MedicalResearch.com Interview with:
V. Zlokovic, MD, PhD
Professor and Chair
Department of Physiology and Biophysics
Keck School of Medicine of USC.
Medical Research: What is the background for this study? What are the main findings?
Dr. Zlokovic: Our team used high-resolution imaging of the living human brain to show for the first time that the brain’s protective blood barrier becomes leaky with age, starting at the hippocampus, a critical learning and memory center that is damaged by Alzheimer’s disease.
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MedicalResearch.com Interview with:
Ya-lin (Aileen) Huang, PhD.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Atlanta, GA, 30329
Medical Research: What is the background for this study? What are the main findings?
Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment.
Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic. (more…)
MedicalResearch.com Interview with:
Michael Wilson, MD, PhD, FAAEM
Attending Physician, UCSD Department of Emergency Medicine
Director, Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab UC San Diego Health System
MedicalResearch: What is the background for this study? What are the main findings?Dr. Wilson: Emergency departments (EDs) nationwide are crowded. Although psychiatric patients do not make up the largest proportion of repeat visitors to the emergency department, psychiatric patients stay longer in the ED than almost any other type of patient. So, it’s really important to find out things about these patients that may predict longer stays.
In this study, we looked at patients on involuntary mental health holds. The reasoning is simple: patients on involuntary mental health holds aren’t free to leave the ED. So, the only thing that should really matter is how quickly an Emergency department can release them from the involuntary hold. Surprisingly, though, this wasn’t the only thing that correlated with longer stays.
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MedicalResearch.com Interview with: Raphaëlle Varraso
INSERM U1168, VIMA (Aging and chronic diseases. Epidemiological and public health approaches), 16 avenue Paul Vaillant Couturier
Villejuif, FranceMedicalResearch: What is the background for this study? What are the main findings?Response: Respiratory health and lung function, strongly predict general health status and all-cause mortality. Chronic obstructive pulmonary disease (COPD) is currently ranked the third leading cause of death worldwide. The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, suggesting that other factors are involved. Besides smoking, relatively little attention has been paid to other modifiable risk factors that might decrease risk of developing COPD, including diet. The Alternate Healthy Eating Index (AHEI)-2010, a new measure of diet quality based on current scientific knowledge, has been linked to risk of major chronic diseases, such as cardiovascular disease, diabetes and cancer. However, the role of dietary scores on risk of COPD is unknown.
We examined this issue among >120,000 US female and male health professionals (Nurses’ Health Study and Health Professionals Follow-up Study), and we reported that a high AHEI-2010 dietary score score (reflecting high intakes of whole grains, vegetables, fruit, polyunsaturated fatty acids, nuts and legumes, and long-chain omega-3 fats, a moderate intake of alcohol, and low intakes of red/processed meats, trans fat, sodium and sugar-sweetened beverages) was associated with a lower risk of COPD in both women and men. This novel finding supports the importance of diet in COPD pathogenesis.
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MedicalResearch.com Interview with:
Mark Brittan MD MPH
Assistant Professor, Pediatric Hospital Medicine
Children's Hospital Colorado
University of Colorado School of Medicine
MedicalResearch:What is the background for this study? What are the main findings?Dr. Brittan: As hospitals face reimbursement penalties for excess readmissions, clinicians are increasingly focused on improving care transitions in order to reduce readmissions. We are interested in learning about feasible ways to reduce pediatric readmissions so that we can improve the quality of care and experience of children and families who are being discharged from the hospital. The purpose of this study was to assess whether outpatient follow-up visits after hospital discharge can help to prevent readmissions. We chose to examine this question in a population of medically complex children enrolled in Medicaid. Children with medical complexity account for a growing proportion of pediatric hospitalizations and inpatient costs. These children are often dependent on technology (for example, ventilator machines, feeding tubes, and chronic indwelling catheters), and can have very complex care plans and medication regimens. Publically insured children are also vulnerable to increased hospital utilization and may not always have optimal or easy access to outpatient services. Showing a relationship between post-discharge outpatient visits and fewer readmissions would suggest that improvements in coordination of care or access to outpatient follow-up care may help to reduce readmissions in these children. To assess this relationship, we retrospectively analyzed 2006-2008 Colorado Medicaid claims data from which we were able to gather demographic, clinical, and visit information for all enrollees.
In our study, we excluded children who were readmitted within 3 days of hospital discharge so that we could evaluate children who had a chance to follow-up. The study cohort included 2415 medically complex children aged 6 months to 18 years who were hospitalized at least once. Of these children, 6.3% were readmitted on days 4 – 30 after hospital discharge. Almost 22% of the children had an outpatient follow-up visit within 3 days of discharge, and 40% had a visit on days 4-29 after discharge. In the final analysis, we found expected associations between readmission and previously described risk factors, including number of patient comorbidities and longer initial hospital length of stay. Examining the relationship between outpatient follow-up and readmission, we found that children with later outpatient follow-up visits (days 4-29) were significantly less likely to be readmitted than those who did not have an outpatient visit on days 4-29 after discharge.
