Author: Marie Benz MD FAAD
18 Jun Epigenetic Profiling Of Tumor Metastases May Improve Therapeutic Options
Posted at 00:39h
in Author Interviews, Biomarkers, Cancer Research, Mayo Clinic, MD Anderson, Nature
MedicalResearch.com Interview with:
Eric Jonasch, MD
Associate Professor Department of Genitourinary Medical Oncology
University of Texas MD Anderson Cancer Center
Houston, TX
and
Dr. Thai H. Ho, MD Ph.D.
Department of Oncology
Mayo Clinic Scottsdale Arizona
Medical Research: What is the background for this study? What are the main findings?
Response: The blueprints of a cell are encoded in DNA strands (its genome) which are highly compressed in order to fit into a tiny cell. The reading (called the epigenome) of these DNA ‘blueprints’ determines whether that cell will develop into a kidney cell or another type of cell. However, in cancer, errors occur either in the blueprints themselves or the cell makes mistakes in reading the blueprints. Cancers of the kidney affect more than 61,000 patients annually and over 13,000 patients die annually, making it one of the top 10 leading causes of cancer deaths. Studies have revealed that mutations occur in genes that regulate how our DNA ‘blueprints’ are compacted in greater than >50% of kidney cancers, making these genes as a group the most frequently mutated. In our study, we identified that these errors that initially arise in an early kidney cancer lead to propagation of these same errors in metastases, a phenomenon in which the cancer has spread to another organ and is a major cause of death. Furthermore, we generated a detailed map of these epigenomic changes in patient-derived tumors.
16 Jun High Coronary Calcium Score May Encourage Healthier Lifestyle
MedicalResearch.com Interview with: Ms. Rikke Elmose Mols Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD. Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.16 Jun Skin Mottling Associated In Increased Mortality In ICU Patients
MedicalResearch.com Interview with: Rémi Coudroy MD CHU de Poitiers, Service de Réanimation Médicale CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France Medical Research: What is the background for this study? What are the main findings? Dr. Coudroy: Skin mottling is characterized by a red-violaceous discoloration of the skin. Its occurrence, as impaired consciousness and decreased urinary output are well-known clinical signs of shock. Skin mottling has been investigated only in patients with septic shock and recent studies have found that the extent and the persistence of skin mottling for more than 6 hours were associated with mortality. However, in daily clinical practice, we noticed that skin mottling occurred in patients without septic shock, and there was no data supporting the impact of skin mottling on the prognosis of critically ill patients. In a retrospective monocentric observational study over a 1-year period in a 15-bed tertiary medical ICU where skin mottling over the knees is assessed by nurses, we found that skin mottling occurred in 29% of patients admitted to ICU. Nurses’ evaluation of skin mottling was highly reliable. In 60% of cases, mean arterial pressure was ≥ 65 mmHg without vasopressors. The occurrence of skin mottling was associated with mortality independently from calculated severity scores at admission (i.e. Simplified Acute Physiology Score II). Similarly, the persistence of skin mottling for more than 6 hours was associated with mortality independently from organ failure at the onset of skin mottling (i.e. the use of vasopressors, the need for mechanical ventilation and hyperlactatemia).15 Jun Dramatic Increase In Young Children Accidentally Exposed To Pot
MedicalResearch.com Interview with:
Dr. Gary Smith MD, DrPH
Center for Injury Research and Policy
Nationwide Children's Hospital
Columbus, Ohio
Medical Research: What is the background for this study? What are the main findings?
Dr. Smith: As of January 2015, 23 states and Washington D.C. have legalized marijuana for medical use. Four of those same states and Washington D.C. have also voted to legalize marijuana for recreational use. The debate about legalization often focuses on health effects among adults, economic benefits, and crime rates. Lost in the discussion is the potential harm to young children from unintentional exposure to marijuana.
The study found that the rate of marijuana exposure among children 5 years of age and younger rose 147.5 percent from 2006 through 2013 across the United States. The rate increased almost 610 percent during the same period in states that legalized marijuana for medical use before 2000.
In states that legalized marijuana from 2000 through 2013, the rate increased almost 16 percent per year after legalization, with a particular jump in the year that marijuana was legalized. Even states that had not legalized marijuana by 2013 saw a rise of 63 percent in the rate of marijuana exposures among young children from 2000 through 2013.
Most children were exposed when they swallowed marijuana – that may be related to the popularity of marijuana brownies, cookies and other foods.
