impact it’s having on curbing the obesity epidemic gripping the nation and the city.
An estimated third of adult Americans are obese (with a body mass index of 30 or more), and that number is expected to rise to 42 percent by 2030, among the highest of any country in the developed world.
Our study looks at the effects of so-called calorie counts some six years out from when the law took effect. Between 2013 and 2014, a team of NYU Langone researchers analyzed the receipts of some 7,699 diners at fast-food restaurants in NYC and in nearby NJ cities to see if the menu labels reduced the overall number of calories that consumers of fast food order and presumably eat. Our research team compared calories consumed at fast-food eateries with and without calorie labels.
Researchers found that the average number of calories bought by patrons at each sitting between 2013 and 2014 was statistically the same as those in a similar survey we conducted in 1,068 fast-food diners in 2008, when New York City initially imposed menu labeling. Diners were surveyed at major fast-food chains: McDonald’s, Burger King, KFC, and Wendy’s.
Calorie counts in the 2013-2014 analysis averaged between 804 and 839 per meal at menu-labeled restaurants, and between 802 and 857 per meal at non-labeled eateries; whereas, they averaged 783 per meal for labeled restaurants and 756 per meal for non-labeled restaurants shortly after the policy was introduced.
For the surveys, diners entering the fast-food restaurant were asked to return their itemized receipt to research assistants and answer some follow-up questions in person in exchange for two dollars.
Our study suggests that menu labeling, in particular at fast-food restaurants, will not on its own lead to any lasting reductions in calories consumed.
03 Nov Patients with Colon Cancer May Have Memory and Cognitive Impairments
Posted at 01:03h
in Author Interviews, Cancer Research, Cognitive Issues, Journal Clinical Oncology, Memory
[caption id="attachment_19020" align="alignleft" width="141"]
Dr. Vardy[/caption]
MedicalResearch.com Interview with:
Dr Janette Vardy BMed (Hons), PhD, FRACP
A.Prof of Cancer Medicine
University of Sydney
Medical Oncologist ,Concord Cancer Centre
Concord Repatriation & General Hospital
Concord, Australia
Medical Research: What is the background for this study?
Dr. Vardy: Many patients complain that their memory and concentration is not as good after chemotherapy. Most of the studies have been in younger women with breast cancer, and are often limited by small sample sizes and short term follow up. This is the largest longitudinal cohort study assessing impacts of cancer and its treatment on cognitive function.
We evaluated changes in cognitive function in 289 men and women with localized colorectal cancer (CRC), comparing those who received chemotherapy to those who did not require chemotherapy, 73 with metastatic disease, and a group of 72 healthy controls.?The localized CRC patients were assessed at baseline (soon after diagnosis and prior to any chemotherapy), 6, 12 and 24 months. The healthy controls and metastatic group were assessed at baseline, 6 and 12 months. We also examined underlying mechanisms.
03 Nov How Often Should Patients With Familial Colorectal Cancer Risk Be Screened?
[caption id="attachment_19022" align="alignleft" width="201"]
Dr. Vasen[/caption]
MedicalResearch.com Interview with:
Hans F.A. Vasen, MD
Department of Gastroenterology
Leiden University Medical Center and
Netherlands Foundation for the Detection of Hereditary Tumours
Leiden, the Netherlands
Medical Research: What is the background for this study?
Dr. Vasen: People with familial colorectal cancer (CRC) have a 3-6 fold increased risk of
colorectal cancer. It has been estimated that about 2% of the population have familial CRC (about 2.7 million people in the US). Previous studies showed that colonoscopic surveillance reduces the CRC-mortality by >80%. In people with hereditary CRC, i.e., Lynch syndrome (10 fold increased risk of CRC), an intensive screening program with colonoscopy 1x/1-2 years, is recommended. In familialcolorectal cancer, the optimal screening program is unknown.
Medical Research: What are the main findings?