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MedicalResearch.com Interview with:Dr. Eleanor B. Schwarz, M.D., M.S
University of California, Davis
Sacramento, CA
MedicalResearch.com:What is the background for this study? What are the main findings?Dr. Schwarz: The background for this study is that…
Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects.
Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others.
MedicalResearch.com:What should clinicians and patients take away from your report?Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard).
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MedicalResearch.com Interview with:
Prof Jean-Michel Molina
Maladies Infectieuses et Tropicales, Hôpital
Saint-Louis, Paris FranceMedical Research: What is the background for this study? What are the main findings?
Prof. Molina: Treatment of co-infected patients is complicated by drug drug interactions with HIV drugs, and the news DAAs are not very potent on HCV G2 and 3 infections.
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MedicalResearch.com Interview with:
W. H .Wilson Tang, M.D., F.A.C.C., F.A.H.A.
Professor in Medicine, Cleveland Clinic Lerner College of Medicine
Cleveland Clinic, Cleveland, OH 44195.
Medical Research: What is the background for this study? What are the main findings?
Dr. Tang: Our group has previously demonstrated that TMAO is linked to future cardiac risks in both humans and in animal models. We now show that long-term exposure to higher levels of TMAO promotes renal functional impairment and fibrosis in animal studies. We also show that in humans, as the kidneys lose function, TMAO isn’t eliminated as easily, and their blood levels further rise, thereby increasing cardiovascular and kidney disease risks further. This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and chronic kidney disease.
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MedicalResearch.com Interview with:
John Tower, PhD
Professor, Molecular and Computational Biology Program
Department of Biological Sciences
USC Dana and David Dornsife College of Letters,...
MedicalResearch.com Interview with: Uzma Samadani, M.D., Ph.D.
Assistant Professor
Departments of Neuroscience and Physiology
NYU Langone Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Samadani: Research dating back as early as 3,500 years ago suggests the eyes serve as a window into the brain, with disconjugate eye movements -- eyes rotating in different directions -- considered a principal marker for head trauma. Current estimates suggest up to 90 percent of patients with concussions or blast injuries exhibit dysfunction in their eye movements.
We wanted to find a way to objectively track and analyze eye movements following a head injury to measure injury severity and replace the current “state of the art” method of asking a patient to follow along with a finger. CT-scans and MRIs may not necessarily reveal concussion or traumatic brain injury (TBI) in the absence of structural damage, presenting a need for a diagnostic measure of head injury severity.
In a study published earlier this year in the Journal of Neurosurgery, my team at the NYU Cohen Veterans Center tested our novel eye-tracking technology on military veterans, and found our device and tracking algorithm could reveal edema in the brain as a potential biomarker for assessing brain function and monitoring recovery in people with head injuries.
Our latest paper, published January 29 in Journal of Neurotrauma, looked at a civilian population of patients admitted to the Bellevue Medical Center emergency department in New York City, with whom the NYU School of Medicine has an affiliation agreement. We compared 64 healthy control subjects to 75 patients who had experienced trauma that brought them to emergency department. We tracked and compared the movements of patients' pupils for over 200 seconds while watching a music video.
We found that 13 trauma patients who had hit their heads and had CT scans showing new brain damage, as well as 39 trauma patients who had hit their heads and had normal CT scans, had significantly less ability to coordinate their eye movements than normal, uninjured control subjects. Twenty-three trauma subjects who had bodily or extremity injuries but did not require head CT scans had similar abilities to coordinate eye movements as normal uninjured controls.
Among patients who had hit their heads and had normal CT scans, most were slightly worse at 1-2 weeks after the injury, and subsequently recovered about one month after the injury. Among all trauma patients, the severity of concussive symptoms correlated with severity of disconjugacy.
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MedicalResearch.com Interview with:
Dr. Andrea Gore PhDGustavus & Louise Pfeiffer Professor
University of Texas Austin/Div of Pharmacology/Toxicology
MedicalResearch.com Editor’s Note: Dr. Gore, Editor-in-Chief of the Journal Endocrinology, has graciously answered several questions regarding the recent concerns of environmental chemicals linked to both early puberty and early menopause.
Medical Research: How can chemicals found inside the home impact onset of menopause?Dr. Gore: It is important to clarify that the cause-and-effect relationship between chemicals and menopause is not established. The timing of menopause in women is due to a variety of factors including genetic traits, nutritional status, and general health or chronic disease. Some research on humans, including the recent study by Grindler et al., also suggests that environmental chemicals may contribute to the timing of earlier menopause. Animal models also suggest an advance in the timing of reproductive failure following earlier life exposures to endocrine-disrupting chemicals (EDCs). [See references below]. The question of exactly how chemicals may change the timing of menopause is therefore unresolved, but based on animal studies it is likely that the mechanisms include effects of endocrine-disrupting chemicals on the expression of genes and proteins involved in ovarian function that may lead to premature loss of follicles (eggs). Because the control of reproduction involves the brain and the pituitary gland, as well as the ovary, it is possible that endocrine-disrupting chemicals also impair how these organs regulate reproductive hormones.