15 Jun Parkinson’s Disease Can Be Stratified Into Three Distinct Groups
MedicalResearch.com Interview with:
Ron Postuma, MD, MSc
Associate Professor
Department of Neurology
Montreal General Hospital
Montreal, Quebec
Medical Research: What is the background for this study? What are the main findings?
Dr. Postuma: The background is that we often think about Parkinson’s Disease as a single disease. However, every clinician knows that there is a great deal of variability from patient to patient. If we can understand the main aspects that separate patients into groups, we can target therapy better.
The analysis used a semi-automated means to divide Parkinson’s patients into groups, using extensive information about motor and non-motor aspects of disease. We found that the non-motor symptoms, especially cognition, sleep disorders, and blood pressure changes were the most powerful predictors of which group a patient would be in. Based on these non-motor (and some motor aspects), the most accurate way to divide patients was into three groups - diffuse (many non-motor symptoms), pure motor, and intermediate (halfway between the other). We then followed patients over time. The diffuse group had, by far, the worse prognosis. This was not only for the non-motor aspects, but the motor as well.
15 Jun Bone Marrow Receptor Opens Door To New Therapy For a Pediatric Leukemia
MedicalResearch.com Interview with:
Susan Schwab, PhD
Assistant professor at NYU Langone
Skirball Institute of Biomolecular Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Schwab: T cell acute lymphoblastic leukemia (T-ALL) remains a devastating pediatric disease. Roughly 20% of children do not respond to current therapies. Furthermore, metastasis to the central nervous system is common in T-ALL, and intrathecal chemotherapy, even when successful at eradicating the cancer, causes serious long-term cognitive side-effects.
Here we report that the chemokine receptor CXCR4 is essential for T cell acute lymphoblastic leukemia progression in both mouse and human xenograft models of disease. Consistent with sustained disease remission in the absence of CXCR4, loss of CXCR4 signaling results in decreased levels of c-Myc, which is required for leukemia initiating cell activity. T-ALL cells reside near cells generating the CXCR4 ligand CXCL12 in the bone marrow, and our data suggest that vascular endothelial cells may be an important part of the T-ALL niche.
15 Jun ACA Medicaid Expansion Will Require More Primary Care Providers, Especially In Low Income Areas
MedicalResearch.com Interview with: Eric T. Roberts and Darrell Gaskin Johns Hopkins University Bloomberg School of Public Health Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults. We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps.15 Jun Biologics in Rheumatic Disease Reduce Missed Workdays
MedicalResearch.com Interview with: Cécile Gaujoux-Viala, MD, PhD Université Montpellier I Chef de Service de Rhumatologie CHU de Nîmes Carémeau France Medical Research: What is the background for this study? Response: Chronic inflammatory rheumatic diseases – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) – confer significant patient and economic burdens : 1/5 of people with rheumatic conditions has been forced to change career, 1/3 will have stopped working within two years of onset and 1/2 will be unable to work within ten years. The addition of biological agents in treatment strategies for rheumatic diseases have improved the possibility of controlling disease activity and slowing the progression of joint damage. But these treatments are very expensive and their effect on work participation remains unclear.14 Jun Simple and readily available patient characteristics predicts death and dialysis dependence in critically ill patients with severe acute kidney injury
MedicalResearch.com Interview with:
Raghavan Murugan MD, MS, FRCP, FCCP
Associate Professor of Critical Care Medicine and Clinical and Translational Science
Core Faculty, Center for Critical Care Nephrology, CRISMA Center,
John Kellum, MD
Professor and Vice Chair for Research
Director, Bioengineering and Organ Support Program, CRISMA Center
Director, Center for Assistance in Research using eRecord (CARe)
Department of Critical Care Medicine
University of Pittsburgh Pittsburgh, PA
Medical Research: What is the background for this study? What are the main findings?
Response: In our prior studies, we found that nearly one-half of critically ill patients in the intensive care unit who receive dialysis die by 2 months after acute illness and more than one-third of surviving patients are dialysis dependent. We sought to examine whether simple patient characteristics and inflammatory biomarkers predicted death and non-recovery of kidney function after severe acute kidney injury.
We found that a combination of four simple and readily available patient characteristics including older age, lower mean arterial pressure, need for mechanical ventilation, and higher serum bilirubin levels predicted death and dialysis dependence. Higher plasma concentration of interleukin (IL)-8 in combination with the clinical characteristics also increased risk prediction. To our knowledge, this study is the first large study to examine risk prediction for outcomes after severe acute kidney injury using a panel of biomarkers in a large cohort of critically ill patients receiving dialysis.
