Author: Marie Benz MD FAAD
14 Mar Hispanic and Uninsured Adults May Experience Barriers To Blood Pressure Control
Posted at 12:18h
in AHA Journals, AHRQ, Author Interviews, Blood Pressure - Hypertension, Electronic Records, NYU/NYMC
MedicalResearch.com Interview with:
Stella Yi, Ph.D., MPH, Assistant Professor
Department of Population Health
New York University School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Yi: Self-blood pressure monitoring has been shown to be an effective tool for improving blood pressure control, however most studies have only included white race participants. We were interested in assessing whether distribution of self-blood pressure monitors (intervention) would improve blood pressure and hypertension control over usual care (control) in a 9-month period in a predominantly Hispanic, uninsured population. Systolic blood pressure improved over time in both the intervention (n=409) and the control (n=419) arms by 14.7 mm Hg and 14.1 mm Hg, respectively, as did hypertension control; 39% of study participants overall achieved control at the end of follow-up. However there were no statistical differences between the outcomes in the intervention and usual care groups.
14 Mar ‘Exercise Pill’ Irisin Appears To Be A Myth
MedicalResearch.com Interview with:
Harold P. Erickson Ph.D.
James B. Duke Professor, Department of Cell Biology
Duke Univ. Med. Center Durham, NC 27710
MedicalResearch: What is the background for this study?
Dr. Erickson: In Jan 2012 a paper reported the discovery of irisin, a hormone reportedly lopped off a precursor in muscle and sent through the bloodstream to fat tissue, where it turned white fat into brown fat. Brown fat burns calories, and is what hibernating animals – and even human babies -- use to keep warm. Turning on brown fat had exciting promise for obesity, diabetes, etc. Dozens of labs around the world jumped on the discovery and started trials in animals and humans of how irisin levels in blood were altered by exercise and a variety of metabolic challenges.
MedicalResearch: What are the main findings? Early reports.
Dr. Erickson: The follow-up studies from different labs reported a huge range of values for the level of irisin in blood, so they could not all be right. And most of them failed to find any significant effect of exercise. In 2013 two papers criticized the irisin study. A commentary article by Harold Erickson (Adipocyte 2:289-93) reported two substantial flaws in the original study. A research paper by S. Raschke, J. Eckel and colleagues (PloS one 8:e73680) concluded that humans did not make significant amount of irisin. The human gene for irisin has a deleterious mutation in the start codon, and Raschke et al showed that this reduced irisin expression to only 1% the level with the normal start. These two reports may have slowed new labs entering the field, but many groups already invested continued to publish.
13 Mar Majority of Women Experience Stressful Life Events In Year Before Giving Birth
MedicalResearch.com Interview with: Elizabeth Burns, MPH Rollins School of Public Health Emory University MedicalResearch: What is the background for this study? What are the main findings? Response: Epidemiologic studies suggest that prenatal stress is associated with preterm birth, low birth weight and peripartum anxiety and depressive symptoms. The most recent population-based study on the prevalence of stress among pregnant women, which used data from 1990-1995, reported that 64% of women experience stressful life events (SLEs) in the year before their infant’s birth. More recent estimates of prevalence and trends of prenatal stressful life events are useful for clinicians in order to understand the risk profile of their patients. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects self-reported information on maternal experiences and behaviors before, during, and after pregnancy among women who delivered a live infant. PRAMS includes 13 questions about maternal SLEs experienced in the year preceding the birth of the child. Based on previous research, SLEs were grouped into four dichotomous constructs: 1) emotional stressors (family member was ill and hospitalized or someone very close died); 2) financial stressors (moved to a new address, lost job, partner lost job, or unable to pay bills); 3) partner-associated stressors (separated/divorced, argued more than usual with partner/husband, or husband/partner said he did not want pregnancy); and 4) traumatic stressors (homeless, involved in a physical fight, partner or self-went to jail, or someone very close had a problem with drinking or drugs). The prevalence of self-reported stressful life events decreased modestly but significantly during 2000–2010. Despite this, 70.2% of women reported ≥1 SLEs in 2010. Prevalence of stressful life events vary by state and maternal demographic characteristics and are especially prevalent among younger women, women with ≤12 years of education (75.6%), unmarried women (79.6%), and women that were covered by Medicaid for prenatal care or delivery of their child (78.7%).13 Mar Longer Breastfeeding Not Linked To Higher Childhood IQ
[caption id="attachment_12651" align="alignleft" width="150"]
Sabine Roza MD[/caption]
MedicalResearch.com Interview with:
Sabine Roza MD Ph.D. and
Ayesha Sajjad MD, Phd student
Department of Child and Adolescent Psychiatry & Psychology
Department of Psychiatry, Erasmus MC,
Rotterdam, The Netherlands.