Gore AC, Walker DM, Zama AM, Armenti AE, Uzumcu M. Early
life exposure to endocrine-disrupting chemicals causes lifelong molecular
reprogramming of the hypothalamus and premature reproductive
aging. Mol Endocrinol. 2011;25:2157–2168.
Shi Z, Valdez KE, Ting AY, Franczak A,GumSL, Petroff BK. Ovarian
endocrine disruption underlies premature reproductive senescence
following environmentally relevant chronic exposure to the
aryl hydrocarbon receptor agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin.
Biol Reprod. 2007;76:198–202.
Akkina J, Reif J, Keefe T, Bachand A. Age at natural menopause and
exposure to organochlorine pesticides in Hispanic women. J Toxicol
Environ Health A. 2004;67:1407–1422.
Cooper GS, Savitz DA, Millikan R, Chiu Kit T. Organochlorine
exposure and age at natural menopause. Epidemiology. 2002;13:
729–733.
Hatch EE, Troisi R, Wise LA, et al. Age at natural menopause in
women exposed to diethylstilbestrol in utero. Am J Epidemiol.
2006;164:682–688.
KnoxSS, Jackson T, Javins B, Frisbee SJ, Shankar A, DucatmanAM.
Implications of early menopause in women exposed to perfluorocarbons.
J Clin Endocrinol Metab. 2011;96:1747–1753.
Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, Cooper GS.
Pesticide exposure and timing of menopause: the Agricultural
Health Study. Am J Epidemiol. 2006;163:731–742.
Medical Research: What are the primary sources of exposure to these chemicals?Dr. Gore: Endocrine-disrupting chemicals exposures come from a variety of sources, including plastic containers (e.g. water bottles) and other products, certain foods, personal care products, pesticides, and many others.
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MedicalResearch.com Interview with:
Agnel Sfeir PhD Assistant Professor
Skirball Institute - NYU
New York, NY 10016
Medical Research: What is the background for this study? What are the main findings?
Dr. Sfeir: The main finding of this study, published in the journal Nature, is that inhibiting the action of a particular enzyme dramatically slows the growth of tumor cells tied to BRCA1 and BRCA2 genetic mutations which, in turn, are closely tied to breast and ovarian cancers.
This discovery about the enzyme — called polymerase theta, or PolQ — resulted from efforts to answer a fundamental biological question: How do cells prevent the telomere ends of linear chromosomes, which house our genetic material, from sticking together? Cell DNA repair mechanisms can stitch together telomeres broken as part of cell metabolism. But such fusions, the researchers say, compromise normal cell growth and survival.
In the purest biological sense, our findings (in experiments in mice and human cells) show how this particular enzyme, which we know is active in several tumors, promotes unwanted telomere fusions by inserting whole segments of DNA via a disruptive DNA repair pathway termed alt-NHEJ. It was quite remarkable to find that by blocking PolQ action, cancer cell growth was cut by more than half.
Additional experiments confirmed that PolQ is needed to activate the alt-NHEJ pathway of DNA repair. Unlike the main, error-free pathway — or HDR pathway — the alt-NHEJ pathway does not use a related chromosome’s genetic material as a template to meticulously correct any damaged genetic material. As such, alt-NHEJ is highly likely to leave coding mistakes.
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MedicalResearch.com Interview with:
Mette Gyldenløve MD
Gentofte Hospital, University of Copenhagen
Denmark
MedicalResearch: What is the background for this study?
Dr. Gyldenløve: Epidemiological studies have shown that patients with psoriasis have increased risk of type 2 diabetes. The pathophysiology is largely unknown, but it is hypothesised that systemic inflammation causes insulin resistance, which is an early feature of type 2 diabetes. Insulin sensitivity has only been sparsely investigated in patients with psoriasis, and previous studies have used suboptimal methodology. The objective of the present study was to investigate, if patients with psoriasis exhibit impaired insulin sensitivity when assessed by the hyperinsulinaemic euglycaemic clamp technique (gold standard).
MedicalResearch: What are the main findings?
Dr. Gyldenløve: In this study we found that normal glucose-tolerant patients with moderate-to-severe psoriasis (n=16) had significantly reduced insulin sensitivity compared to age, gender, and body mass index (BMI)-matched, healthy control subjects (n=16). The two groups were similar with regard to age, gender, BMI, body composition, physical activity, fasting plasma glucose, and glycosylated haemoglobin.