14 Jun Healthy Diet May Reduce Mortality In Low Income Populations
MedicalResearch.com Interview with: Wei Zheng, MD, PhD, Professor of Medicine Anne Potter Wilson Chair in Medicine Director, Vanderbilt Epidemiology Center and Danxia Yu, PhD Research Fellow Vanderbilt Epidemiology Center Vanderbilt University School of Medicine Nashville, TN, 37203 Medical Research: What is the background for this study? What are the main findings? Response: The Dietary Guidelines for Americans (DGA) provide the most authoritative advice in the US about healthy eating. Higher adherence to the DGA, reflected by a higher Healthy Eating Index (HEI) score, has been found to be associated with lower risk of developing or dying from chronic diseases (e.g. diabetes, cardiovascular disease, and certain cancers) in several US studies. However, these studies recruited mostly non-Hispanic white individuals and middle to high income Americans. It has been reported that racial/ethnical background and socioeconomic status may influence food choices and diet quality. However, no previous study has adequately evaluated the association between adherence to the DGA and risk of death due to diseases in racial/ethnical minorities and low-income Americans. Therefore, it is uncertain whether the health benefits of adherence to the current DGA can be generalized to these underserved populations. We analyzed diet and mortality data from the Southern Community Cohort Study (SCCS), a large, prospective cohort study including approximately 85,000 American adults, 40-79 years old, enrolled from 12 southeastern states between 2002 and 2009. Two-thirds of the SCCS participants were African-American and more than half reported an annual household income <$15,000. During a mean follow-up of 6.2 years, we identified 6,906 deaths in the SCCS, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. Using multivariate analysis methods, we found that participants in the top 20% of the HEI score (highest adherence to the DGA) had only about 80% of the risk of death due to any diseases compared with those in the bottom 20% of the HEI score. This protective association was found regardless of sex, race and income levels.14 Jun Your Smartphone May Help You Control Your Blood Pressure
Posted at 14:38h
in Author Interviews, Beth Israel Deaconess, Blood Pressure - Hypertension, Technology
MedicalResearch.com Interview with:
Neetika Garg, MD
Fellow in Nephrology
Beth Israel Deaconess Medical Center
Division of Nephrology, Department of Medicine
Boston, MA 02215
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Garg: One in every three Americans suffers from hypertension. Since high blood pressure (BP) frequently does not cause any symptoms, self-blood pressure monitoring at home and patient education are critical components of patient management. With more than 58% of the US adults owning a smartphone, mobile-based health technologies (most commonly in the form of applications or “apps”) can serve as useful adjuncts in diagnosis and management of hypertension. At the same time, several smartphone-based applications are advertised as having blood pressure measurement functionality, which have not been validated against a gold standard. In this cross-sectional study, we analyzed the top 107 hypertension related apps available on the most popular smartphone platforms (Google Android and Apple iPhone) to analyze the functional characteristics and consumer interaction metrics of various hypertension related apps.
Nearly three-quarters of the apps record and track blood pressure, heart rate, salt intake, caloric intake and weight/body mass index. These app features can facilitate patient participation in hypertension management, medication adherence and patient-physician communication. However, it was concerning to find that 6.5% of the apps analyzed could transform the smartphone into a cuffless BP measuring device. None of these had any documentations of validation against a gold standard. Furthermore, number of downloads and favorable user ratings were significantly higher for these apps compared to apps without blood pressure measurement function. This highlights the need for greater oversight and regulation in medical device development.
14 Jun Children With Traumatic Brain Injuries Can Have Poor Sleep Quality
MedicalResearch.com Interview with: Kimberly Allen PhD, RN Assistant Professor Center
for Narcolepsy, Sleep and Health Research
Department Women Children and Family Health Science
Chicago, IL 60612
Medical Research: What is the background for this study?
Dr. Allen: Pediatric traumatic brain injuries (TBI) are a leading cause of morbidity and mortality worldwide.Each year in the United States over 1Ž2 million children are admitted to the hospital for traumatic brain injuries (TBIs). Depending on the severity of the injury and how the individual child responds to the primary injury, a range of medical care may be necessary from an overnight hospital admission for observation to admission in the intensive care unit (ICU) and inpatient rehabilitation facility to re-teach and help to recover skills children once knew. The short- and long-term consequences of traumatic brain injuries include: motor and sensory impairments; cognitive, emotional, psychosocial impairments; headaches, and sleep disruptions.
Medical Research: What are the main findings?