Medical Research: What is the background for this study? What are the main findings?
Dr. Roza: WHO guidelines recommend six months of exclusive breastfeeding followed by partial breastfeeding until two years for overall optimum growth and development of children. However, the role of breastfeeding duration on child cognitive development remains a topic of continual debate. Previous research has shown mixed results on the role of breastfeeding duration and exclusivity on child IQ. Several methodological differences in study design inhibit comparisons of these studies and thus limit their generalizability. Furthermore, the association of breastfeeding with child cognitive development is subject to confounding by various factors especially maternal IQ. Therefore, we aimed to study the association between breastfeeding duration and breastfeeding exclusivity with non-verbal IQ in children. We used data the Generation R Study, which is a prospective cohort study from fetal life until young adulthood. Due to the large variability in ethnic backgrounds in our study participants, we focused on non-verbal IQ. In a large sample of 3761 children aged on average 6 years, we found an initial advantage of 0.32 points in non-verbal IQ for every increasing month of breastfeeding, which strongly attenuated after adjustments were made for child factors, maternal factors, sociodemographic factors, parental lifestyle and maternal IQ. Similar attenuation of effect sizes was observed for breastfeeding duration as a categorical variable and duration of exclusive breastfeeding.
13 Mar Medical Students Have Mixed Knowledge and Expectations of ACA
MedicalResearch.com Interview with: Tyler Winkelman, M.D. Internal Medicine and Pediatrics - PGY 4 University of Minnesota MedicalResearch: What is the background for this study? What are the main findings? Dr. Winkelman: Future physicians will practice after key provisions of the Affordable Care Act (ACA) have been enacted. Whether medical students support or understand the legislation or are willing to engage in its implementation or modification as part of their professional obligation is unknown. We surveyed medical students at 8 U.S. medical schools to assess their views and knowledge of the ACA (RR=52%). We found that the majority of students support the ACA and indicate a professional obligation to assist with its implementation. There are, however, gaps in knowledge with regards to Medicaid expansion and insurance plans available within the health exchanges. Students anticipating a surgical or procedural specialty, compared to those anticipating a medical specialty, were less likely to support the ACA, less likely to indicate a professional obligation to implement the ACA, and more likely to have negative expectation of the ACA. Moderates, liberals, and those with above average knowledge scores were more likely to support the ACA and indicate a professional obligation to assist with its implementation.13 Mar Abuse Deterrent Opioids Inadvertently Led To Increased Heroin Use
MedicalResearch.com Interview with:
Theodore J. Cicero, PhD
Professor, Vice Chairman for Research
Department of Psychiatry, Washington University
St Louis, Missouri
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Cicero: Prescription opiate abuse (eg Vicodin, Percocet, OxyContin) has reached epidemic proportions in this country over the past decade. Although most people swallow the drugs whole, a relatively large number either chew the drugs to produce an immediate delivery of large quantities of drugs or they crush them and/or dissolve them in some solvent which makes them useful for intranasal (eg snorting) or intravenous administration. Non-oral routes, particularly injection, represent the most serious public health risk due to a high incidence of infection, including Hepatitis C and HIV, and the much greater severity of abuse. In an effort to reduce these practices, drug companies are introducing so-called abuse deterrent formulations (ADF) which are resistant to crushing or dissolving in an aqueous solution. In one such important effort, the company responsible for distributing one of the most widely abused prescription opiates, OxyContin, introduced an ADF in 2010. Although the abuse deterrent formulations was highly successful in reducing abuse of OxyContin by either chewing, crushing, or dissolving in water, there was none-the-less a clear limit to how effective it was. For example, some people simply switched to the oral route of administration or never did snort or inject the drug, whereas a small number found ways to defeat the abuse deterrent formulations and persisted in harmful patterns of abuse. Unfortunately, there was also an unintended result. ADF-OxyContin caused many individuals to abandon the use of OxyContin - a good thing - in favor of other opiates (a bad thing). Most serious, however, was that 70% of those who switched drugs moved from OxyContin to heroin abuse. Although by no means the only factor, the abuse deterrent formulations has contributed to the wide-spread reports of heroin abuse in suburban and rural Caucasian male and females, a group here-to-fore not the typical heroin users (i.e. poor minorities, living in large urban centers).