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MedicalResearch.com Interview with:
Mark Slifstein, PhD
Associate Professor of Neurobiology (In Psychiatry) Dept. of Psychiatry
Columbia University NYSP
Dr New York NY 10032MedicalResearch: What is the background for this study?Dr. Slifstein:There has been considerable basic and clinical neuroscience research showing that the neurotransmitter dopamine plays a role in tuning cognitive processes taking place in the cortex. It has long been thought that dopamine is involved in the cognitive difficulties experienced by patients with schizophrenia, but it has been challenging to study dopamine in the cortex and other parts of the brain except in a deep structure rich in this neurotransmitter and its receptors, the striatum. In our study, we used an experimental design with Positron Emission Tomography (PET) imaging that allowed us to infer the amount of dopamine in the cortex.
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MedicalResearch.com Interview with:
Dr. Judy Stevens PhDNational Center for Injury Prevention and Control
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
Medical Research: What is the background for this study? What are the main findings?
Dr. Stevens: Falls among people aged 65 and older are a serious, costly, and growing public health problem. As our population ages, falls will continue to increase unless we implement effective prevention strategies that are also cost-effective.
This study found that three evidence-based fall prevention programs, the Otago Exercise Program, Tai Chi: Moving for Better Balance, and Stepping On, were not only practical and effective but also provided a positive return on investment (ROI) or net benefit. An ROI of 150% means for each $1 spent on implementing the program, you can expect a net benefit of $1.50.
The analysis found that the cost of implementing each of these fall prevention programs was considerably less than the potential medical costs needed to care for someone injured from a fall. These research findings can help community organizations and policymakers identify and use programs that can both save lives and reduce costs.
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MedicalResearch.com Interview with:
Dr Stefan M Gold
Institute of Neuroimmunology and Multiple Sclerosis (INIMS)
Centre for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf
Hamburg, Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Gold: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (brain and the spinal cord). In addition to motor symptoms such as walking impairment, patients with Multiple sclerosis frequently suffer from psychological problems including difficulties with learning and memory as well as depressed mood. Depression is particularly common in this patient group with a 3-4 fold elevated risk for developing major depressive disorder compared to the general population. Depression in Multiple sclerosis is associated with decreased quality of life, absence from work, and numerous other psychosocial problems. Despite this major impact on patients’ lives, depression in Multiple sclerosis is often not adequately diagnosed and treated: Antidepressant medication in this patient group often has side effects and the neurological problems associated with MS such as difficulties with concentration and fatigue make it particularly difficult for MS patients to complete “classical” depression treatments such as psychotherapy. The goal of our study was to make psychological treatments available for the many patients with Multiple sclerosis suffering from depression, who often have difficulties to find adequate treatment.
For this study, published in The Lancet Psychiatry, we conducted a randomized controlled trial of a fully-automated, computer-based program that can be accessed directly from patients’ homes over the internet. The program called “deprexis” was developed by the Hamburg-based company GAIA and uses methods of “cognitive behavioral therapy” or “CBT”. Ninety Multiple sclerosis patients were enrolled in the trial and randomly assigned to a 3 months therapy using the deprexis program or a waitlist control group. At the end of the intervention, depression had significantly decreased in the treatment group but remained unchanged in patients who did not have access to the program. In addition, patients using the computer program also reported reduced fatigue and improved quality of life. (more…)
MedicalResearch.com Interview with:
Dr Matthew R Moore, MD
National Center for Immunization and Respiratory Diseases,
Centers for Disease Control and Prevention, Atlanta, GA, USA
MedicalResearch: What is the background for this study? Dr. Moore: Since introduction, pneumococcal conjugate vaccines have resulted in dramatic decreases in the number of cases of invasive pneumococcal disease in both children and adults. The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine infant immunization program in the United States in 2000. It was recommended for infants using a 4-dose schedule: 2, 4, 6, and 12 through 15 months of age. Studies showed that PCV7 was highly effective in preventing invasive pneumococcal disease. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 using the same 4-dose schedule. PCV13 is similar to PCV7, but includes protection against six additional serotypes of Streptococcus pneumoniae. There are more than 90 serotypes of pneumococcal bacteria.
Streptococcus pneumoniae, or pneumococcus, is a major cause of illness and death globally. Pneumococcus can cause many types of illness that ranging from mild to life-threatening, including pneumonia, ear and sinus infections, meningitis, and bacteremia. Some of these infections are considered invasive because they invade parts of the body that are normally free from bacteria. Invasive pneumococcal disease, including meningitis and bacteremia, is often severe and can be deadly.
MedicalResearch: What are the main findings? Dr. Moore: Invasive pneumococcal disease decreased substantially in the first 3 years after PCV13 was introduced into the U.S. infant immunization schedule. By June 2013, more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths are estimated to have been prevented in the United States due to PCV13. Children under the age of five, which is the age group that actually received the vaccine, experienced the greatest and quickest benefit from PCV13. For example, the overall number of cases of invasive pneumococcal disease decreased by 64% in this age group between 2010 and 2013. Significant decreases were seen as early as six months after the immunization recommendation was made.
