Author Interviews, Heart Disease, JAMA, Johns Hopkins, Outcomes & Safety / 09.12.2014

Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins UniversityMedicalResearch.com Interview with: Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins University   Medical Research: What is the background for this study? What are the main findings? Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection. We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI. (more…)
Author Interviews, Education, Emergency Care / 09.12.2014

Catherine A. Marco, MD, FACEP Professor Department of Emergency Medicine Wright State University Kettering, OH 45429MedicalResearch.com Interview with: Catherine A. Marco, MD, FACEP Professor Department of Emergency Medicine Wright State University Kettering, OH 45429 Medical Research: What is the background for this study? What are the main findings? Dr. Marco: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented standards on duty hours and supervision. A maximum of 80 hours of duty per week were stipulated.  The aim of these standards was to promote resident learning and patient safety.  However, evidence has not clearly demonstrated whether the 2003 requirements improved trainee well-being or patient safety.    On July 1, 2011, the ACGME implemented additional regulations on duty hours and supervision, including a 16 hour maximum shift length for PGY1 residents. The duty hours standards were implemented to ensure patient safety and provide an excellent teaching environment.  Emergency Medicine has additional duty hours requirements for emergency department rotations, including a maximum of 12 continuous scheduled hours, and a maximum 60 scheduled hours per week seeing patients in the emergency department, and no more than 72 duty hours per week. We found that among a large cohort of 4134 Emergency Medicine residents, the majority of residents stated that they are working the appropriate number of hours to practice independently at graduation.  The majority of residents believe that current duty hours regulations improve patient safety.  The majority of residents agreed that duty hour regulations are currently appropriate. (more…)
Author Interviews, Kidney Disease, Vanderbilt / 09.12.2014

Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with: Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Lewis: The 48-week Open Label Extension (OLE) study for Auryxia™ (ferric citrate) was conducted to determine long term safety following the Phase 3 52-week active-control period. The study also evaluated changes in serum phosphorus, transferrin saturation (TSAT), serum ferritin, hemoglobin, hematocrit and additional parameters, as well as intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) usage. In the OLE study, Auryxia demonstrated long-term safety in dialysis-dependent chronic kidney disease (CKD) patients. The results were consistent with those seen in the published pivotal Phase 3 trial. The study demonstrated that the adverse events (AE’s) profile of Auryxia was similar to that seen in the Phase 3 52-week active-control period. AEs occurred in 142 patients treated with Auryxia. They were primarily non-serious gastrointestinal (GI) - related AE’s, including diarrhea, nausea, vomiting and constipation. Serious adverse events occurred in 75 patients, though none were related to Auryxia. In addition, there were no clinically or statistically significant differences in liver enzymes or aluminum levels observed from baseline to the end of the 48 weeks. Similar to the original trial, we witnessed excellent phosphorus control with the drug, along with an increase and then a plateau in serum ferritin and TSAT levels with Auryxia. The plateauing of serum ferritin and TSAT further supports iron absorption is highly regulated by the gastrointestinal track as seen in the 52-week active control period. This suggests that the body absorbs iron as needed for effective erythropoiesis. Additionally, iron store increases from ferric citrate resulted in, by the end of the extension study, 85% of subjects not using any IV iron. We presented this data at the 2014 American Society of Nephrology Meeting. The abstract can be found online at www.asn-online.org. (more…)
AHA Journals, Author Interviews, Stroke / 08.12.2014

Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital Epidemiology Program, F6 The Ottawa Hospital, Civic Campus Ottawa, Ontario MedicalResearch.com Interview with Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario Medical Research: What is the background for this study? What are the main findings?

Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented.  Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population. Dr. Perry: Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:

  • 2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
  • 5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
  • 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels (microangiopathy), in addition to acute ischemia;
  • 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.
(more…)
Author Interviews, Diabetes, Heart Disease / 07.12.2014

Simin Liu, MD, ScD, Professor of Epidemiology School of Public Health, Professor of Medicine The Warren Alpert School of Medicine Director, Molecular Epidemiology and Nutrition Brown UniversityMedicalResearch.com Interview with: Simin Liu, MD, ScD, Professor of Epidemiology School of Public Health, Professor of Medicine The Warren Alpert School of Medicine Director, Molecular Epidemiology and Nutrition Brown University MedicalResearch: What is the background for this study? What are the main findings? Dr. Liu: Cardiovascular Disease (CVD) and type 2 diabetes (T2D) are highly heritable and share many risk factors and show ethnic-specific prevalence. Nevertheless, a comprehensive molecular-level understanding of these observations is lacking. We conducted a comprehensive assessment of whole genome assessment using network-based analysis in >15,000 women and identified eight molecular pathways share in both diseases as well as several “key driver” genes that appear to form the gene networks in which these pathways connect and interact. (more…)
Author Interviews, CDC, Education / 07.12.2014

MedicalResearch.com Interview with Dr. Rui Li, PhD Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion CDC Medical Research: What is the background for this study? What are the main findings? Dr. Li: Diabetes is a serious disease associated with severe complications and premature death. Diabetes Self-management Education and Training (DSMT) helps patients improve blood sugar control, which could reduce the risk for diabetes complications, hospitalizations, and health care costs. However, data showed that fewer than 7% of persons with private health insurance received DSMT within 1 year after diagnosis with diabetes. Furthermore, across different population subgroups, DSMT participation rates were less than 15%. (more…)
Author Interviews, Ophthalmology / 06.12.2014

MedicalResearch.com Interview with: Lilach Bareket School of Electrical Engineering, ‡Tel Aviv University Center for Nanoscience and Nanotechnology, and ⊥School of Chemistry, Tel Aviv University, Tel Aviv 69978, Israel Medical Research: What is the background for this study? Response: Neuro-prosthetic devices aim to restore impaired function through artificial stimulation of the nervous system. Visual prosthetic devices, operating by light activation of neurons, are presently developed as an approach to treat blindness. In particular, in the case of patients suffering from age-related macular degeneration in which the photoreceptors in the retina degenerate. (more…)
Author Interviews, Outcomes & Safety, PLoS, UCSF / 06.12.2014

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610MedicalResearch.com Interview with: Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco

MedicalResearch: What is the background for this study? What are the main findings? Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms. (more…)
Author Interviews, Brain Injury, PTSD / 05.12.2014

James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands DivisionMedicalResearch.com Interview with: James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands Division Medical Research: What is the background for this study? Dr. Spira:  Approximately 1.5 million Americans survive a traumatic brain injury (TBI) from traffic accidents, assaults, sports, and work injuries, with the vast majority of these being primarily mild (mTBI), otherwise known as concussion.1 Concussion, however, is uniquely problematic in the military given the new strategies of war encountered by service members when fighting an insurgency using improvised explosive devices. The rate of concussion experienced by United States (U.S.) service members engaging in combat during the wars in Afghanistan and Iraq has been estimated at between 15% and 22%.2–4There has been controversy in the area of neurotrauma as to whether persistent postconcussive symptoms (PPCSx) are due to neurological causes or solely due to the psychological sequelae of having been exposed to a traumatic event.  The recent wars in Iraq and Afghanistan have afforded an opportunity to examine these factors, although teasing them apart has proven difficult.  The most influential study of persistent effects of concussion in service members is that of Hoge and colleagues,5 in which they failed to find an independent effect of prior concussion on PPCSx, once depression and posttraumatic stress (PTSD) was taken into account.  They went so far as to recommend that assessment for concussion following deployment is unnecessary.  Others, however, have reported persistent cognitive, emotional, and physical symptoms following concussion. (more…)
Author Interviews, PLoS, Smoking, Weight Research / 05.12.2014

Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United KingdomMedicalResearch.com Interview with: Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Munafo: We were conducting an analysis of data on smoking behaviour and body mass index (BMI), in order to better understand the potential causal effects of smoking on different measures of adiposity. Mendelian randomisation uses genetic variants associated with the exposure of interest (in this case smoking) as proxies for the exposure, in order to reduce the risk of spurious associations arising from confounding or reverse causality. As expected, we found that, among current smokers, a genetic variant associated with heavier smoking was associated with lower BMI, providing good evidence that smoking reduces BMI. However, we also unexpectedly found that the same variant was associated with higher BMI in never smokers. This suggests that this variant might be influencing BMI via pathways other than smoking. (more…)
Alcohol, Author Interviews, Nature, University Texas / 05.12.2014