13 Mar Cochlear Implants May Improve Cognition in Elderly Patients
MedicalResearch.com Interview with: Isabelle Mosnier, MD, Praticien Hospitalier ORL Otologie, Implants Auditifs et Chirurgie de la Base du Crâne Centre Référent Implant Cochléaire Adulte d'Ile de France Centre Maladies Rares Surdité Génétique de l'adulte et Neurofibromatose de type 2 Groupe Hospitalier de la PITIE-SALPETRIERE Paris MedicalResearch: What is the background for this study? What are the main findings? Dr. Mosnier: Association between hearing impairment and cognitive decline has been established; however, the impact on cognition through cochlear implantation in profoundly deaf elderly patients is not known. The focus was to determine the impact of hearing rehabilitation including cochlear implant on cognitive functions, in addition to the influence of cognitive factors on cochlear implant outcomes over time.13 Mar Lifestyle Factors May Limit Cognitive Decline
MedicalResearch.com Interview with: Miia Kivipelto MD, PhD, Professor Deputy Head, Senior Geriatrician Aging Research Center and Alzheimer Disease Research Center Karolinska Institutet Clinical Trials Unit, Memory Clinic Karolinska University Hospital Stockholm, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Kivipelto: Epidemiological studies have linked several modifiable risk factors to cognitive impairment and dementia but evidence from randomized controlled trials (RCT) has been lacking showing the efficacy of the interventions. Because cognitive impairment, dementia and Alzheimer’s disease are complex, multi-factorial disorders, multidomain interventions targeting several risk factors and disease mechanisms simultaneously could be needed for optimum preventive effect. The FINGER study is the first large, long-term RCT indicating that multi-domain intervention can improve and maintain cognitive functioning in at risk elderly people from the general population. We observed a significant intervention effects on the primary outcome (overall cognition), main secondary outcomes (executive functioning and processing speed) as well as on complex memory tasks and risk of cognitive decline. The multidomain lifestyle intervention was feasible and safe.13 Mar Biomarkers Improve Cardiovascular Risk Prediction After STEMI
MedicalResearch.com Interview with: Matthijs A. Velders, MD PhD Uppsala Clinical Research Center Uppsala, Sweden. Medical Research: What is the background for this study? What are the main findings? Dr. Velders: Outcomes in patients with ST-elevation myocardial infarction have been substantially improved by early reperfusion with primary percutaneous coronary intervention, but recurrent events after the acute...
12 Mar Germline Mutations Studied In Patients With Family History Of Early Onset Colon Cancer
MedicalResearch.com Interview with:
Matthew B. Yurgelun, MD
Instructor in Medicine
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Yurgelun: Germline mutations in the TP53 gene are linked to Li-Fraumeni syndrome, which is an inherited syndrome associated with a 73-100% lifetime risk of cancer. Classically, cancers linked to Li-Fraumeni syndrome include early-onset breast cancer, leukemias, soft tissue sarcomas, brain cancer, and adrenocortical cancer, although recent data have shown an increased risk of colorectal cancer as well. Our study’s primary aim was to determine the frequency of germline TP53 mutations in patients with early-onset colorectal cancer.