Dr. Vasen: In this randomized trial with 528 individuals at risk for familial CRC, we compared screening intervals of 3 and 6 years. We found that patients had significant more high-risk adenomas (precursor lesions of CRC) at 6-years-follow-up compared to at 3-years-follow-up. However, because of the relatively low rate of high-risk adenomas at 6 years (7%) and the absence of colorectal cancer in the 6-years group, we consider a 6-year-interval safe.
03 Nov Children Have Lower Risk of Asthma In Home With Dog
[caption id="attachment_18950" align="alignleft" width="133"]
Dr. Tove Fall[/caption]
MedicalResearch.com Interview with:
Dr. Tove Fall, PhD
Associate Professor in Epidemiology
Ingelsson Group
Upssala University
Medical Research: What is the background for this study? What are the main findings?
Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies.
03 Nov Chemotherapy-induced Peripheral Neuropathy Linked To Cognitive Dysfunction In Breast Cancer Patients
Posted at 00:17h
in Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, Cognitive Issues
MedicalResearch.com Interview with:
Kelly N. H. Nudelman, Ph.D.
Department of Radiology and Imaging Sciences
Indiana University-Purdue University Indianapolis (IUPUI)
Indianapolis, IN 46202
Medical Research: What is the background for this study?
Dr. Nudelman: Varying levels of cognitive problems and related changes in brain structure and function have been reported in breast cancer patients treated with chemotherapy. Pain has also been associated with altered brain structure and function. However, the association of chemotherapy-induced peripheral neuropathy (CIPN), a side-effect of chemotherapy treatment characterized by nerve damage primarily in the extremities, has not been specifically investigated for association with cognitive symptoms in breast cancer. We used data from a prospective, longitudinal breast cancer cohort to investigate the relationship of CIPN and neuroimaging measures of cognitive dysfunction.
Medical Research: What are the main findings?
Dr. Nudelman: We found that increased chemotherapy-induced peripheral neuropathy symptoms were associated with resting brain blood flow increase in regions known to be involved in pain processing. We also found that decreased frontal lobe gray matter density was correlated with these changes, suggesting a link between chemotherapy-induced peripheral neuropathy and cognitive dysfunction.
02 Nov Statins May Dampen Efficacy of Flu Vaccination
[caption id="attachment_18978" align="alignleft" width="142"]
Dr. Saad Omer[/caption]
MedicalResearch.com Interview with:
Saad Omer MBBS MPH PhD
Associate Professor Emory Vaccine Center
Associate Professor Global Health and Epidemiology
Rollins School of Public Health
Emory University
MedicalResearch: Can you give us a little background on this study?
Dr. Omer: My background is in global health, epidemiology and pediatrics and I have been fortunate to conduct field and clinical vaccine trials in a number of countries and with multiple infectious diseases including influenza, polio, measles and pneumococcal vaccines.
We were familiar with the data on investigating the potential effects of statins on other infections i.e. sepsis and community acquire pneumonia including
Dr. Vandermeer’s study in 2012 suggesting that “statin use may be associated with reduced mortality in patients hospitalized with influenza”.
Statins have lipid-lowering effects but they also exhibit anti-inflammatory and immunomodulatory properties. For lack of a better image, I think of statins as acting like a ‘big hammer made of Jell-O’: they have a broad, small dampening effect on immune response (as opposed to a narrow or deep effect).
01 Nov No Link Found Between Macrolide Antibiotics and Birth Defects
MedicalResearch.com Interview with:
Anick Bérard PhD FISPE
Research chair FRQ-S on Medications and Pregnancy
Director, Réseau Québécois de recherche sur le médicament (RQRM)
Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy, University of Montreal
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine
Medical Research: Should we have any reservations about prescribing these macrolides during pregnancy?
Dr. Bérard: With penicillin, macrolides are amongst the most used medications in the general population and in pregnancy. However, debate remained on whether it is the infections or in fact the macrolides used to treat them that put women and their unborn child at greater risk of adverse pregnancy outcomes, including birth defects.