Adults, who were not targeted for vaccination, also experienced health benefits from PCV13 introduction. For example, the overall number of cases of invasive pneumococcal disease decreased by 32% for adults aged 18 to 49 years, while adults 65 and older experienced a more modest 12% decrease. These reductions are further evidence that both PCV7 and PCV13 reduce the spread of pneumococcus, which is why vaccinating children leads to disease reductions in adults.
For both children and adults, the greatest reductions were seen in the number of cases of invasive pneumococcal disease that were caused by serotypes that are covered by PCV13 but not PCV7 (serotypes 19A and 7F specifically).
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MedicalResearch.com Interview with:
Margaret M. Cortese MDDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Cortese: The introduction of rotavirus vaccine in the United States resulted in a dramatic reduction in hospitalizations and emergency department care for rotavirus disease among young children, as well as provided indirect protection to unvaccinated peers.
However, what our study looked at was whether or not older children and adults may experience indirect protection from having children in the house who are vaccinated for rotavirus.
We used 2008-2012 Marketscan claims data to compare gastroenteritis rates among households whose child had received rotavirus vaccine with households whose child did not receive vaccine.
We found statistically significantly lower rates of hospitalization from rotavirus gastroenteritis or unspecified-gastroenteritis in vaccinated households among all persons 20-29 years and females 20-29 years during the 2008-2009 rotavirus season as well as males 30-39 years in the 2009-2010 season. Lower emergency department gastroenteritis rates occurred in vaccinated households among females 20-29 years during the 2009-2010 season and individuals 5-19 years during the 2010-2011 season.
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MedicalResearch.com Interview with John Holcomb, M.D.
Principal investigator, Retired U.S. Army Surgeon
Director of the Division of Acute Care Surgery
The University of Texas Health Science Center at Houston
UTHealth Medical School
MedicalResearch: What is the background for this study?
Dr. Holcomb: This study is the result of two decades of work by literally hundreds of investigators. It started as an observation in 1993 in Somalia that whole blood was a superior resuscitation product in casualties that were bleeding to death. Unfortunately, whole blood is not widely available, and 1:1:1 is the closest we can get at this time. After many studies from the battlefield, and even more in the civilian area, we have now published a randomized study documenting that 1:1:1 is a superior transfusion strategy, safe and helps prevent patients from bleeding to death.
MedicalResearch: What are the main findings?Dr. Holcomb: The 1:1:1 resuscitation strategy significantly decreased the rate of bleeding to death, and there were no increased complications between groups.
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MedicalResearch.com Interview with:
Robert Hutchins, M.D., M.P.H.Department of Medicine, Division of General Internal Medicine
UCSF
Medical Research: What is the background for this study? What are the main findings?
Dr. Hutchins: "Utility" refers to the effect on quality of life that a certain intervention carries and a utility value generally varies from 0-1.0. The more negative the effect is, the lower the utility value (closer to 0), and the less it affects quality of life, the closer to 1.0 it is. On a theoretical scale, "perfect health" is 1.0 and death is 0. There are a number of studies that -- USE a utility value for taking pills, generally between 0.95 and 1.0. However, many cost-effectiveness analyses ignore the utility value altogether, or arbitrarily choose 1.0 as the utility. We found that a small change in the utility value can have a very large effect on the overall cost-effectiveness of an intervention. We found that the utility value of taking pills, assessed by three different commonly used methods, to be 0.990-0.994, depending on the method.
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MedicalResearch.com Interview with:
Dr. Ryan Merkow, M.D. M.S.
American College of Surgeons
Chicago, Illinois
MedicalResearch.com:What is the background for this study? What are the main findings?Dr. Merkow: The measurement of hospital readmissions has become an important quality and cost-containment metric. Hospitals, policy makers, and individual practitioners are closely tracking readmissions. For the past decade the focus has been primarily on three medical conditions (pneumonia, heart failure and myocardial infarction) and although controversial, many thought leaders and policy makers believed that readmissions were preventable, and stemmed from poor transition of care, outpatient follow up or simply a failure of the medical system to appropriately care for these patients. Recently, the Center for Medicare and Medicaid Services has become increasingly interested in using readmissions as a quality measure and is now mandated by the Hospital Readmission Reduction Program to track hospital-wide readmissions (including all surgical patients), and for the first time, after individual surgical procedures (i.e., total hip and knee replacement). Future inclusion of additional surgical procedures is anticipated.
However, despite the growing focus on readmissions after surgery, there have been few studies comprehensively evaluating the underlying reasons and factors associated with readmissions after surgical hospitalizations. Furthermore, the relationship between readmissions and complications that occur during the initial hospitalization after surgery is not clearly established. Importantly, unlike medical conditions, surgical patients undergo a discrete invasive event with known risks of complications. By studying this topic, initiatives to decrease readmissions can be more precisely determined, and national policy decisions that are now targeting readmissions can be appropriately formulated.