We studied 457 patients from the multinational Colon Cancer Family Registry who were diagnosed with colorectal cancer at age 40 or younger, and found that 1.3% carried a germline alteration in the TP53 gene. None of these individuals had personal or family histories of cancer that fulfilled clinical criteria for Li-Fraumeni syndrome.
12 Mar Inappropriate Breast, Prostate Imaging Regionally Clustered
MedicalResearch.com Interview with:
Danil Makarov, MD Lead Investigator
Assistant Professor, Departments of Urology, Population Health and Health Policy
Member, Laura and Isaac Perlmutter Cancer Center
NYU Langone Medical Center, New York, NY
Medical Research: What is the background for this study?
Dr. Makarov: The background for this study is that regional variation in patterns of care and healthcare spending is widely known. The drivers of this regional variation, though, are poorly understood. Certain policy groups like the IOM have suggested that policy efforts be focused on individual providers and patients. Programs such as Choosing Wisely, which encourage a dialogue between physicians and patients, are a great example of such efforts. However, some of our prior research suggests that regional variation is not random and that there might be are regional-level factors which drive variation.
To test out our hypothesis, we wanted to see whether inappropriate imaging for two unrelated cancers was associated at a regional level (it should not be).
Medical Research: What are the main findings?
Dr. Makarov: We found that, at a regional level, inappropriate breast cancer imaging was associated with inappropriate prostate cancer imaging.
12 Mar Pre-pregnancy BMI And Gestational Weight Gain Linked To Childhood Obesity
MedicalResearch.com Interview with: Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Widen: The Columbia Center for Children’s Environmental Health Mothers and Newborns...
12 Mar NSAIDS May Be Helpful In Bladder Cancer Prevention
MedicalResearch.com Interview with: James Scheiman, M.D. Professor of Gastroenterology University of Michigan Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Scheiman: Using aspirin or other nsaids to reduce the risk of many cancers has been an active area of investigation. This study demonstrates in an...
12 Mar Epigenetics, Not Just Genes, Control Many Complex Traits
MedicalResearch.com Interview with:
Prof. Moshe Szyf Ph.D.
James McGill Professor of Pharmacology and Therapeutics
McGill University
Medical Research: What is the background for this study? What are the main findings?
Dr. Szyf: Humans exhibit a marked variation in traits both physical and behavioral and different susceptibilities for developing disease. What causes this inter-individual variation? The prevailing dogma has been that changes in the sequences of genes or heritable genetic differences are responsible for these differences. We tested here an alternative hypothesis that perhaps some of the reason for this natural variation in traits is not caused by differences in inherited genes but by “epigenetic” changes that alter the way genes work without changing the genes. The main difference between genetic and epigenetic changes is that epigenetic changes could be introduced by experience and exposure to environment. The experiences that can cause epigenetic changes include physical as well as social environments. Although we had known that epigenetic differences occur in humans and animals we didn’t have evidence that these changes are behind the natural variation in traits that is observed in humans and animals. Ants are an exciting biological paradigm that exhibits quantitative variations in size and therefore provided a unique opportunity to test this hypothesis.
11 Mar ESCAPE Study Evaluates Stepped Care For Chronic Pain in Veterans
MedicalResearch.com Interview with:
Matthew J. Bair, MD, MS
Research Service, Veterans Affairs Health Services Research and Development, Center for Health Information and Communication
Richard L. Roudebush Veterans Affairs Medical Center,
Department of Medicine, Indiana University School of Medicine, Health Services Research, Regenstrief Institute, Inc, Indianapolis, Indiana
MedicalResearch.com: What is the background for this study?
Dr. Bair: Despite the prevalence and functional, psychological, and economic impact of chronic pain, there have been few intervention studies to treat chronic pain in Veterans.
MedicalResearch.com: What are the main findings?
Dr. Bair: A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in Veterans with chronic musculoskeletal pain.