Our study was performed within the Quebec Pregnancy Cohort, one of the largest pregnancy cohorts in the World, and did not find a statistically significant association between macrolide use (a widely used class of antibiotics) during pregnancy and the risk of malformations. When looking at specific types of macrolides, no association was found between azithromycin, clarithromycin or erythromycin use during the first trimester of pregnancy and the risk of major malformations or cardiac malformations. This is reassuring when treating infections during pregnancy.
31 Oct Immunotherapy May Ward Off Fall Asthma Attacks in Predisposed Children
[caption id="attachment_18959" align="alignleft" width="135"]
Dr. Stephen Teach[/caption]
MedicalResearch.com Interview with:
Stephen J. Teach, MD, MPH
Chair, Department of Pediatrics
Children's National Health System
Washington, DC
Medical Research: What is the background for this study? What are the main findings?
Dr. Teach: Inner-city children aged 6 to 17 years with moderate to severe asthma continue to experience exacerbations at high rates during the fall season despite therapy which follows the guidelines of the National Institutes of Health. These exacerbations are most common among children with a history of prior exacerbations and sensitivities to common indoor allergens who develop an upper respiratory infection with the common cold virus (rhinovirus). The PROSE study found that treatment with omalizumab begun 4 to 6 weeks before the children return to school, significantly reduced exacerbations of asthma in the first 90 days of the school year. This effect was most dramatic among those children who had experienced an exacerbation in the months preceding the beginning of the school year. Omalizumab is an antibody which binds and deactivates the IgE antibody. The IgE antibody serves as the basis for allergic sensitivity.
31 Oct Handheld Probe Scans For Breast Cancer Without Compression or Radiation
MedicalResearch.com Interview with: Anuradha Godavarty PhD and Dr. Sarah J Erickson-Bhatt PhD Dept of Biomedical Engineering, Florida International University Miami, FL Medical Research: What is the background for this study? What are the main findings? Response: It is well known that early detection and staging of breast cancer is crucial in order to save lives. While the current gold standard for breast cancer screening is x-ray mammography, this method still misses many cancers especially in younger women with denser tissue. Our group and others have explored diffuse optical tomography using near-infrared light to image breast tumors. We have developed a unique optical imager with a hand-held probe that can contour to breast curvature in order to image the tissue without painful compression and without ionizing radiation (like x-rays). This study demonstrated the ability of the device to detect lesions in breast cancer patients due to elevated levels of total hemoglobin concentration in tumor vasculature. The hand-held has a potential to not only image the breast contours, but the probe was flexible to image the surrounding chest wall regions, thus expanding its application to image lymphatic spread as well.30 Oct Having A Primary Care Doctor Does Not Reduce ER Visits For Women’s Health Issues
[caption id="attachment_18885" align="alignleft" width="192"]
Dr. Sacchetti[/caption]
MedicalResearch.com Interview with:
Alfred Sacchetti, M.D.
Department of Emergency Medicine
Our Lady of Lourdes Medical Center, Camden, NJ
Thomas Jefferson University, Philadelphia, PA
Medical Research: What is the background for this study?
Dr. Sacchetti: Much of the value of the "Affordable Care Act" is based on the concept that a primary care provider will limit the need for Emergency Department visits. Unfortunately, this has never been proven, particularly for women's health issues. The purpose of our study was to determine if a relationship with a primary care provider did limit the need to access Emergency Department services.
Medical Research: What are the main findings?
Dr. Sacchetti: What our results demonstrated was that patients with a primary care Obstetrical / Gynecologic provider utilized the emergency department to the same extent as patients without a documented primary OB/GYN relationship. Patients with women's health issues still required the services of the ED, even with an established primary care provider. What was very interesting was that Emergency Department use was not restricted to off hours in the evenings and on weekends. In fact the use of the ED occurred as much during the 9-5 hours on the weekdays as it did during other times. The majority of the ED visits were for ambulatory complaints, with most patients being discharged to home after their care.
