MedicalResearch.com Interview with:
Kamen Tsvetanov, PhD
Centre for Speech, Language and the Brain
Department of Psychology
University of Cambridge
Downing Street
Cambridge, United Kingdom
Medical Research: What is the background for this study? What are the main findings?Dr. Tsvetanov: Older brains may be more similar to younger brains than previously thought! In our study we have shown that changes in the aging brain previously observed using functional magnetic resonance imaging (fMRI) – one of the standard ways of measuring brain activity – may be due to changes in our blood vessels, rather than changes in the activity of our nerve cells, our neurons. Given the large number of fMRI studies used to assess the aging brain, this has important consequences for understanding how the brain changes with age and it challenges current theories of ageing.
(more…)
MedicalResearch.com Interview with:
Arnold Bakker, Ph.D. Assistant Professor
Division of Psychiatric Neuroimaging
Department of Psychiatry and Behavioral Sciences
The Johns Hopkins University School of Medicine
Baltimore, MD 21287Medical Research: What is the background for this study? What are the main findings?
Dr. Bakker: Patients who are at increased risk for developing dementia due to Alzheimer’s disease show hyperactivity in an area of the brain called the hippocampus, which is critically important for memory function. This study investigated the functional significance of this hyperactivity and determined if, similar to animal studies, treatment with low dose levetiracetam would reduce this increased activation and improve memory function in these patients. Results showed that this overactivity is a dysfunctional condition that contributes to the memory impairment such that treatment with very low doses of levetiracetam both reduces this overactivity and improves memory function in these patients.(more…)
MedicalResearch.com Interview with:
Prof Vlado Perkovic MBBS PhD FASN FRACP
George Institute for Global Health
University of Sydney
Sydney Australia
Medical Research: What is the background for this study? What are the main findings?
Prof. Perkovic: There has been much discussion about the large number of people with kidney disease around the world- more than 10% of the population in most countries- but the current number of people with kidney failure had not been clearly defined.
We therefore systematically collected information on the number of people with kidney failure around the world and found that 2.6 million people were receiving treatment for kidney failure in 2010, almost 80% of whom were undergoing dialysis while the others had received a kidney transplant. We then noticed very large differences in the number of people receiving treatment in different regions and countries, so used mathematical modeling to calculate the number of people who should be receiving treatment for kidney failure. The results of this analysis suggested there should be between 5 and 10 million people receiving treatment for kidney failure, suggesting that between half and three-quarters of people with kidney failure around the world died without access to dialysis, as a result of the high cost of dialysis treatment that is not affordable for many people around the world. These people are doomed to die of kidney failure, a condition for which we have had an effective treatment for over 50 years. (more…)
MedicalResearch.com Interview with: Loren G. Miller, M.D., M.P.H.
Los Angeles Biomedical Research Institute
(LA BioMed) Infectious Disease Specialist
Medical Research: What is the background for this study?Dr. Miller: Skin and skin structure infections are extremely common reasons for persons
to seek medical care in the U.S., accounting for approximately 14.2 million
outpatient visits in 2005, the latest year for which statistics are
available, and 850,000 hospital admissions. Until this study was completed,
the most effective approach to outpatient antibiotic treatment of
uncomplicated skin infections in the era of community-acquired
methicillin-resistant Staphylococcus aureus (MRSA) was unclear. Prior to
this research, there were no data on which antibiotics were best for
treatment of these common skin infections.
Medical Research: What are the main findings?Dr. Miller: Two antibiotics frequently prescribed to treat serious skin infections -
clindamycin and trimethoprim sulfamethoxazole (TMP-SMX) - had similar rates
of success in curing uncomplicated infections in outpatients. They also had
similar rates of side effects.