MedicalResearch.com Interview with: R. Dayne Mayfield PhD and Sean Farris Post Doc Fellow Harris Lab Waggoner Center for Alcohol and Addiction Research University of Texas at Austin MedicalResearch: What is the background for this study? Response: Alcoholism is psychiatric disorder adversely affecting the health of millions of individuals worldwide. Despite considerable research efforts, alcoholism cannot be attributed to any individual gene. We sought out to identify coordinately regulated gene networks, rather than a single candidate gene, that may be collectively driving the consumption of alcohol. (more…)
Author Interviews, BMJ, Cost of Health Care, Pediatrics / 05.12.2014

MedicalResearch.com Interview with Rosemary Dodds Senior Policy Adviser NCT (formerly National Childbirth Trust), London, UK Medical Research: What is the background for this study? What are the main findings? Response: The study, which was commissioned by UNICEF UK, was designed to take an in-depth look at how raising breastfeeding rates might save money for the health service through reducing illness. It found that low breastfeeding rates in the UK are costing the health service millions of pounds.  We calculated that from reducing rates of illnesses, where the evidence is strongest, moderate increases in breastfeeding could see potential annual savings to the health service of around £40m per year. It should be noted however, that this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account. Economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterocolitis (NEC) in the baby), show that moderate increases in breastfeeding would translate into the following cost savings for the NHS:
  •  If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:
-      865 fewer cases of breast cancer -      With cost savings to the NHS of over £21million -      Improved quality of life equating to more than £10million[1] Over the lifetime of each annual cohort of first-time mothers.
  • If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfeeding at discharge, each year there would be:
-      3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million -      5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million -      21,045 fewer GP visits for ear infection, saving £750,000 -      361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million (more…)
Asthma, Author Interviews / 05.12.2014

MedicalResearch.com Interview with: Katarzyna Niespodziana, PhD and Rudolf Valenta, MD Division of Immunopathology, Department of Pathophysiology and Allergy Research,Medical University of Vienna, Austria MedicalResearch: What is the background for this study? What are the main findings? Response: Infections with the common cold virus (Rhinovirus, RV) are in fact a major trigger factor for acute exacerbations of asthma and COPD (chronic obstructive pulmonary disease). An attack can also lead to the worsening of the underlying disease. In previous studies we have found that although the human body produces antibodies against rhinoviruses, these are not directed against the surface structures on the virus which the virus uses to infect host cells and therefore do not protect against infection. In the framework of the EU project "Predicta”, we have collaborated with investigators from London and published in EBioMedicine a novel study which shows for the first time that increases of antibodies against a portion of the rhinovirus coat protein VP1 might be strain-specific surrogate markers for the severity of rhinovirus-induced respiratory symptoms. In this work, asthma patients and healthy subjects were infected with the rhinovirus under controlled conditions. Results of the subsequent antibody tests with recombinant virus antigens showed that the asthmatics that experienced the most severe respiratory symptoms upon infections produced significantly higher antibodies to a part of the structure protein VP1, than any of the subjects with mild or no symptoms. (more…)
Aging, Author Interviews, BMJ, Brigham & Women's - Harvard, Mediterranean Diet / 05.12.2014

Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115MedicalResearch.com Interview with: Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115 MedicalResearch: What is the background for this study? What are the main findings? Dr. De Vivo: Our study found that greater adherence to the Mediterranean diet is associated with longer telomeres. Following a diet closer to the Mediterranean diet, can prevent accelerated telomere shortening. Our unique contribution to the literature is that we provide a potential molecular mechanism, preventing telomere shortening. Telomeres are bits of DNA that protect your chromosomes. MedicalResearch: Is telomere shortening reversible? Dr. De Vivo: Telomere shortening is a biological process, the shorten with age. However, lifestyle choices can help to prevent accelerated shortening. Fruits, vegetables, olive oil and nuts – key components of the Mediterranean diet have well known antioxidant and anti-inflammatory effects that could balance out the “bad effects” of smoking and obesity. (more…)
Author Interviews, Cancer Research, University of Michigan / 04.12.2014