The primary findings of our study identified surgical site infections as the most frequent reason that patients are readmitted after surgery, Importantly, in >95% of patients this complication was new, occurring after they left the hospital. The other common reason for readmission was obstruction or ileus, which was the second most frequent reason for readmission, particularly after abdominal surgery. Overall, the vast majority of readmissions were the result of new postdischarge, postoperative complications. With respect to factors associated with readmissions, most of the variation was due to differences in patient factors, such as ASA class, renal failure, ascites and/or steroid use.
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MedicalResearch.com Interview with: Dr. Jean-Pol Frippiat
Stress, Immunity and Pathogens Laboratory
Lorraine University
Vandoeuvre-lès-Nancy, France
What is the background for this study? What are the main findings?Dr. Frippiat: Osteoporosis is associated to spaceflight. Consequently, we wondered whether changes in bone micro-structure induced by a ground-based model of spaceflight, hindlimb unloading (HU) that simulates some of the effects of spaceflight on mice, induces changes in B lymphocyte production in the bone marrow.
To this end, we analyzed both bone parameters and the frequency of cells of the B lineage in the bone marrow of young, old and HU mice. We found that HU leads to a decrease in both bone micro-structure and the frequency of B cell progenitors in the bone marrow. A major block at the pro-B to pre-B cell transition was observed indicating a decrease in the formation of B cells in the bone marrow. Interestingly, the modifications in B cell production were similar to those observed in aged mice.
These findings demonstrate that mechanical unloading, to which astronauts are subjected during spaceflight, results in a decrease in B cell differentiation that resemble age-related modifications in B lymphopoiesis.
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Nicholas Osborne, M.D., M.SVascular Surgery Fellow
University of Michigan, Ann Arbor
MedicalResearch.com: What is the background for this study?Dr. Osborne: The American College of Surgeons launched the National Surgical Quality Improvement Program (ACS-NSQIP) in the early 2000s. This program collects and reports surgical outcomes to participating hospitals. One retrospective study of participating hospitals in the ACS-NSQIP reported improvements in risk-adjusted outcomes with participation. This study, however, did not compare ACS-NSQIP hospitals to control hospitals. The purpose of our study was to compare ACS-NSQIP to similar non-participating hospitals over time and determine whether participation in the ACS-NSQIP was associated with improved outcomes.
MedicalResearch.com: What are the main findings?Dr. Osborne: When comparing hospitals participating in a national quality reporting program (ACS-NSQIP) to similar hospitals, there is no appreciable improvement in outcomes (mortality, morbidity, readmissions or cost) outside of pre-existing trends across all hospitals. In other words, Hospitals nationwide were improving over this same time period and ACS-NSQIP hospitals did not improve above and beyond these existing trends.
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MedicalResearch.com Interview with:
Adeel A. Butt, MD, MS, FACP, FIDSA
Adjunct Associate Professor of Medicine and Clinical and Translational Science
University of Pittsburgh School of Medicine
MedicalResearch:What is the background for this study? What are the main findings?
Dr. Butt: Studying clinical consequences of hepatitis C virus (HCV) infection is often limited by the lack of knowledge of actual time of infection. We used the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES), a well-established national cohort of HCV infected veterans and corresponding HCV-uninfected controls, to identify patients with a known time frame for HCV infection. Our primary aim was to determine the rate of liver fibrosis progression among HCV-infected persons over time, with and to determine factors associated with development of cirrhosis and hepatic decompensation among these persons.
Among 1840 persons who were HCV+ and 1840 HCV− controls, we found that fibrosis progression started early after HCV infection tapered off after 5 years. After 10 years of follow-up, 18.4% of HCV+ and 6.1% of HCV- persons developed liver cirrhosis. Nine years after diagnosis of cirrhosis, only 1.8% of HCV+ and 0.3% of HCV- persons had developed hepatic decompensation.
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MedicalResearch.com Interview with: Dr. Matthias Bossard, MD
Clinical and Research Fellow Cardiology Division
Department of Medicine University Hospital Basel
Basel Switzerland
MedicalResearch: What is the background for this study? What are the main findings?Dr. Bossard: Endothelin-1 (ET-1) and its pleiotropic effects have been implicated in the regulation of vascular and renal physiology as well as inflammation. Moreover, elevated ET-1 levels have been associated with endothelial dysfunction and atherosclerosis. Until now, data on the relationships between ET-1 and individual cardiovascular risk factors were scarce, especially from large-scale population based studies. This may be attributable to the previously used laboratory assays.The emergence of new ET-1 assays has facilitated ET-1 measurement in large populations.