To conduct the study, we recruited outpatients from emergency departments,
clinics and other healthcare facilities associated with Los Angeles County's
Harbor-UCLA Medical Center, University of Chicago Medical Center, San
Francisco General Hospital and Vanderbilt University Medical Center from May
2009 to August 2011. We studied 524 adults and children with uncomplicated
skin infections who had cellulitis, abscesses of 5 centimeters or more or
both. In the multicenter, double blind, randomized clinical trial, 264
received clindamycin and 260 received TMP-SMX. We followed the outpatients
for a month after their treatment.
We found similar outcomes for both groups - 80.3% of the outpatients who
received clindamycin and 77.7% of the outpatients in the group that received
TMP-SMX were cured within seven to 10 days after the end of their treatment.
These are not considered significant differences, so our evaluation is that
these two commonly prescribed antibiotics for serious skin infections are
similarly effective in treating uncomplicated skin infections in children
and adults who have few or no major co-existing conditions.
(more…)
MedicalResearch.com Interview with:
Jeff Coller, PhD Associate professor
Division of General Medical Science
Associate director, The Center for RNA Molecular Biology,
Case Western Reserve University School of Medicine
MedicalResearch: What is the background of this study?
Dr. Coller: There are a diverse number of half-lives for any individual messenger RNA (mRNA). The range of those half-lives is from seconds to hours. What the field has wanted to know for 30 years is how those rates are regulated, and there has been considerable anecdotal and real evidence that sequences in untranslated regions (UTRs) could regulate decay, but it doesn’t explain all of the half-lives that are observed for all messages. In addition, we have known mRNAs that are translated better are more stable than mRNAs that are translated poorly, so those pieces together led to the discovery.
(more…)
MedicalResearch.com Interview with:
Russel E. Kaufman, MD President Emeritus
Professor, Molecular and Cellular Oncogenesis Program
Molecular and Cellular Oncogenesis Program
The Wistar Institute
Medical Research: What is the background for this study? What are the main findings?
Response: Targeted therapies in cancer were hailed as a “magic bullet” because of their ability to act upon the mutations responsible for cancer while leaving nearby healthy cells alone. Using an approach like this, it would make sense that therapies designed to target mutations of BRAFV600E/K could be effective for melanoma, since that gene is mutated in about half of all cases of the disease.
However, we’ve learned over time that these targeted therapies simply aren’t as effective as we had hoped they would be. In the case of these BRAF inhibitors, while patients do live slightly longer, they eventually relapse within months of treatment. We wanted to know why this was happening.
We decided to look at macrophages, which are the most abundant inflammatory cells in melanoma. The more macrophages present in a patient with melanoma, the worse his or her outcome will be. They’ve been linked to cancer progression, but before this study, no one had really looked at the role they may play in the resistance to treatment with BRAF inhibitors.
We found that BRAF inhibitors activate the mitogen-activated protein kinase (MAPK) pathway in macrophages. When this pathway is activated, it leads to the production of vascular endothelial growth factor (VEGF), a signaling protein closely associated with angiogenesis. The VEGF produced in the macrophages is able to activate the MAPK pathway in melanoma cells, thereby stimulating the growth of cancer cells.
Taking these findings one step further, we discovered that when we blocked the MAPK pathway or VEGF signaling, we appeared to reverse macrophage-mediated resistance. When we targeted macrophages, we were able to increase the antitumor activity of BRAF inhibitors in mouse and human models.
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MedicalResearch.com Interview with:
Yuichiro Yano MD
Dept of Preventive Medicine,
Northwestern University, Chicago
Medical Research: What is the background for this study? What are the main findings?
Response: Previous research has suggested that nocturnal blood pressure (blood pressure during sleep) is more predictive of cardiovascular events than daytime blood pressure. However, the effect of nocturnal blood pressure on cognitive function in midlife, especially for young adults, has not been studied before.
The long-term clinical significance of the findings is that nocturnal blood pressure measurements in younger adults could be potentially useful to identify those who may be at risk for developing lower cognitive function in midlife.
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MedicalResearch.com Interview with:
Joyce Maalouf MS MPH
Nutrition Epidemiologist
CDC, Atlanta
Medical Research: What is the background for this study? What are the main findings?
Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity.
Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods.
In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods.
To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010.
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MedicalResearch.com Interview with:
Jonathan Thornburg, PhD
Director, Exposure and Aerosol Technology
RTI International
Research Triangle Park, NC
MedicalResearch: What is the background for this study? What are the main findings?Dr. Thornburg: RTI wants to improve the human condition by protecting public health from exposure to contaminants. That includes secondhand exposure to electronic cigarette vapors. RTI realized that most research has focused on the electronic cigarette user, not on secondhand exposure. Our research created a simulated lung in our laboratory to produce representative electronic cigarette aerosol that a user would exhale so we could measure the aerosol size distribution and chemical composition. Those two parameters are critical characteristics for understanding the physical and chemical properties of the aerosol as it disperses in the environment to produce the airborne concentrations that determine someone’s secondhand exposure. Our main findings were:
The aerosol particles exhaled by a user are smaller than 1000 nm, with median size between 100 and 200 nm. The aerosol size distribution varies with the type of e-liquid used.
The aerosol is made of water, glycerin/propylene glycol, nicotine, artificial flavors, and preservatives
Artificial flavors identified were ethyl maltol, 2-methyl naphthalene and 2-tert-butyl-p-cresol present.
BHA and BHT preservatives were present.
Dosimetry modeling determined that more than 50% of the electronic cigarette emissions were exhaled by the user, potentially leading to secondhand exposure.
MedicalResearch.com Interview with:Donald M Lloyd-Jones, MD/ScM
Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor
Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology
Northwestern University Feinberg School of MedicineMedicalResearch: What is the background for this study? What are the main findings?Dr. Lloyd-Jones: Previous studies have examined the associations of cardiovascular health, as defined by the American Heart Association, with outcomes in younger and middle-aged adults. Prior studies have also examined the status (i.e., prevalence) of cardiovascular health in adults across the age spectrum, and in adolescents ages 12-19 years. However, no study to date has examined the status of cardiovascular health in children under 12 years of age, so we sought to define it in detail using nationally-representative data.
Overall, although we have inadequate surveillance systems to monitor cardiovascular health optimally in our youngest children, this study shows that there are concerning signals that they are losing the intrinsic cardiovascular health they are born with, even well before age 12 years. The implications for loss of cardiovascular health before adulthood have been well established, with earlier onset of cardiovascular diseases, cancer and other diseases, earlier mortality, lower quality of life and many other adverse consequences.
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MedicalResearch.com Interview with:
Dr Angela Woods
Associate Editor, BMJ Medical Humanities Journal
Senior Lecturer in Medical Humanities
Deputy Director, Centre for Medical Humanities
Durham University
Medical Research: What is the background for this study? What are the main findings?Dr. Woods: We’ve known for a long time that hearing voices, or auditory hallucinations, is reported by people with a wide range of psychiatric diagnoses as well as by those who have no diagnosis. 5–15 per cent of adults will hear voices at some point during their lives – in circumstances that may be related to spiritual experiences, bereavement, trauma, sensory deprivation or impairment, as well as mental and emotional distress. However, what we know about voices clinically and empirically comes from a small handful of studies, typically conducted in mental health settings with patients with a diagnosis of schizophrenia using quantitative scales and measures. Our study asked people to describe, in their own words, what it is like to hear voices. We designed an open-ended online questionnaire which was completed by 153 people with a range of diagnoses, including 26 who had never had a psychiatric diagnosis.
Our study found that a large majority of participants described hearing multiple voices (81%) with characterful qualities (70%). While fear, anxiety, depression and stress were often associated with voices, 31% of participants reported positive and 32% neutral emotions. To our surprise less than half the participants reported hearing literally auditory voices; 45% reported either thought-like or mixed experiences. Perhaps the most startling finding concerned the physicality of voices. Bodily sensations while hearing voices were reported by 66% of participants – these included feelings of tingling, numbness, burning, pressure, and a sense of being distanced or disconnected from the body.