30 Oct Diabetes: Study Compares Gliptins vs Sulfonylureas as Add-Ons to Metformin
[caption id="attachment_18935" align="alignleft" width="157"]
Dr. Yung-Tai Chen[/caption]
MedicalResearch.com Interview with:
Dr. Yung-Tai Chen MD
Division of Nephrology
Department of Medicine
Taipei City Hospital
Heping Fuyou Branch
Taipei, Taiwan
Medical Research: What is the background for this study? What are the main findings?
Dr. Chen: Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors can provide glycemic control but also raised concerns about the risk of heart failure in patients with Type 2 Diabetes Mellitus (T2DM). However, large-scale studies of the effects of DPP-4 inhibitors versus sulfonylureas (SUs) on cardiovascular outcomes when used as add-ons to metformin therapy remain scarce. Our study showed that compared to SUs, DPP-4 inhibitors were associated with a lower risk of all-cause mortality, stroke and hypoglycemia as an add-on to metformin. Besides, dipeptidyl peptidase-4 inhibitors had comparable risks of hospitalization for heart failure to sulfonylureas as add-ons to metformin.
30 Oct Electronic Health Records Linked To Only Slightly Better Medical Care
[caption id="attachment_18882" align="alignleft" width="120"]
Dr. Enriquez[/caption]
MedicalResearch.com Interview with:
Jonathan R. Enriquez, MD
Assistant Professor of Medicine
Division of Cardiology
University of Missouri- Kansas City
Director, Coronary Care Unit
Truman Medical Center
Medical Research: What is the background for this study?
Dr. Enriquez:
- In 2009, U.S. legislation appropriated tens of billions of dollars to promote the use of electronic health records (EHRs).
- Approximately 4 million hospitalizations for cardiovascular diagnoses occur annually in the U.S., which are more hospitalizations than for any other category of disease. Therefore, evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.
30 Oct Earlier Isotretinoin Discussion May Decrease Long-Term Antibiotic Use For Acne
[caption id="attachment_18899" align="alignleft" width="185"]
Dr. Nagler[/caption]
MedicalResearch.com Interview with:
Arielle Nagler MD
Instructor, Department of Ronald O. Perelman Department of Dermatology
NYU Langone Medical Center
Medical Research: What is the background for this study of acne patient who eventually require isotretinoin?
Dr. Nagler: Isotretinoin is a highly effective medication for the treatment of severe acne. In fact, it is the only medication that has been shown to provide patients with a durable cure for acne. However, its use is limited by its known teratogenicity as well as controversies regarding its relationship with psychiatric disturbances and inflammatory bowel disease. For many patients, systemic antibiotics provide an effective treatment for inflammatory acne. However, antibiotics do not provide the long term clearance that isotretinoin provides. Moreover, antibiotics are getting increasing attention due to fears of emerging bacterial resistance. There has been a recent emphasis on limiting antibiotic use in acne. As a result, this study sought to understand antibiotic use patterns amongst patients who eventually received isotretinoin.
30 Oct End of Life Home Care Nursing Reduces Emergency Department Visits
MedicalResearch.com Interview with:
Dr. Hsien Seow, PhD
Associate Professor Department of Oncology
Cancer Care Ontario Research Chair in Health Services Research
Associate Member, Department of Clinical Epidemiology & Biostatistics
McMaster University
Canadian Institutes of Health Research Young Investigator
Hamilton, Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Seow: Despite being commonplace in healthcare systems, little research has described the effectiveness of publicly-provided generalist homecare nursing to reduce unnecessary acute care use at end-of-life, such as emergency department (ED) visits. It is also unclear how homecare nursing intent, which varies by standard care or end-of-life, affects this relationship. Our study examined a population-based cohort of cancer decedents in Ontario, Canada who used homecare nursing in their last six months of life. Specifically, we examined the relationship between homecare nursing rate in a given week on the ED visit rate in the subsequent week. In our cohort of 54,576 decedents, there was a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week. Homecare nursing for those who are receving end of life care will find that it can provide immediate assistance when needed.