11 Mar Nonsurgical Treatments May Equal Surgery For Many Broken Shoulders
MedicalResearch.com Interview with:
Prof. Amar Rangan
Clinical Professor, Trauma & Orthopaedic Surgery
School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon
The James Cook University Hospital Middlesbrough
Medical Research: What is the background for this study? What are the main findings?
Prof. Rangan: The majority of fractures of the proximal humerus (broken shoulders) occur in people older than 65 years. Although surgical treatment is being increasingly used for the more serious (displaced) fractures, it has been unclear whether surgical intervention (fracture fixation or humeral head replacement) produces consistently better outcomes than non-surgical treatment (arm-sling); both followed by physiotherapy.
Our multicentre randomized controlled trial (ProFHER), funded by the UK National Institute for Health Research’s Health Technology Assessment Programme, recruited 250 patients aged 16 years or older (mean age, 66 years) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 after sustaining the most common types of acute displaced fracture of the proximal humerus.
Data for 231 patients (92.4% of 250) included in the primary analysis showed that there was no significant difference between the two treatment groups over two years or at 6, 12 and 24 months follow-up in self-reported pain and function scores. Nor were there significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, later surgery or treatment for these complications, and death.
11 Mar Familial Hypercholesterolemia Linked To Lower Type2 Diabetes Risk
MedicalResearch.com Interview with:
Joost Besseling PhD-student
Academic Medical Center
Dept. of Vascular Medicine
Amsterdam
Medical Research: What is the background for this study? What are the main findings?
Response: Statins are associated with an increased risk for type 2 diabetes mellitus (DM). The exact mechanism for this adverse event is largely unknown, although the upregulation of the low-density lipoprotein receptor (LDLR) has been suggested to play a role. In familial hypercholesterolemia (FH) the uptake of LDL-cholesterol via the LDLR is decreased due to a genetic defect. We found that the prevalence of type 2 DM is 50% lower in relative terms in patients with familial hypercholesterolemia. Moreover, there was a dose-response relationship: the more severe the genetic defect that causes familial hypercholesterolemia, the lower the prevalence of type 2 DM.
11 Mar Intranasal Oxytocin Reduced Calorie Consumption in Men
MedicalResearch.com Interview with:
Elizabeth A. Lawson, M.D., M.M.Sc.
Assistant Professor of Medicine
Harvard Medical School
Director, Interdisciplinary Oxytocin Research Program
Neuroendocrine Unit Massachusetts General Hospital
Boston, MA 02114
Medical Research: What is the background for this study? What are the main findings?
Response: Oxytocin is a hormone produced in the brain that has been shown to reduce food intake in animal studies. The role of oxytocin on appetite and food consumption in humans is not well understood. We therefore performed a randomized, placebo controlled cross-over study of single dose administration of intranasal oxytocin (Syntocinon, Novartis) in healthy men. Subjects presented fasting in the early morning and were randomized to receive 24 IU intranasal oxytocin or placebo. They selected breakfast from a menu and were offered double portions. The caloric content of the food they ate was calculated. They returned for a second visit, which was the same except for this time, they received the other treatment (placebo or oxytocin). There was no difference in how much food the men reported eating in the three days leading up to each of the study visits. On average, the men ate 122 fewer calories and about 9 grams less fat after receiving oxytocin compared to placebo. There was also evidence that oxytocin resulted in greater use of fat as a fuel for the body, and improved insulin sensitivity.
11 Mar Interarm Blood Pressure Variability Linked To Greater Cardiovascular Risk in CKD
MedicalResearch.com Interview with:
Dr. Borja Quiroga MD Ph.D.
Nephrology Unit, Hospital General Universitario Gregorio Marañón
Madrid, Spain
Medical Research: What is the background for this study? What are the main findings?
Dr. Quiroga: Chronic kidney disease patients are at high-risk for the development of cardiovascular events. Although several strategies have been tried for identifying those patients with poorer prognosis, no one has demonstrated by itself being the best one. This could be explained by the fact that several factors are implied in the cardiovascular profile of chronic kidney disease patients.