(more…)
MedicalResearch.com Interview with:
Prof. Dr. Nikolaus Becker
Epidemiologisches Krebsregister Baden-Württemberg
Deutsches Krebsforschungszentrum
Heidelberg Germany
Medical Research: What is the background for this study? What are the main findings?
Prof. Becker: Lung cancer is the leading cause of cancer death in our Western countries as well as worldwide. One reason is that it is clinically diagnosed mostly in an advanced stage with a poor five-year survival of less than 10%. Diagnosed at an early stage, more than 70% would survive 5 years. For low dose-multislice CT (MSCT) indications exist that it is able to detect lung cancers early. As every newly upcoming screening tool, it has to be carefully analyzed whether it is really able to decrease the mortality from lung cancers and at which costs in terms of undesired side effects such as false-positive findings and overdiagnosis. Our results indicate that spontaneous MSCT screening with changing doctors might be ineffective due to many false-positive alarms; if screening then within an organizational framework.
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MedicalResearch.com Interview with:
David C.R. Kerr Ph.D.
Sch of Psychological Science Associate Professor
College of Liberal Arts Oregon State University
Medical Research: What is the background for this study? What are the main findings?
Dr. Kerr: Many people assume we already know that low levels of vitamin D contribute to depression, especially in winter. However, studies have not found consistent evidence for this, and most studies have focused on people in late life or with serious medical conditions. We focused on apparently healthy young women living in the Pacific Northwest. We found that women with low blood levels of vitamin D were more likely to report clinically significant depressive symptoms. This link existed even when we considered other factors that might explain both problems, such as diet, obesity, and time of year. (more…)
MedicalResearch.com Interview with:
Prof. Ran Kornowski, M.D, FACC, FESC
Chairman - Division of Cardiology,
Rabin Medical Center
Petah-Tikva, Israel
MedicalResearch: What is the background for this study? Prof. Kornowski: Over the years, the PCI procedure went-through many progresses. Among those are some angioplasty techniques, generalize use of stents and drug eluting stents, and adjuvant novel antithrombotic therapy. Unmistakably, these were associated with an overall improved PCI outcome. As many of the data on PCIs’ adverse outcomes predictors come from predates studies, we sought to update this matter.
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MedicalResearch.com Interview with: Dr Rajeev Kumar Pathak MBBS, FRACP
Cardiologist and Electrophysiology Fellow
Centre for Heart Rhythm Disorders | University of Adelaide
Cardiovascular Investigation Unit | Royal Adelaide Hospital Adelaide Australia
Medical Research: What is the background for this study? What are the main findings?Response: Obesity and atrial fibrillation (AF) are dual epidemics that frequently coexist. Weight-loss reduces atrial fibrillation burden; however, whether this is sustained, has a dose effect or is influenced by weight-fluctuation is not known. In this study we evaluated the long-term impact of weight-loss and weight-fluctuation on rhythm control in obese individuals with atrial fibrillation.
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MedicalResearch.com Interview with:
Donovan Maust, MD, MS
Assistant Professor of Psychiatry
University of Michigan
Research Scientist, Center for Clinical Management Research
VA Ann Arbor Healthcare System
Medical Research: What is the background for this study? What are the main findings?
Dr.Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher.
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MedicalResearch.com Interview with:
Sirpa Soini, MHC, researcher
Department of General Practice and Primary Health Care
University of Helsinki
Medical Research: What is the background for this study? Response: Short-term weight loss is often successful, but he obtained results
are difficult to maintain. Therefore, a study focusing on obese people who successfully lost weight, with special emphasis upon methods applied and background factors,
is of major importance. Many people are successful in losing weight by
themselves without taking part in any organized group activity. The
knowledge about their success and the methods applied does not usually
reach the health care personnel and is one reason why it is difficult
to get reliable information about those who are successful in losing
weight.