Dr. Allen: The main finding from this pilot study with two groups with 15 children in each group: one of children with traumatic brain injuries and one of typically, developing healthy children was that children with traumatic brain injuries have significantly more daytime sleepiness and worse sleep quality compared to the control group. Additionally, children with TBI also had lower overall functional scores (e.g, school, social) compared to the controlled children. All of the surveys were completed by the child’s parent.
13 Jun JAK1-2 inhibitor Baricitinib May Limit Progression of Diabetic Kidney Disease
Posted at 12:35h
in Author Interviews, Diabetes, Immunotherapy, Kidney Disease, University of Michigan
MedicalResearch.com Interview with:
Frank C. Brosius, MD
Professor, Internal Medicine and Physiology
Chief, Division of Nephrology
University of Michigan Ann Arbor, MI
Dr. Matthias Kretzler MD
Professor, Internal Medicine
Research Professor, Computational Medicine and Biology
University of Michigan Ann Arbor, MI
Katherine R. Tuttle MD
Clinical Professor of Medicine, Division of Nephrology
Medical & Scientific Director, Providence Medical Research Center/Sacred Heart Center
Professor of Basic Medical Sciences, WWAMI Program
Washington State University
Medical Research: What is the background for this study?
Response: Our University of Michigan team had found that JAK-STAT gene expression was increased in kidneys in patients with diabetic kidney disease and that these changes correlated with progression of kidney disease. We subsequently substantiated these changes in other studies and have found that by increasing expression of just one of these genes, JAK2, in a single kidney cell type (podocytes) in mice that we can make their diabetic kidney disease much worse.
At around the same time, investigators at Eli Lilly and Co. had FDA approval to test a JAK1-2 inhibitor, baricitinib, in patients with rheumatoid arthritis. The Lilly scientists saw our human results and thought about using baricitinib in patients with diabetic kidney disease. After initial discussions with Dr. Kretzler and myself they concluded that there was good reason to move ahead with this study and just 14 months after the initial meeting the phase 2 clinical trial of baricitinib in the treatment of patients with diabetic kidney disease was initiated.
13 Jun Craniofacial Anomalies Provide More Evidence Pedophilia Develops Prenatally
MedicalResearch.com Interview with: Fiona Dyshniku, M.A. Ph.D. Candidate, Clinical Psychology - Adult Clinical track Department of Psychology University of Windsor MedicalResearch: What is the background for this study? Response: This study was conducted in the context of previous research that has found other evidence that pedophilia has biological roots that start before birth, such as shorter stature and left-handedness. Both of these correlates have prenatal origins, meaning that their development necessarily precedes the onset of more socially oriented correlates, such as parenting styles, sexual abuse during childhood, etc. Moreover, these neurodevelopmental correlates appear permanent and immune to later psychosocial influences. Much like handedness and stature, minor physical anomalies (MPA) develop prenatally, are permanent, and remain immune to psychosocial influences. There are additional benefits to examining minor physical anomalies, including the fact that they tend to develop in a set sequence, are actually formed from the same tissue that gives rise to the central nervous system, and have been widely studied in other well-established neurodevelopmental disorders, such as schizophrenia. MedicalResearch: What are the main findings? Response: We found that individuals simultaneously possessing more craniofacial anomalies and fewer peripheral anomalies scored higher on several well-established pedophilia indices, including phallometric testing, possession of child pornography, and number of child victims. We also found that craniofacial anomalies on their own were more prevalent among individuals classified as pedophiles through phallometric testing. Taken together, these results suggest that there is further evidence for a biological cause of pedophilia. Moreover, since craniofacial anomalies develop around week 5 of gestation, it would appear that biological differences occur quite early on during foetal developmental.13 Jun Antibiotic Impregnated Sponges Reduced Chest Wound Infections After Heart Surgery
MedicalResearch.com Interview with: Mariusz Kowalewski, MD Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital Bydgoszcz, Systematic Investigation and Research on Interventions and Outcomes Medicine Research Network, Poland Medical Research: What is the background for this study? What are the main findings? Dr. Kowalewski: Sternal wound infections occurring after heart surgery performed via median sternotomy, and in particular, after coronary artery bypass grafting (CABG), although rare, still pose serious postoperative complications that increase the length of hospital stay and healthcare costs. One of many ways to prevent them from happening, except from optimal glucose control, tight-fixed closure of the sternum at the end of surgery and perioperative iv. antibiotics, is to insert a gentamicin collagen sponge between two sternal edges, just before wiring them together. High local concentrations of