30 Oct Which High School Sports Have Highest Risk of ACL Injury?
MedicalResearch.com Interview with: Alex L. Gornitzky Medical Student and Theodore J. Ganley, M.D. Director of Sports Medicine, The Children’s Hospital of Philadelphia Associate Professor of Orthopaedic Surgery, The University of Pennsylvania School of Medicine Medical Research: What is the background for this study? Response: Currently, more than half of all high school students participate in organized athletics, and with increasing participation the incidence of ACL injury and subsequent reconstruction are also rising. Furthermore, researchers also know that adolescent and high school athletes have a number of unique risk factors that differentially affect their ACL injury risk profile as compared to older and/or more experienced athletes. To our knowledge, however, no previous studies have described sport-specific seasonal risk for ACL tears in the high school athlete by gender and by sport. More specifically, parents and athletes currently have no available information to more accurately define what their personal risk is for such an important and devastating injury. Therefore, the purpose of our study was to pool data from across the literature in order to objectively quantify an average high school athlete’s risk for ACL injury per season across a variety of varsity-level sports. If a student is injured while playing sports and the school doesn't deal with the injury correctly then it could make the issue worse. This is why it is important for schools to correctly identify is the player has suffered an ACL injury. If you have suffered an injury at school that wasn't properly dealt with then you may want to check out someone like these new york personal injury lawyers to see if you can get compensation. This study will hopefully help students see the risk of them getting an injury meaning they can take measures to prevent one happening to them. Medical Research: What are the main findings? Response: Overall, there is an approximately 1.6 times greater rate of ACL tear per athletic exposure in high school female athletes as compared to males. On a per-season basis, the highest risk sports in females were soccer, basketball and lacrosse at 1.1%, 0.9% and 0.5% risk of ACL tear per athletic season. Comparatively, in males, the highest risk sports were football, lacrosse and soccer at 0.8%, 0.4% and 0.3% risk of ACL tear per athletic season. Looking further at the year-round, multi-sport athlete, this may correspond to either a 2.5% risk per-year or 10% risk per high school career for the female athlete who participates in soccer, basketball and lacrosse, or 1% and 4%, respectively, for the male athlete who plays football, basketball and baseball.30 Oct Why do “Smokers Drink and Drinkers Smoke” ?
[caption id="attachment_18932" align="alignleft" width="120"]
Dr. Thakkar[/caption]
MedicalResearch.com Interview with:
Mahesh Thakkar, Ph.D.
Associate professor and director of research
School of Medicine's Department of Neurology
Missouri University
Medical Research: What is the background for this study? What are the main findings?
Dr. Thakkar: It is well known that “smokers drink and drinkers smoke.” The question is why. In our previous research, we had observed that alcohol promotes sleepiness by inhibiting the brain region known as the basal forebrain. So we asked, “Does nicotine override alcohol-induced inhibition and activate the basal forebrain?” This study was performed to address these questions. The main finding of this study is that nicotine, when co-used with alcohol, attenuates alcohol-induced sleepiness by overriding alcohol-induced inhibition of the basal forebrain region.
30 Oct Counting Bites Instead Of Calories Can Lead To Weight Loss
[caption id="attachment_18929" align="alignleft" width="142"]
Dr. West[/caption]
MedicalResearch.com Interview with:
Joshua H. West, Ph.D., MPH
Department of Health Science
Brigham Young University
Provo, UT 84602
Medical Research: What is the background for this study? What are the main findings?