(more…)
MedicalResearch.com Interview with:
Dr. Adil Haider, MD, MPH
Kessler Director of the Center for Surgery and Public Health (CSPH)
at Brigham and Women’s Hospital
Medical Research: What is the background for this study? Response: Disparities in the quality of care received by minority and low-income patients have been reported for years across multiple medical conditions, types of care, and institutions.
To determine whether clinicians’ unconscious race and/or social class biases correlated with a lower quality of care for minority patients and those of lower socioeconomic status, my colleagues and I conducted a web-based survey among 215 physicians at an academic, level one trauma center. Participants were asked to review eight clinical vignettes, and then respond to three questions about management of care after each. Following their response, a test known as an Implicit Association Test (IAT Test) was used to assess any unconscious preferences.
Medical Research: What are the main findings?Response: We found that race and class biases, as measured by response time to a standardized Implicit Association Test, had no relationship to the way that patients were clinically treated.
Whether the lack of association found between implicit bias and decision making in this study represents a true lack of association or the failure of clinical vignettes to capture the nuances of how implicit biases translate into management decisions remains unclear. Existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters. (more…)
MedicalResearch.com Interview with:
Dr. Pak Kin Wong Ph.D.
Aerospace& Mechanical Engineering Department Biomedical Engineering and Bio5 Institute
The University of Arizona
Medical Research: What is the background for this study? What are the main findings?
Response: Collective cell migration is central to various (patho)physiological processes, such as tissue development, regeneration, and cancer metastasis. At the onset of the process, a subset of cells acquires distinct leader cell phenotypes in the initially homogeneous population and leads the migration. However, how leader cells are initiated among the initial homogeneous population and how leader cell density is regulated during collective migration remain unknown. In this study, we demonstrate the formation of leader cells is regulated dynamically by Dll4 signaling through Notch1 and cellular stress near the leading edge. Our finding provides a molecular basis for the stochastic emergence of leader cells, a process originally considered random.
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MedicalResearch.com Interview with:
Joann G. Elmore M.D., M.P.H.
Professor of Medicine,
Adjunct Professor of Epidemiology,
University of Washington School of Medicine
Harborview Medical Center
Seattle, WA 98104-2499
MedicalResearch: What is the background for this study? What are the main findings?Dr. Elmore: It is estimated that 1.6 million women in the United States each year undergo a breast biopsy. By interpreting these biopsies under the microscope, pathologists provide diagnoses on a spectrum from benign, to atypia, to ductal carcinoma in situ (DCIS), to invasive cancer. Using these diagnostic classifications, clinical doctors work with their patients to decide if they are at increased risk of developing breast cancer in the future, which can lead to additional surveillance, or how to treat them when the diagnosis is invasive breast cancer. As misclassification of breast lesions by pathologists may contribute to overtreatment and undertreatment of breast disease, we decided to study the accuracy of breast pathology diagnoses in the U.S.
In the Breast Pathology (B-Path) Study, we used a set of 240 breast biopsy cases to evaluate the interpretive accuracy of 115 U.S. pathologists who were actively interpreting breast biopsies in their clinical practices. Their diagnoses were compared with reference diagnoses established by a consensus panel of experienced breast pathologists. When the panel members each independently diagnosed the slides pre-consensus, they agreed unanimously on 75 percent of their diagnoses; ninety percent of the panel members’ initial independent diagnoses agreed with the final consensus-derived reference diagnoses.
When comparing participating pathologists’ diagnoses to the reference diagnoses, we found overall agreement for 75 percent of interpretations. The concordance rate for invasive breast cancer was reassuringly high at 96 percent, and fairly high for benign findings without atypia at 87 percent. However, concordance was lower for atypia at 48 percent and for DCIS at 84 percent. This means that nearly one out of five pathologists disagreed on the diagnosis of DCIS. We found disagreement with the reference diagnosis to be statistically more frequent when pathologists had lower weekly case volumes or worked in smaller labs. Disagreement was also statistically significantly more likely when the patient had dense breast tissue on mammogram; however, the absolute difference was small. Our accuracy findings were not altered when we used different methods of defining the reference diagnosis.