Our main findings are that ET-1 levels are independently associated with several individual cardiovascular risk factors an overall cardiovascular risk in a large cohort of young and healthy adults.Specifically, ET-1 levels were significantly associated with systolic blood pressure, current smoking, glomerular filtration rate and high-sensitivity C-reactive protein. (more…)
MedicalResearch.com Interview with:Emanuele Cereda, MD, PhD
Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy and
Federico D’Andrea MD
SCDO Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy
MedicalResearch: What is the background for this study? What are the main findings?Response: Pressure ulcers (PUs) represent an important indicator of patient safety and quality of care. They negatively affect patient quality of life and increase healthcare costs. PUs are closely linked to malnutrition as it contributes not only to their development but also to impaired healing. It's also a sign of neglect if the patient is in a nursing home so you may want to contact someone like this nursing home neglect lawyer if you are worried that your loved one is being mistreated. Pressure ulcers patients are frequently unable to meet energy requirements through spontaneous feeding and nutritional support becomes essential. International guidelines currently recommend nutritional assessment and nutritional support as most Pressure ulcers patients can take advantage from adequate supply of proteins and calories. Beside, recent studies have suggested that additional provision of larger amount of some nutrients putatively involved in wound healing - arginine, zinc and antioxidants - may be of additional benefit. The OEST study has specifically investigated the role of these nutrients and has demonstrated that supplementation of malnourished Pressure ulcers patients with an oral nutritional formula enriched with arginine, zinc and antioxidants improves Pressure ulcers healing, independently of the adequate supply of proteins and calories. (more…)
MedicalResearch.com Interview with:
Kate A O’Neill
Department of Paediatrics
University of Oxford Children’s Hospital
John Radcliffe Hospital Oxford UK
MedicalResearch.com: What is the background for this study? Dr. O'Neill: Cancer affects around 1 in 500 children under the age of 15. Although the diagnosis and treatment of these diseases have seen major advances over the past few decades, survivors often experience health complications later in life, and cancer remains the main cause of disease related death in children in the developed world.
The identification of risk factors for a number of adult cancers has allowed awareness and screening campaigns aimed at preventing disease. For the majority of childhood cancers, however, we still do not know what causes them, and so similar preventative measures are at present not possible.
Incidence rates for many childhood cancers peak within the first few years of life, suggesting that the causative events occur early. For childhood leukaemia, it has even been shown that pre-malignant cells are already present at birth, indicating the disease may originate in utero. Studies exploring potential prenatal risk factors for childhood leukaemia have consistently found that children with the disease have higher birthweights than children who do not, and it is now widely accepted that the faster a foetus grows, the higher the risk of developing leukaemia in childhood.
Leukaemia is the most common childhood cancer, accounting for approximately one third of all cases. Other childhood cancers are rarer, and it is consequently harder to perform similar risk association studies. The aim of this study was to compile information on large enough numbers of cases and controls to allow the analysis of risk associations between birthweight and all types of childhood cancer. Furthermore, we compiled data in different countries (USA and UK) to allow the comparison of results from two independent populations.
MedicalResearch.com: What are the main findings?Dr. O'Neill: We found that with each 0.5kg (1.1lb) increase in birthweight, the risk of childhood cancer increased by 6%. Compared to babies with average birthweights (3-3.49kg, or 6.6lb -7.7lb), babies with clinically high birthweights (4kg, or 8.8lb, and above) had an increased risk of between 16% and 20%.
These increased risks were strongest for certain cancers:
Leukaemias
Tumours of the central nervous system
Renal tumours
Soft tissue sarcoma
Neuroblastoma
Lymphoma
Germ cell tumours
Malignant melanomas
Hepatic tumours showed the reverse association, with risk increasing as birthweight decreased. Retinoblastoma, an embryonal tumour, and malignant bone tumours, which occur predominantly in adolescents, did not associate with birthweight.
Our results were strikingly similar between USA and UK populations. Furthermore, birthweight appeared act independently of other factors that are known or suspected to associate with birthweight and/or childhood cancer (gestational age, birth order, plurality, maternal age and race/ethnicity).
In summary, we found that approximately half of all childhood cancers are associated with birthweight. The association with a diversity of otherwise unrelated cancers indicates that in utero tissue growth and development has an underlying and potentially key role in the development of malignancy in childhood.
(more…)
MedicalResearch.com Interview with
Gavin M. Bidelman, Ph.D.
Assistant Professor Institute for Intelligent Systems
School of Communication Sciences & Disorders
University of Memphis
Memphis, TN 38105
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Bidelman: Musical training as been shown to enhance brain function and impact behavioral skills (e.g., speech and language functions) in younger adults. In the current study, we investigated whether or not these advantages extend to older brains, which are thought to be less "plastic" (i.e., less malleable to experience/training). Older adults also often experience reduced speech recognition abilities later in life so we wanted to see if musicianship can serve as an effective means to bolster speech listening skills that decline across the lifespan.