gentamicin were shown to eliminate any microbial growth in the area, in the same time, not affecting the kidneys, as would be the case with systemic administration. Gentamicin sponges are widely used in orthopadic, gastro-intestinal and vascular surgery and were shown to reduce postoperative infection rates. Although extensively tested in the field of heart surgery, findings of one recent multicenter study have questioned their true benefit. We aimed to perform a comprehensive meta-analysis of studies assessing the efficacy of implantable gentamicin-collagen sponges in sternal wound infection prevention. After screening multiple databases, a total of 14 studies (N = 22,135 patients, among them 4 randomized controlled trials [N = 4,672 pts]) were included in the analysis. Implantable gentamicin-collagen sponges significantly reduced the risk of sternal wound infection by approximately 40% when compared with control (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P = .04 for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P = .01 for observational studies). A similar, significant benefit was demonstrated for deep sternal wound infection (RR, 0.60; 95% CI, 0.42-0.88; P = .008) and superficial sternal wound infection (RR, 0.60; 95% CI, 0.43-0.83; P = .002). The overall analysis revealed a reduced risk of mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P = .01). The risk of death was unchanged. In addition, we investigated, by means of meta-regression, the correlation between sternal wound infections and extent to which the bilateral internal thoracic artery (BITA) was harvested. We found that the benefit provided by the gentamicin sponge was attenuated when BITA was harvested; these results suggest that another potentially preventive measure must be taken in such patients, as with severely reduced blood supply to the sternum (as is the case with BITA), sponge itself might not be enough to prevent wound infection.13 Jun Dual Hormone Artificial Pancreas Reduces Nocturnal Hypoglycemia in Type 1 Diabetes
MedicalResearch.com Interview with:
Dr. Ahmad Haidar Ph.D
Division of Experimental Medicine, Department of Medicine
McGill University, Montreal, QC, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Haidar: This is the first head-to-head-to-head comparison in outpatient setting of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional pump therapy in children and adolescents with type 1 diabetes.
The main finding is that the dual-hormone artificial pancreas seems to outperform the other two systems in reducing nocturnal hypoglycemia in camp settings when the patients are very physically active during the day.
Medical Research: What should clinicians and patients take away from your report?
Dr. Haidar: Glucagon has the potential to reduce nocturnal hypoglycemia if added to the artificial pancreas. However, this needs to be confirmed in larger and longer studies as the single-hormone artificial pancreas might be sufficient in home settings (this study was conducted at a camp, which is an environment different that home).
12 Jun Immediate Postpartum Contraception Implant Is Cost Effective, But Most Insurance Plans Don’t Cover It
MedicalResearch.com Interview with:
Aileen Gariepy, MD, MPH
Assistant Professor Section of Family Planning
Department of Obstetrics, Gynecology, and Reproductive Sciences
Yale School of Medicine
New Haven, CT
Medical Research: What is the background for this study? What are the main findings?
Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy. For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice.
When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient. Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion.
In fact, over half of U.S. pregnancies are unintended. Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient.
However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital. This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby. Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant).
The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion. Women can get pregnant again within 4 weeks of delivering a baby. Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit.
Even for women who want another pregnancy soon, the implant has benefits. When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death. Birth spacing is better for moms and babies.
12 Jun Despite Guidelines, Many Physicians Still Ordering Routine Preoperative Tests
MedicalResearch.com Interview with:
Joseph A. Ladapo, MD, PhD
Assistant Professor of Medicine
Section on Value and Effectiveness
Department of Population Health
NYU Langone School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Ladapo: Routine tests before elective surgery are largely considered to be of low value, and they may also increase costs. In an attempt to discourage their use, two professional societies released guidance on use of routine preoperative testing in 2002. We sought to examine the long-term national effect of these guidelines from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians' use of routine preoperative testing. While we found that overall rates of routine testing declined across several categories over the 14-year study period, these changes were not significant after accounting for overall changes in physicians’ ordering practices. Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice.