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MedicalResearch.com Interview with:
Lona Mody, MBBS, MSc
Associate Division Chief, Clinical and Translational Research
Associate Director, Clinical Programs, VA GRECC
Associate Professor, Internal Medicine
Research Associate Professor, Institute of Gerontology
University of Michigan Geriatrics Ann Arbor, MI
Medical Research: What is the background for this study? What are the main findings?
Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections.
The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates.
A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively.
The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program.
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MedicalResearch.com Interview with:
Dr.Yecai Liu
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Response: Since the early 1900s, immigrants and refugees applying for a visa to come to the United States undergo a medical examination that includes tuberculosis (TB) screening. In 2007, CDC began implementing the new screening guidelines, which require people suspected of having TB to receive a much more sensitive sputum culture test to confirm TB to ensure that those individuals who do have TB receive treatment before they arrive in the United States. These requirements have now been completely rolled out to all countries with U.S.-bound immigrants and refugees.
From 2007 through 2012, half of the 3.2 million arrivals of immigrants and refugees to the United States were screened for TB by the new screening guidelines. Out of more than 4,000 TB cases diagnosed by the new screening guidelines during this period, nearly 2,200 were smear-negative and culture positive. These cases would likely have been missed under the previous screening requirements. The results of this study showed that the updated overseas screening guidelines led to a roughly one-third decrease in the annual number of TB cases among foreign-born persons within their first year in the United States.
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MedicalResearch.com Interview with:
Jeffrey (Jerry) G. Jarvik MD MPH
Professor, Radiology, Neurological Surgery and Health Services
Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine
Director, Comparative Effectiveness, Cost and Outcomes Research Center University of Washington Seattle, WA
Medical Research: What is the background for this study?
Dr. Jarvik: When I arrived at the Univ of WA over 20 years ago, my mentor, Rick Deyo, had just finished leading a project that was responsible for developing one of the first set of guidelines for the diagnosis and treatment of acute low back pain. These guidelines, published in a booklet by AHRQ (then called AHCPR), recommended that patients with acute low back pain not undergo imaging for 4-6 weeks unless a red flag was present. One of the exceptions was that patients older than 50 could get imaged immediately, the rationale being that older adults had a higher prevalence of potentially serious conditions such as cancer, infections, etc, that would justify the early imaging. As a practicing neuroradiologist, it was clear that a potential problem with this strategy is that the prevalence of age-related changes, which may or may not be related to back pain, also increases with age. So earlier imaging of older adults would almost certainly reveal findings, and these could easily start a series of unfortunate events leading to potentially poor outcomes and more healthcare resource use. Thus this policy of early imaging of older adults didn’t entirely make sense.
About 5 years ago, these guidelines hit home when I developed acute low back pain and since I was over 50 (barely) my doctor recommended that I get an imaging study. Being a knowledgeable patient and having a reasonable doctor, we mutually agreed not to get the study. I improved but that wasn’t the end of it. When we had the chance to apply for one of the CHOICE ARRA awards funded by AHRQ, we made answering this question of early imaging in older adults one of our primary goals.
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MedicalResearch.com Interview with:
Stephen W. Waldo, MD
Research Fellow in MedicineMassachusetts General Hospital
MedicalResearch: What is the background for this study? What are the main findings?Dr. Waldo: Public reporting is intended to improve outcomes for our patients. Proponents of public reporting applaud the increased transparency that it offers, allowing both patients and physicians to objectively evaluate health care outcomes for a given institution or individual provider. Previous research has demonstrated, however, that public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention for critically ill patients. The present study sought to evaluate the association between public reporting of outcomes with procedural management and clinical outcomes among patients with acute myocardial infarction. As the data demonstrate, public reporting of outcomes is associated with a lower rate of percutaneous revascularization and increased overall in-hospital mortality among patients with an acute myocardial infarction, particularly among those that do not receive percutaneous intervention. This may reflect risk aversion among physicians in states that participate in public reporting, an unintended consequence of this policy.