With this background, in our study we hypothesized if differences in the interarm systolic blood pressure could detect patients with enhanced cardiovascular risk early, and, consequently therapies could be initiated.
Our results provide interesting data on this regard, as we have concluded that an interarm systolic blood pressure difference higher that 10 mmHg is an independent prognosis factor for cardiovascular events.
11 Mar Nearly All Babies Born With Neonatal Abstinence Syndrome Were Exposed To Opioids
MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities,
CDC
Medical Research: What is the background for this study?
Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers. NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat.
Medical Research: What are the main findings?
Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation.
11 Mar ‘Leadership Saves Lives’ Program Aims To Reduce Heart Attack Mortality
MedicalResearch.com Interview with:
Leslie Curry PhD, MPH
Senior Research Scientist in and Lecturer in Public Health (Health Policy)
Co-Director, Robert Wood Johnson Clinical Scholars Program
Yale School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Curry: Quality of care for patients with acute myocardial infarction (AMI) has improved substantially in recent years due to important investments by clinicians and policymakers; however, survival rates across U.S. Hospitals still differ greatly. Evidence suggests links between hospital organizational culture and hospital performance in care of patients with AMI. Yet few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with acute myocardial infarction. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We have a large team of people with backgrounds in nursing, medicine, health care administration and research working in 10 very diverse hospitals across the country in 10 states. All hospitals are members of the Mayo Clinic Care Network and are fully committed to saving lives of patients with heart attacks. Teams of 10-12 clinicians and administrators are devoting substantial energy, expertise and good will to this project.
11 Mar Conflicts of Interest in Peer Review of Biomedical Research Funding Studied
MedicalResearch.com Interview with:
Stephen Gallo, Ph.D.
Technical Operations Manager
American Institute of Biological Sciences Scientific Peer Advisory and Review Services
Reston, VA 20191
Medical Research: What is the background for this study? What are the main findings?
Dr. Gallo: Peer review is an evaluation process widely used to help research funders identify the best projects to support. A cornerstone of the process is the independence and integrity of the review panel, which includes a fair and non-conflicted evaluation of the proposed research. Despite the importance of the process, there are few research studies investigating the frequency and type of conflicts that occur, particularly with regard to the independent peer review of basic science research proposals.
To improve our understanding of conflict of interest in the peer review process, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of conflict of interest data from the independent peer review of 282 biomedical research applications.
The overall ‘conflicted-ness’ of these panels was significantly lower than that reported for regulatory review panels, which have been studied by others. This might be explained by the fact that no direct financial conflicts were identified; the majority of identified conflicts were institutional or collaborative in nature.
The analysis revealed that 35 percent of conflicts were self-reported by review panel members. Importantly, peer review panel managers identified 65 percent of conflicts. These results underscore the important role administrators who organize review panels play in identifying conflicts of interest.
11 Mar Breath Test for Drug Testing In the Pipeline
MedicalResearch.com Interview with:
Niclas Stephanson, PhD
Leg. Apotekare, Analytisk kemist
Karolinska Universitetssjukhuset
Stockholm
Medical Research: What is the background for this study? What are the main findings?
Dr. Stephanson: Drug testing is most commonly performed using urine samples, which is based on a long and comprehensive experience. The methodology and regulations for reliable urine testing are well developed and can be considered the current gold standard for drug testing. However, one problem with urine testing is related to the sample collection, often perceived as inconvenient and privacy-overriding by those undergoing the test. To overcome this problem a group of researchers from the Department of Laboratory Medicine at the Karolinska Institute in Sweden have worked on developing a more donor-friendly alternative to urine testing for drugs by focusing on exhaled breath.
Doctor Niclas Stephanson in the research group led by Professor Olof Beck, has developed the first fully validated and robust screening method for the routine measurement of drugs of abuse in exhaled breath. The procedure involves a simple method of sample collection and preparation, which is followed by a highly sensitive analytical technique known as LC-MS (Liquid chromatography–mass spectrometry). The drug groups which are identified: amphetamine, methamphetamine, cannabis, cocaine and heroin.