Dr. West: Americans consume too much food. Yet most of our focus is on the qualitative aspects of food. Overconsumption of ‘good’ food can also negative outcomes. Most diets are confusing, costly to the individual, and difficult to adhere to. Even counting calories can be cumbersome and time-consuming. We found that participants lost weight by prioritizing worrying less about what they were eating and simply reducing how much they were eating, as estimated using a bite counting method.
30 Oct Brains of Men and Women More Similar Than Different
MedicalResearch.com Interview with:
Lise Eliot PhD
Associate Professor of Neuroscience
Chicago Medical School
Rosalind Franklin University
North Chicago, IL 60064
Medical Research: What is the background for this study?
Dr. Eliot: The hippocampus participates in many behaviors that differ between men and women, such as episodic memory, emotion regulation, and spatial navigation. Furthermore, the hippocampus is known to atrophy in diseases such as depression, anxiety disorders, and Alzheimer's disease, all of which are more prevalent in women. It is conceivable that a premorbid difference in hippocampal volume contributes to females' greater vulnerability. In the scientific literature, the hippocampus is often said to be proportionally larger in females than males. We set out to test this by doing a systematic review of the literature for hippocampal volumes in matched samples of healthy males and females, measured using structural MRI data collected from over 6000 participants of all ages.
30 Oct HPV Vaccination Rate Low for Girls Under Both Commercial and Medicaid Plans
[caption id="attachment_18919" align="alignleft" width="300"]
Shannon Stokley MPH[/caption]
MedicalResearch.com Interview with:
Shannon Stokley, MPH
Epidemiologist in the
CDC Immunization Services Division
Medical Research: What is the background for this study? What are the main findings?
Response: To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who complete the recommended HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage level for female adolescents among commercial and Medicaid plans was 12% and 19%, respectively (ranges = 0%–34% for commercial plans, 5%–52% for Medicaid plans). The results of this study indicate that there are significant opportunities for improvement as HPV vaccination coverage among female adolescents was low for both commercial and Medicaid plans.
29 Oct NIHSS Stroke Database is Incomplete and May Have Selection Bias
[caption id="attachment_18912" align="alignleft" width="169"]
Prof. Reeves[/caption]
MedicalResearch.com Interview with:
Mathew J. Reeves BVSc, PhD, FAHA
Professor, Department of Epidemiology and Biostatistics,
Michigan State University
East Lansing, MI 48824
Medical Research: What is the background for this study?
Dr. Reeves: The National Institutes of Health Stroke Scale (NIHSS) is the single most important prognostic factor in predicting outcomes of individual stroke patients. NIHSS data is obviously important at the patient level but also at a hospital level since the case mix of stroke patients are assumed to vary widely across different hospitals and referral centers.
Measuring stroke outcomes at a hospital level is becoming increasingly important as work proceeds in the US to develop integrated stroke systems of care. But it is also very relevant to the new payment models being introduced by CMS which are based on hospital rankings that are developed from statistical risk adjustment models. One would expect that NIHSS would be a major contributor to these models but currently a major limitation is that NIHSS is incompletely documented in clinical registries such as GWTG-Stroke, and is completely absent from administrative data.
The problem of missing NIHSS data plays havoc with the ability to risk adjust stroke outcomes across hospitals. Missing data results is a smaller number of stroke cases being included in the risk adjusted calculations for a given hospital which results in greater uncertainty over what the actual hospital outcomes are. Further there is concern that NIHSS data is not missing at random, and so the NIHSS data that is documented may represent a biased selection of all the cases that a hospital admits. This too could have important consequences for hospital rankings.
To determine the degree of potential bias in the documentation of NIHSS data this study examined trends in and predictors of documentation of NIHSS across 10 years of data (2003-2012) in the GWTG-Stroke program.
29 Oct Formal Guidelines May Improve Resident-Attending Communication in Hospital
[caption id="attachment_18908" align="alignleft" width="135"]
Dr. El Saleeby[/caption]
MedicalResearch.com Interview with:
Chadi El Saleeby, MD. MS.