12 Jun Diet and Supervised Exercise May Be Helpful In Preventing Excessive Pregnancy Weight Gain
MedicalResearch.com Interview with: Theresa A Lawrie World Health Organization Department of Reproductive Health and Research Geneva, Switzerland MedicalResearch: What is the background for this study? Response: Excessive weight gain in pregnancy is associated with various undesirable outcomes in pregnancy. The aim of the review was to assess data from all relevant clinical trials in the field, to determine whether diet and/or exercise interventions during pregnancy were effective in reducing the chance of excessive weight gain in pregnancy. We also wanted to know whether these interventions could reduce the chance of having large babies (macrosomia), as this is associated with difficult labor, c/section, postpartum hemorrhage, birth injuries and other complications. MedicalResearch: What are the main findings? Response: Altogether 49 trials contributed data to the review. Approximately half the trials recruited women of any pre-pregnancy weight, the other half recruited women who were overweight or obese at the start of pregnancy. Most of the trials were conducted in high income countries. Interventions varied, some involved individual counseling, others group sessions, some were counseling interventions only, other programs were actively supervised by fitness trainers. Health outcomes for women receiving the intervention programs in addition to routine antenatal care (the intervention group) were compared with those of women receiving the routine antenatal care only (the control group). We found that diet or exercise or combined interventions led to an average 20% reduction in the number of women gaining excessive weight in pregnancy. This reduction was fairly consistent across the different types of interventions, although the largest effect was observed for combined diet and supervised exercise interventions. Overall findings suggested a small reduction in caesarean section (of about 5%) and in large babies (of about 7%). However, a bigger reduction in large babies (in the region of a 19% reduction) was noted for exercise-only interventions, which were more likely to be supervised interventions. Other findings: We also found no difference in the risk of preterm birth between groups. Fewer women in the intervention group were assessed as having high blood pressure during pregnancy (although we assessed this as low quality evidence). Low quality evidence also suggested that women in the intervention group were likely to retain less weight at six months postpartum compared with the control group. Interestingly, data from two studies suggested that women receiving diet and exercise interventions were less likely to have babies with breathing difficulties at birth. These findings will hopefully be corroborated by other studies. A limitation of the review, is that we did not include gestational diabetes as an outcome as this is partly covered in a separate Cochrane review. Our exploratory analyses, however, suggested that there may be a reduction in gestational diabetes for certain types of interventions, and we hope to include these data in future review updates. In general, we did not find differences in outcomes for women according to pre-pregnancy weight or BMI.12 Jun Both Gastric Banding and Bypass Surgery Reduce Medical Costs
Posted at 14:36h
in Author Interviews, Cost of Health Care, JAMA, Kaiser Permanente, Surgical Research, Weight Research
MedicalResearch.com Interview with: Kristina H. Lewis, MD, MPH, SM Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta Department of Population Medicine Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts Medical Research: What is the background for this study? Dr. Lewis: The prevalence of severe obesity (BMI ≥40 kg/m2) in the U.S. is rising. This is...
12 Jun Women and Men Have Similar Colon Cancer Recurrence-Free Death Risk
MedicalResearch.com Interview with: Prof. Catherine Quantin Teaching Hospital, Department of Biostatistics and Medical Informatics France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France and Dr Michal Abrahamowicz Ph.D Department of Epidemiology, Biostatistics and Occupational Health McGill University, Montreal, Canada Medical Research: What is the background for this study? Response: One difficulty, common to prognostic studies of cancer, concerns the need to separate the effects of prognostic factors on different clinical endpoints, such as disease recurrence vs recurrence-free death. Some published prognostic studies used a Cox regression model that included recurrence as a time-dependent covariate, to assess the impact of recurrence on mortality, and to adjust for recurrence when estimating the effects of other prognostic factors on mortality. However, the Cox model is limited to the assessment of the effects of covariates on a single endpoint, such as death. This limitation is overcome by multi-state models, that make it possible to model alternative pathways of disease progression and to assess the impact of prognostic factors on both recurrence-free death vs death after recurrence, and recurrence followed by death. Another difficulty, is that the cause of death is not available or not accurately coded. Yet, some patients are likely to die of causes not related to the disease of primary interest, especially in cancers with longer survival and in those that affect older subjects. The effects of prognostic factors estimated with Cox model, or classic multi-state models, are not able to discriminate between their effects on the mortality due to cancer of primary interest vs natural mortality. However, age is a very strong predictor of overall mortality, but is not systematically associated with higher cancer-specific mortality. To deal with this difficulty, many prognostic studies use relative survival methods. The general idea is to use the mortality tables for the relevant general population to estimate survival corrected for the expected natural mortality, due to other causes of death.12 Jun Some Prostate Cancer Patient Decision Aids Need Updating
MedicalResearch.com Interview with: Prajakta Adsul, MBBS, MPH, PhD; Ricardo Wray, PhD, and Sameer Siddiqui, MD Center for Cancer Prevention, Research and Outreach Saint Louis University MedicalResearch: What is the background for this study? What are the main findings? Response: Patient decision aids are interventions designed to help patients engage in shared decision making with their providers when multiple choices with more or less equivalent efficacy are available for a particular medical decision. Several patient decision aids exists for numerous medical conditions and previous research has demonstrated them to be effective in improving the patient's knowledge and understanding of treatment options and their relative efficacy and side-effects and resulting in a higher proportion of decision that are consistent with patient's values and personal preferences. In the context of prostate cancer treatment, the practice of shared decision making is vital as highlighted by recent calls from the American Urological Association and the American Cancer Society. To aid with this process, several patient decision aids exist. However, the content presented, the format and presentation styles of decision aids can be variable and can have an influence on the choice made by the patients. The purpose of this study was to assess the characteristics of the patient decision aids designed for men facing prostate cancer treatment. We used the widely accepted International Patient Decision Aids Standards (IPDAS) for the assessment, supplemented with implementation criteria to strategize successful future improvement and promotion of decision aids in routine urological practice. The main findings of the review were that none of the decision aids reviewed met all standards. The aids had variable content, format and presentation of prostate cancer treatment information. Several decision aids were outdated and critical issues such as the risk of overtreatment and active surveillance as a treatment option for prostate cancer were not always covered in decision aids.12 Jun Defects in DNA Repair Could Underlie Cognitive Decline
MedicalResearch.com Interview with:
Dr. Li-Huei Tsai Ph.D.