The underlying mechanism in exhaled breath drug testing is believed to be the formation of aerosol particles from the airway lining fluid by the breathing process. These aerosol particles may contain drugs present in the body, which enables drugs to be analyzed. A simple collection device is currently available which selectively collects the micrometer aerosol particles on a filter and enables further laboratory investigation of possible drug content.
11 Mar Inhaled Nitric Oxide Still Used Off-Label In Preterm Infants
Posted at 12:01h
in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety, Pediatrics, Pediatrics
MedicalResearch.com Interview with:
Marc Ellsworth, M.D
Neonatology fellow at the
Mayo Clinic Children’s Center
MedicalResearch: What is the background for this study?
Dr. Ellsworth: Inhaled Nitric Oxide (iNO) is a drug that has FDA approval for use in neonates >34 weeks gestational age. It is used for severe respiratory failure secondary to pulmonary hypertension. However, it has been previously shown that neonatologists have been using this medication off-label and especially in the most premature neonates. Over the last 10 years there have been multiple large studies trying to determine a clinical use (ie long term benefit) for iNO in preterm neonates (patients where there is no FDA approval for iNO use currently). Despite evidence of short term benefit (improved clinical stability) use of this drug has not been shown to improve long-term outcomes (death and chronic lung disease) in premature neonates. As a result of these findings the National Institute of Child Health and Human Development (NICHD) released a consensus guideline in 2011 indicated that available evidence did not support the routine use of iNO in preterm neonates and discouraged this use of this expensive therapy in preterm neonates. Similarly, in 2014 the American Academy of Pediatrics issued a similar statement with similar recommendations.
In 2014 a group of NICUs (collectively called the Neonatal Research Network) associated with the NICHD published a report showing that the use of Inhaled Nitric Oxide in preterm infants (ie off-label) decreased following the report in 2011.
However, I did not feel that these NICUs were representative of the United States alone as the Neonatal Research Network consists of only a handful of NICUs (~15) and is directly associated with the NICHD. As a result I wanted to get a better idea of Inhaled Nitric Oxide use in a population based study to see if the trends were similar (ie use of iNO has been decreasing) on a much larger, more representative scale. (Editorial comment: My anecdotal experience was that rates of iNO use off-label have not decreased in preterm neonates since the 2011 report).
11 Mar Personalized Risk Calculations May Reduce Readmissions Of Sepsis Survivors
Posted at 11:50h
in Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, JAMA, University of Michigan
MedicalResearch.com Interview with:
Hallie Prescott, MD, MSc
Clinical Lecturer, Internal Medicine
Division of Pulmonary & Critical Care Medicine
University of Michigan Health System
Ann Arbor, MI 48109-2800
Medical Research: What is the background for this study? What are the main findings?
Dr. Prescott: The post-hospital period has been widely recognized as a vulnerable time for patients. In particular, patients who survive sepsis are frequently readmitted to the hospital in the following three months.
In this study, we examined data from 2,600 survivors of sepsis, a severe infection that leads to organ failure. About 42% of the sepsis patients were readmitted in the next 90 days, similar to the rate seen for patients hospitalized for other acute conditions.
However, the reasons for hospital readmission after sepsis are different. A greater number of patients are re-hospitalized for “ambulatory-care sensitive conditions”, which are conditions that could potentially be prevented or treated early in the outpatient setting to avoid a hospital stay.
11 Mar ‘Traffic Light’ Nutrition Labels Help Consumers Make Healthier Choices
MedicalResearch.com Interview with:
Professor Dr. Bernd Weber
Heisenberg Professor
Department of Epileptology
Head - NeuroCognition | Imaging
Life&Brain Center Board of Directors
Center for Economics and Neuroscience Bonn
11 Mar Test Can Help Predict Toxic Reactions To New Medications
MedicalResearch.com Interview with:
Professor Jane A. Mitchell
Head of Vascular Biology Section
Head of Cardiothoracic Pharmacology
National Heart and Lung Institute,
Institute of Cardiovascular Medicine & Science,
Imperial College, London
Medical Research: What is the background for this study? What are the main findings?