Assistant Professor of Pediatrics, Harvard Medical School
Pediatric Hospital Medicine and
Pediatric Infectious Disease Units
Mass. General Hospital for Children
Boston, MA 02114
Medical Research: What is the background for this study? What are the main findings?
Dr. El Saleeby: The Institute of Medicine, the Accreditation Council of Graduate Medical Education, and the American Board of Pediatrics stress the importance of appropriate supervision of trainees to reduce errors, lower patient mortality, and improve quality of care. However, how appropriate supervision should be implemented in clinical practice is not well defined. After-hours supervision can be especially difficult when attendings or fellows may not be immediately available on-site and residents must determine when to contact a supervising physician regarding a clinical issue.
The purpose of this study was to evaluate expectations when a pediatric resident should a contact a supervising physician while working after hours. To that effect, we developed 34 scenarios of the most common or the most serious issues encountered by residents on a general pediatric floor. We included these scenarios in an online survey, which was sent to the residents, fellows and attendings, asking for each scenario, if they would communicate immediately to discuss, or delay communication until the following day.
There were two main findings of the study.
First, in half of the scenarios, there were significant differences in communication preferences between residents and their supervisors. In all of these 17 discrepant scenarios without one single exception, more supervising clinicians wanted immediate communication compared to the residents.
Second, there was no internal agreement between supervising physicians themselves. The junior attendings were more similar in their responses to residents while the more senior group (attendings with 5 or more years of clinical experience) asked to be immediately contacted much more frequently.
29 Oct Work Productivity, Quality of Life Factor in Decision For Sinus Surgery
[caption id="attachment_18904" align="alignleft" width="300"]
Dr. Luke Rudmik[/caption]
MedicalResearch.com Interview with:
Luke Rudmik, MD
Division of Otolaryngology–Head and Neck Surgery
Department of Surgery
University of Calgary
Calgary, Alberta, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Rudmik: The main findings were that patients with chronic sinusitis who have lower impairments in their quality of life can have their work productivity maintained with continuing medical therapy. Although there were no 'improvements' in the patients productivity with continuing medical therapy, it is important to note that patients in this study had better baseline quality of life and better baseline productivity compared to patients who chose to receive sinus surgery who had worse baseline quality of life and baseline productivity impairment.
29 Oct US Continues To Make Progress in Mortality Reduction
MedicalResearch.com Interview with:
Jiemin Ma, PhD, MHS
Director of Surveillance and Health Services Research
American Cancer Society
Medical Research: What is the background for this study? What are the main findings?
Dr. Ma: This study is an analysis of long-term trends in mortality for all causes combined and for 6 leading causes of death, including heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), unintentional injuries, and diabetes, in the United States from 1969 through 2013. We found that death rates for all causes and for five of these 6 leading causes (except COPD) decreased during this time period, although the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. COPD death rates doubled during this time period, although the rate began to decrease in men since 1999.
29 Oct Beta Blockers May Reduce Ability To Lose Weight
MedicalResearch.com Interview with: Mirna Azar MD Division of Endocrinology and Metabolism University of Ottawa Weight Management Clinic The Ottawa Hospital Ottawa, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Azar: Previous studies have shown an association between beta-blockers and weight gain but little is known about the effect of beta-blockers on weight loss. Here we demonstrate that patients treated with beta-blockers exhibit a reduced ability to lose weight in response to a standardized 900 kcal meal replacement program. From a database of 3,582 patients who participated in a 6-week 900 kcal/day Optifast meal replacement weight loss program, 173 patients were on beta-blockers. We determined differences in rate of weight loss and changes in waist circumference in the first 6 weeks of meal replacement program in these subjects as compared to controls, matched for sex, age and initial weight and to the entire population with adjustment for age, sex, initial body weight, ACE inhibitor and diuretic therapy and existing cardiovascular disease. In comparison with matched controls, beta-blocker treated subjects lost a mean of 0.67 kg less than their matched controls (P = 0.01) and their percent weight loss was 0.6% lower (P = 0.0001). Differences were also noted for changes in waist circumference (-24.2 vs -25.2 cm, P= 0.04). Findings were not altered after adjustment for cardiovascular indications for beta-blocker therapy.29 Oct Superlative Terms May Be Overused When Describing Cancer Drugs
[caption id="attachment_18889" align="alignleft" width="142"]
Dr. Prasad[/caption]
MedicalResearch.com Interview with:
Vinay Prasad, MD MPH
Assistant Professor of Medicine
Division of Hematology Oncology in the Knight Cancer Institute
Department of Public Health and Preventive Medicine
Senior Scholar in the Center for Health Care Ethics
Oregon Health and Sciences University
Portland, Oregon 97239
Medical Research: What is the background for this study? What are the main findings?