Professor and Director - Picower Institute
For Learning and Memory
Department of Brain and Cognitive Sciences
Massachusetts Institute of Technology
Medical Research: What is the background for this study? What are the main findings?
Dr. Tsai: For a while now, we have been interested in observations made by many labs, including our own, that the accumulation of DNA lesions is a hallmark of the aging brain, and that mutations in DNA repair factors manifest in congenital and neurodegenerative disorders. However, the precise contribution of unrepaired DNA lesions to the development of neurological disorders remains poorly understood. A major confounding factor is that the sources that generate DNA lesions in the brain are not well characterized, and it is not known whether damage accumulates non-specifically throughout the genome, or whether there are certain regions that are more prone to accumulate DNA damage.
In this regard, our study reports three major findings:
(1) Physiological neuronal activity itself results in the formation of DNA breaks;
(2) Neuronal activity-induced DNA breaks form at highly specific locations, including within the promoters of a subset of immediate early genes, including Fos, Npas4, and Egr1. These genes are also rapidly expressed in response to neuronal stimulation, and play crucial roles in experience-driven changes to synapses, and learning and memory;
(3) Neuronal activity-induced breaks are generated by a topoisomerase, Topo IIβ, and Topo IIβ-generated DNA breaks facilitate the rapid expression of these immediate early genes following neuronal stimulation.
12 Jun Preoperative Pulmonary Function Testing Decreased After ACP Guidelines
MedicalResearch.com Interview with:
Louise Sun, MD SM FRCPC
Assistant Professor Department of Anesthesiology,
University of Ottawa Staff | Division of Cardiac Anesthesiology
University of Ottawa Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Sun: Preoperative testing provides important information for perioperative
planning and decision-making. However, given the rapid increase in health
care costs, there has been growing emphasis on the more rational use of
resources and thus the need to better understand the utilization patterns
of specific tests. Preoperative pulmonary function tests (PFTs) are
important in helping perioperative physicians identify patients at risk
for postoperative pulmonary complications, but few appropriate use
guidelines exist for this test. We conducted a population-based study
using linked administrative databases in Ontario, Canada to describe
temporal trends in preoperative pulmonary function tests
and assess whether the recent 2006 American College of Physicians (ACP) guidelines on risk assessment and prevention of postoperative pulmonary complications for non-cardiothoracic surgery influenced these trends.
We examined 511,625 individuals undergoing non-cardiothoracic surgery, amongst whom
3.6% underwent preoperative pulmonary function tests while 3.3% had non-operative PFTs.
Preoperative pulmonary function tests rates decreased over the study period and following the 2006 ACP guidelines while non-operative rates remained stable. By 2013,
preoperative pulmonary function tests were performed in fewer than 8% of Ontario patients with risk factors for pulmonary complications, while preoperative testing
rates among individuals without known respiratory disease had approached
rates seen in the non-operative setting. The decreasing preoperative pulmonary function tests rates contrast starkly against concurrent increases in rates of other
perioperative interventions such as preoperative anesthesia consultations
and stress testing.