Response: In 2006 a drug called TGN1412 was given to 6 healthy male volunteers as a final test for safety. The drug had passed all of the preclinical tests and showed no problem when it was given to laboratory animals. However when it was given to people it caused a catastrophic side effect known as a ‘cytokine storm response’. All 6 volunteers became sick very quickly and needed immediate hospital treatment, they nearly died and remain at risk of immune problems still. We found a way to mimic the effects of TGN1412 in the laboratory using stem cell technology to engineer two different types of cells from the same donor to be grown and mixed together in a dish. Our test is better than the current tests used because it mimics better the human body and uses cells from one individual donor.
11 Mar Study Raised Concerns About Ability of Appropriate Use Criteria To Guide Decision Making
MedicalResearch.com Interview with: Harindra C. Wijeysundera MD PhD FRCPC Interventional Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre Scientist, Sunnybrook Research Institute (SRI) Assistant Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation University of Toronto Adjunct Scientist, Institute for Clinical Evaluative Sciences (ICES) Toronto, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Wijeysundera: Given the rapid increase in health care costs, there has been growing emphasis on the more rational use of resources. One such effort is the development of appropriate use criteria. Such criteria have been developed in many areas of medicine, including in cardiology for diagnostic angiography. The underlying rationale for a test to be appropriate is that its anticipated benefit outweighs its anticipated harms. However, there is a paucity of empirical evidence validating this conceptual framework. Our goal was to validate the 2012 appropriate use criteria for diagnostic coronary angiography, by examining the relationship between the appropriateness of a coronary angiography in patients with suspected stable ischemic heart disease and the proportion of patients who were found to have obstructive coronary artery disease. We used data obtained from the Cardiac Care Network registry of Ontario, Canada. This is a population based registry of all cardiac procedures in the province of Ontario. We examined 48,336 patients and found that 58.2% of angiographic studies were classified as appropriate, 10.8% were classified as inappropriate, and 31.0% were classified as uncertain. Overall, 45.5% of patients had obstructive CAD. In patients with appropriate indications for angiography, 52.9% had obstructive CAD, with 40.0% undergoing revascularization. In those with inappropriate indications, 30.9% had obstructive CAD and 18.9% underwent revascularization; in those with uncertain indications, 36.7% had obstructive CAD and 25.9% had revascularization. Although more patients with appropriate indications had obstructive CAD and underwent revascularization (P < 0.001), a substantial proportion of those with inappropriate or uncertain indications had important coronary disease. Our conclusion was that despite the association between appropriateness category and obstructive CAD, this study raises concerns about the ability of the appropriate use criteria to guide clinical decision making.11 Mar Should Hospitalized Patients Have Access To Their Electronic Medical Record?
MedicalResearch.com Interview with:
Jonathan Pell, MD
Assistant Professor Hospital Medicine
University of Colorado Denver
Medical Research: What is the background for this study?
Dr. Pell: Back in 2001, the Institute of Medicine's charter document Crossing the Quality Chasm proposed that the health care system needs to do a better job of patient centered care. In order to provide true patient centered care, we must provide patients and their families with the knowledge and tools they need to make autonomous and informed decisions about their healthcare. A patient cannot make informed decisions about their healthcare without having easy access to their own health information. Almost 15 years later, we are still discussing whether or not patients should have immediate electronic access to information in their electronic health record. Studies have shown that giving outpatients direct electronic access to their test results and even doctors notes does not cause patients worry or confusion, and there is no undue burden on care providers explaining this newly accessible information to their patients - if they can deliver thinking of you flowers from Flowercard, there's no reason they can't deliver a simple print-out of relevant information. Despite this, many institutions still have a moratorium on release of patients' test results, and the duration of this moratorium is variable from institution to institution. The technology to deliver this type of information real-time to patients is readily available. We decided to explore the effect of giving hospitalized patients real-time access to their test results and hospital medication list/schedule.