Dr. Prasad: We wanted to get some information about when and which cancer drugs were called "game changer" or "breakthrough" or "revolutionary". What we found was surprising. The use of these grandiose terms, or superlatives, was common in news articles. They occurred across many classes of medication, were used for approved and unapproved drugs, and some of the use was questionable.
29 Oct Diabetes Raises the Risk of Surgical Infections
MedicalResearch.com Interview with:
Emily Toth Martin, Ph.D. MPH
Assistant Professor, Epidemiology
University of Michigan School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Response: Surgical site infections are responsible for billions in health care costs in the U.S. We are working to identify groups of people who are particularly impacted by surgical site infections. By looking at the results of 94 studies, we were able to take a 60,000 foot view of the connection between diabetes and surgical site infection. We found that diabetes raises the risk of infection across many types of surgeries.
28 Oct Out-of-Pocket Expenses Greatest For Families Caring For Dementia Patient
Posted at 23:26h
in Annals Internal Medicine, Author Interviews, Cognitive Issues, Cost of Health Care, End of Life Care
[caption id="attachment_18871" align="alignleft" width="130"]
Dr. Kelley[/caption]
MedicalResearch.com Interview with:
Amy S. Kelley, MD, MSHS
Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, NY
Medical Research: Why is it so important to understand the financial burdens families may face in providing end-of-life care for a loved one and why do you think the burdens may be greater for dementia than for other medical conditions?
Dr. Kelley: Understanding the financial risks that older adults face in the last years of life is important for individuals and families, in order to plan and save, if possible. It is also important for our policy makers, in particular, to know about these costs so that this information can help shape health and social policy that will best serve our society. Households of those with dementia face the greatest burden of costs, on average, particularly with regard to out-of-pocket expenses and the costs of caregiving. Many costs related to daily care for patients with dementia are not covered by health insurance, and these care needs, including everything from supervision, to bathing and feeding, may span several years.
28 Oct Improving Diabetes Control Means Decreasing Mortality
MedicalResearch.com Interview with:
Marcus Lind, M.D., Ph.D
Department of Medicine, Uddevalla Hospital
Uddevalla, Swede
Medical Research: What is the background for this study?
Dr. Lind: One of the main goals of the diabetes care is to reduce excess mortality in individuals with type 2 diabetes close to that of the general population. We want patients to have a similar life expectancy as individuals in the general population. Earlier studies have shown that targeting good glucose levels, blood lipid and blood pressure levels are beneficial with respect to decrease cardiovascular disease being the main cause for mortality. We wanted to evaluate the prognosis for individuals with type 2 diabetes today in Sweden.
Further, earlier population-based studies have generally assessed mortality rates only on a group level whereas we believe the prognosis differs greatly depending on various factors such as how well risk factor control is obtained in clinical practice. The Swedish Diabetes Registry include more than 90% of all individuals with type 2 diabetes in Sweden and information of e.g. the glycaemic control, measured by a biomarker called A1c exists for most persons. There were 97% who had at least 1 measurement. Also most patients had information of other risk factors, among others renal complications which we believed were of special concern.