12 Jun Spring Babies Have Highest Lifetime Risk of Cardiovascular Disease
MedicalResearch.com Interview with:
Nicholas Tatonetti, PhD
Department of Biomedical Informatics
Department of Systems Biology, Department of Medicine
Columbia University
New York, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Tatonetti: For decades, researchers have studied the link between disease incidence and the seasons. We’ve known, for example, that those born when the dust mite population is highest (summer) will have an increased chance of developing asthma. Traditionally, diseases have been studied one at a time to identify these seasonal trends. Because of the rapid adoption of electronic health records, it is now possible to study thousands of diseases, simultaneously. That is what we did in this study. We evaluated over 1,600 diseases and discovered 55 that showed this seasonal trend. Many of these had been studied previously, but several are new discoveries — most prominently, we found that the lifetime risk of developing cardiovascular disease is highest for those born in the spring.
12 Jun Weekend Discharge Not Associated With Higher Rate of Readmission
MedicalResearch.com Interview with:
Jordan M. Cloyd, MD
Department of Surgery
Stanford University
Stanford, California
Medical Research: What is the background for this study? What are the main findings?
Dr. Cloyd: The motivation for the study was that, anecdotally, we had noticed that several of our patients who had been discharged on a weekend required readmission for potentially preventable reasons. We wanted to investigate whether the data supported the idea that weekend discharge was associated with a higher risk of hospital readmission.
12 Jun More Screen Time Linked To Lower Bone Mass In Boys
MedicalResearch.com Interview with:
Anne Winther Msc
Department of Health and Care Sciences, UiT The Arctic University of Norway
Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
Medical Research: What is the background for this study? What are the main findings?
Response: Norway has one of the highest reported incidences of osteoporotic fractures in the world. Research on fracture risk has primarily focused on bone mass in the elderly. However, there is a growing awareness of the importance of bone mass during growth as a compensation for the inevitable bone loss and prevention of fractures in the elderly . A recent study on Norwegian adolescents´ lifestyle and bone health concluded that peak bone mass seem to be modifiable by lifestyle factors as higher physical activity levels were strongly associated with bone mass. The other way around; low levels of physical activity may have considerable negative effects on bone health, and increasing sedentary behavior in place of sports and play during growth is worrying. In this study we explored the associations between self-reported hours spent in front of television/computers during weekends along with self reported hours spent on leisure time physical activities and bone mass density (BMD) levels at the hip. This population based study, Fit Futures 1 consisting of 388 girls and 359 boys 15-17 years old was conducted in 2010/2011, and repeated two years later including 66% of the original cohort (Fit Futures 2; 312 girls and 231 boys).
Boys spent more time in front of computers and television than girls; approximately 5 and 4 hours, compared with 4 and 3 hours daily in weekends and weekdays, respectively.
Physical activity levels were adversely related to leisure time computer use at weekends. However, 20 % of the girls and 25 % of the boys balanced 2-4 hours in front of the screen daily with more than 4 hours of sports and hard training per week.
Screen time at weekends was negatively associated with bone mass density levels in boys and positively in girls, after adjustments of several confounders known to affect bone, including age, puberty, physical activity levels and weekday screen time.
Moreover; these contrasting patterns persisted two years later.
12 Jun Pre-Frontal Brain Cortex Size Linked To Moral Reasoning
MedicalResearch.com Interview with:
Dr. rer. nat. Kristin Prehn, Dipl.-Psych.
Charité Universitätsmedizin Berlin
Department of Neurology & NeuroCure Clinical Research Cente
Berlin Germany
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Prehn: The study is based on the theory by renowned American psychologist Lawrence Kohlberg stating that people progress through different levels of moral reasoning. At lower levels, individuals judge moral issues based on self-interest or laws and rules. Individuals at the post-conventional level also take into account deeper principles and shared ideals. The Kohlbergian theory influenced moral psychology and education for decades. No study to date, however, had investigated in which way moral development is reflected in human brain structure and function.
In our study, we compared gray matter brain volume in healthy young subjects who either reached the post-conventional level or did not reach that level so far. We found that subjects at the post-conventional level showed larger volume in a specific brain region of the prefrontal cortex which is essential for moral reasoning as well as the integration of emotion and cognition during human behavior.
11 Jun Oncotype DX Breast Cancer Assay Quickly Adopted Under Medicare Guidelines
MedicalResearch.com Interview with:
Michaela Dinan, Ph.D.
Duke Clinical Research Institute and Duke Cancer Institute
Department of Medicine
Duke University School of Medicine
Durham, North Carolina
Medical Research: What is the background for this study? What are the main findings?
Response: I think it will be critical to further explore the implications of Oncotype DX breast cancer assay (ODX testing) in women with breast cancer. The ODX test helps predict which cancers will be more aggressive as well as guide recommendations as to which patients would most likely benefit from chemotherapy. I think we should look to see what impact this test is really having on the use of chemotherapy and its associated costs and outcomes for real-world breast cancer patients.