Main findings:1) On average, older musicians were 20% faster in identifying speech sounds behaviorally than their nonmusician peers. Interestingly, this is similar to the benefit we have observed in young people with musical training.
2) We were able to predict how well people classify/identify speech via (EEG) brain activity in both groups. However, this brain-behavior correspondence was ~2-3x better in older musicians. In other words, old musicians' brains provide a much more detailed, clean, and accurate depiction of the speech signal which is likely why they are much more sensitive to speech behaviorally.
3) We compared neural responses generated from multiple levels of the auditory system and found that musicians had more coordination (significantly higher correlations) between different regions. This implies that the "musical brain" operates more in concert than in non-musicians.
All of these findings challenge conventional views that older brain's are no longer plastic, are somehow noisier, and show poorer coordination across brain regions. In fact we show just the opposite. In older brains, musicianship does produce pervasive plasticity, provides cleaner (less noisy) representations of speech, and orchestrates more neural coordination.
(more…)
MedicalResearch.com Interview with:Peter Bayley PhD
War Related Illness and Injury Study Center
Veteran Affairs Palo Alto Health Care System
Palo Alto, California
MedicalResearch.com: What is the background for this study? What are the main findings?Dr. Bayley: There is currently widespread interest and debate surrounding the topic of screening for Alzheimer’s disease and other types of dementia The study describes results from National Memory Screening Day in 2010, an annual community event sponsored by the Alzheimer Foundation of America. Face-to-face screening takes place in a private setting; only the individual being tested and the screener are present. The memory screening consists of one of seven validated cognitive tests: the GPCOG (General Practitioner Assessment of Cognition), MINI-COG, MIS (Memory Impairment Screen), the BAS (Brief Alzheimer’s Screening), Kokmen Short Test of Mental Status, Mini-Mental State Examination, Montreal Cognitive Assessment, or the Saint Louis University Mental Status Examination. Participants with scores below cutoff for possible dementia are encouraged to bring the results to their healthcare professional for follow-up and/or inclusion in medical files.
We report the results from a subset of 3,064 participants. Overall, 11.7% failed one of the memory screening tests. As expected, failure rates were higher in older and less-educated participants (P’s < .05). Subjective memory concerns were associated with a 40% greater failure rate for persons of similar age and education but no memory concerns (odds ratio = 1.4, 95% confidence interval = 1.07–1.78). However, most individuals who expressed concern about their memories passed the screening tests (54-96%, depending on age and education).
(more…)
MedicalResearch.com Interview with:
A/Prof Rana Hinman PhD
Australian Research Council Future Fellow
Centre for Health Exercise & Sports Medicine
Department of Physiotherapy School of Health Sciences
The University of Melbourne, Carlton, Victoria, Australia
Medical Research: What is the background for this study?
Response: It has been well established that hip and knee osteoarthritis (OA) is a major causes of musculoskeletal disease burden worldwide. There is currently no cure and joint replacement is typically reserved for advanced disease. Non-operative management strategies are the mainstay of osteoarthritis treatment. Clinical guidelines recommend the use of aerobic and/or resistance exercises, hydrotherapy and weight loss for those who are overweight for people with hip or knee osteoarthritis. Little is known about how often these treatments are used, and whether treatment use differs for those with hip osteoarthritis compared to those with knee osteoarthritis.
Medical Research: What are the main findings?
Response: The use of non-drug non-operative interventions was generally low amongst the entire cohort of people with hip or knee osteoarthritis. Although half reported making efforts to lose weight, very few were undertaking muscle strengthening, hydrotherapy or aerobic exercises, all of which are strategies most strongly endorsed by international guidelines. 12% of the cohort had never used any of the interventions listed in our survey.
Interestingly, use of five treatments was significantly higher among people with knee osteoarthritis than those with hip osteoarthritis, suggesting people with knee osteoarthritis may be more likely to try non-drug non-operative treatments than those with hip osteoarthritis, however there is no clear explanation for this.
(more…)
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V. Zlokovic, MD, PhD
Professor and Chair
Department of Physiology and Biophysics
Keck School of Medicine of USC.
Medical Research: What is the background for this study? What are the main findings?
Dr. Zlokovic: Our team used high-resolution imaging of the living human brain to show for the first time that the brain’s protective blood barrier becomes leaky with age, starting at the hippocampus, a critical learning and memory center that is damaged by Alzheimer’s disease.
(more…)
V. Zlokovic, MD, PhD
Professor and Chair
Department of Physiology and Biophysics
Keck School of Medicine of USC.
Medical Research: What is the background for this study? What are the main findings?
Dr. Zlokovic: Our team used high-resolution imaging of the living human brain to show for the first time that the brain’s protective blood barrier becomes leaky with age, starting at the hippocampus, a critical learning and memory center that is damaged by Alzheimer’s disease.
(more…)