(more…)
MedicalResearch.com Interview with:
Raffaele Bugiardini, M.D.
Professor of Cardiology
University of Bologna
Medical Research: What is the background for this study? What are the main findings?
Dr. Bugiardini: Our analysis differs from previous reports of outcomes following STEMI because prior studies have not looked at sex differences in outcomes adjusted for time from symptom onset to hospital presentation and subsequent utilization of cardiac revascularization procedures, and rates of revascularization are typically significantly lower in women compared with men
Our study is the first to look at the relationship between delays and outcomes. (more…)
MedicalResearch.com Interview with:Marco Valgimigli, MD, PhD
Erasmus MC, Thoraxcenter,
Rotterdam The Netherlands
MedicalResearch: What is the background for this study? What are the main findings?Dr. Valgimigli: Interventional cardiologists can choose between two entry sites in order to perform a diagnostic coronary angiography and or a percutaneous coronary intervention, namely an artery which is in the groin called femoral artery or an artery which is located in the wrist which is called radial artery. The latter is more superficial and has small calibre as compared to the former. Femoral artery is the entry site which is most frequently used in the world especially in US where the use of radial artery is relatively limited.
Our study randomly allocated 8,404 patients to undergo diagnostic coronary angiography and PCI, if clinically indicated, either vie the femoral or the radial artery.
The main results of our study are that radial access reduced the composite of net adverse clinical events driven by a reduction of mortality and of major bleeding, including transfusions and need for surgical repair or the entry site.
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MedicalResearch.com Interview with:
Jagpreet Chhatwal Ph.D.
Assistant Professor, Department of Health Services Research
Division of Cancer Prevention and Population Sciences
The University of Texas MD Anderson Center
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Chhatwal: More than two million people in the U.S. are infected with Hepatitis C (HCV), a virus found in the liver. In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force both recommended a one-time hepatitis C screening for baby boomers – people born between the years 1946 and 1964. Last year, the Food and Drug Administration approved the medications sofosbuvir and ledipasvir for Hepatitis C treatment. The newly approved oral regimen comes at a staggering price to payers – as much as $1,125 per day. As a result, several payers have questioned if the price is justified.
The study results show that using new therapies is cost-effective in the majority of patients. However, the budget required to treat all eligible patients would be $136 billion over the next five years. Compared with the old drugs, new therapies would cost an additional $65 billion, whereas the cost offsets would be only $16 billion.
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MedicalResearch.com Interview with: Pam R. Taub, MD, FACC
Assistant Professor of Medicine
UC San Diego Health System
Division of Cardiology Encinitas, CA 92024
Medical Research: What is the background for this study?Dr. Taub: Epidemiological studies indicate that the consumption of modest amounts of dark chocolate (DC), which contains the natural cacao flavanol (-)-epicatechin (Epi,) is associated with reductions in the incidence of cardiovascular diseases (CVD). The health benefits of dark chocolate have been attributed to Epi. Clinical studies using cocoa and/or DC in normal volunteers or subjects with CVD have reported improvements in peripheral and coronary vascular endothelial function, blood pressure, lipids, insulin resistance, and inflammatory markers. The mechanism underlying these improvements is thought to be due to increased nitric oxide levels and improved endothelial function. We have also shown that capacity of Epi to favorable impact mitochondria under normal and disease states.
We previously conducted pilot study in five patients with heart failure and type II diabetes, and showed that in skeletal muscle (SkM) biopsies there is a severe reduction in mitochondrial volume and cristae, as well as, in structural/functional proteins. After treatment with Epi rich dark chocolate , there was a significant recovery of SkM mitochondrial cristae, structural/functional proteins (e.g. mitofilin), as well as in regulators of mitochondrial biogenesis. However, no studies have examined the capacity of Epi rich dark chocolate to enhance exercise capacity in normal subjects and assess its impact on mitochondrial and oxidative control systems.
Medical Research: What are the main findings?Dr. Taub: Seventeen subjects were randomized to placebo (n=8) or DC groups (n=9) and consumed 2 squares of chocolate (20 g, provided by Hershey) for 3 months.
We showed in the chocolate group subjects had improved levels of HDL cholesterol and enhanced exercise capacity that is linked to the stimulation of SkM metabolic control endpoints which enhance mitochondrial function.
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MedicalResearch.com Interview with:
Jay S. Kaufman, Ph.D
Canada Research Chair in Health Disparities
Department of Epidemiology, Biostatistics, and Occupational Health
McGill University
Montreal, Quebec Canada
Medical Research: What is the background for this study? What are the main findings?
Response: Published scientific articles speculate frequently about genetic predispositions in different racial groups as explanations for observed disease disparities. They infer this from the higher rates observed in racial minorities, even after adjusting for some social and behavioral measures. Taking the example of the racial disparity between blacks and whites in cardiovascular diseases (stroke, heart attack, heart failure, hypertension, etc), ours is the first published study to review all of the existing results from GWAS (genome-wide association studies) to see if they provide any support for this commonly stated position. To date, they do not. We performed an electronic literature search through the PubMed database to identify review articles and meta-analyses related to genetic risk factors for cardiovascular disease in samples that included populations of European and African ancestries. We focused our search on the 7-year period from January 1, 2007 to January 1, 2014, which corresponded to the rapid proliferation of large pooled GWAS activity. This search strategy yielded 197 review articles or meta-analyses. 68 of these articles contained relevant data, but very few reported significant associations in both racial groups, with just 3 variants meeting study-specific significance criteria. For most outcomes, there were too few estimates for quantitative summarization, but when summarization was possible, racial group did not contribute to heterogeneity. Most associations reported from genome-wide searches were small, difficult to replicate, and in no consistent direction that favored one racial group or another.
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MedicalResearch.com Interview with:
Sameer Bansilal, MD, MS
Asst. Prof.- Medicine and Cardiology
Clinical Trials & Global Health Studies
Icahn School of Medicine at Mount Sinai
Medical Research: What is the background for this study? What are the main findings?
Dr. Bansilal: Our group has previously published data from FREEDOM, COURAGE and BARI showing that adherence to recommended therapies are low in diabetic (DM) patients. We have spent the last decade developing a potential solution to this- the Fuster-Ferrer polypill. This study was done to better inform the association between levels of medication adherence and long term major adverse cardiovascular events (MACE) in high risk diabetic patients.
We analyzed a U.S. health insurers’ claims data for 19,962 high risk diabetic subjects. Using proportion of days covered (PDC) for 1 year after first refill, we stratified patients as fully adherent (FA≥80%), partially adherent (PA ≥40- ≤79%) or non-adherent (NA <40%) and examined the associations with a primary cardiovascualr outcome measure of death, myocardial infarction, stroke and coronary revascularization. We found that only 34% participants were fully adherent to therapy. When compared to being non-adherent at 2 yrs follow up,, being fully adherent was associated with a 28% lower rate of MACE; being partially adherent was associated with a 21% lower rate of MACE. Efforts towards improving adherence in diabetic subjects may lead to substantial reductions in MACE.
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MedicalResearch.com Interview with:
Kamen Tsvetanov, PhD
Centre for Speech, Language and the Brain
Department of Psychology
University of Cambridge
Downing Street
Cambridge, United Kingdom
Medical Research: What is the background for this study? What are the main findings?
Dr. Tsvetanov: Older brains may be more similar to younger brains than previously thought! In our study we have shown that changes in the aging brain previously observed using functional magnetic resonance imaging (fMRI) – one of the standard ways of measuring brain activity – may be due to changes in our blood vessels, rather than changes in the activity of our nerve cells, our neurons. Given the large number of fMRI studies used to assess the aging brain, this has important consequences for understanding how the brain changes with age and it challenges current theories of ageing.
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