MedicalResearch.com Interview with: Silvana Papagerakis M.S., M.D., Ph.D. Research Assistant Professor, Department of Otolaryngology-Head and Neck SurgeryDirector, Oral, Head and Neck Cancer Invasion and Metastasis Laboratory Ann Arbor MI Silvana Papagerakis M.S., M.D., Ph.D. Research Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Director, Oral, Head and Neck Cancer Invasion and Metastasis Laboratory, Ann Arbor MI MedicalResearch: What is the background for this study? What are the main findings? Dr. Papagerakis: We had suspicions that these medications somehow had a favorable impact on patient outcomes. This led us to review our large cohort of patients and screen them for common medications, focusing on antacids. In fact, our study did show that people taking antacids are doing better. What this study makes clear is that these medications may be more beneficial to the patients than just controlling side effects of chemotherapy or radiation treatment for head and neck cancer. (more…)
Author Interviews, Brain Injury, Memory / 04.12.2014

Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical SchoolMedicalResearch.com Interview with Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Sandry: We were interested in better understanding the relationship between cognitive reserve and long-term memory impairment in moderate to severe Traumatic Brain Injury, from a cognitive perspective. The theory of cognitive reserve suggests that individuals who engage in intellectually enriching activities may be less susceptible to the negative cognitive consequences of long-term memory impairment that often accompanies neurological disorders. There’s significant evidence in support of cognitive reserve; however, it’s somewhat unclear what particular cognitive processes are involved in this relationship and how those cognitive processes may differ across high and low reserve individuals. We derived our predictions on the basis of well-established cognitive theory and found that working memory capacity partially mediates the cognitive reserve – long-term memory relationship in Traumatic Brain Injury. Or to put it another way, working memory may be one underlying cognitive process involved in this relationship. Importantly, this finding corroborates some recent related work we have conducted in multiple sclerosis. (more…)
Orthopedics, Radiology / 04.12.2014

Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine Boston MA 02118MedicalResearch.com Interview with: Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term. (more…)
Heart Disease / 04.12.2014

MedicalResearch.com Interview with: Dr. Joanne van Ryn, PhD Department of CardioMetabolic Disease Research Boehringer Ingelheim GmbH & Co., Germany MedicalResearch: What is the background for this study? What are the main findings? Response: Idarucizumab is a humanized antibody fragment, or Fab, being investigated as a specific antidote to reverse the anticoagulant effect of dabigatran. Currently, there are no specific antidotes available for any of the newer oral anticoagulants, or NOACs, to complement the existing range of bleed management options during critical care situations. Idarucizumab is being developed to provide physicians with an additional therapeutic option they could consider should a patient require emergency intervention or if a patient experiences uncontrolled bleeding. Pre-clinical studies indicated idarucizumab binds specifically to and inhibits dabigatran. Phase I data with idarucizumab in healthy volunteers demonstrated the potential of idarucizumab to achieve immediate, complete and sustained reversal of dabigatran-induced anticoagulation. In that placebo-controlled study, idarucizumab did not cause any clinically relevant side effects. This phase I sub-study in 35 healthy volunteers showed that idarucizumab restores dabigatran-induced inhibition of fibrin formation at a small wound site. Fibrin, the main component of a blood clot, was assessed by measuring levels of fibrinopeptide A (FPA), a substance that is released when fibrin is formed. Fibrin formation was assessed after a small scratch, similar to a paper cut, was made. Measurements were conducted at baseline, after administration of dabigatran, and after subsequent administration of idarucizumab or placebo. The results showed that dabigatran almost completely inhibited the production of FPA at the wound site, and that idarucizumab restored FPA production:
  • At baseline, before the volunteers took dabigatran, the average level of FPA was 3981 ng/mL.
  • On day three, 2.5 hours after the volunteers took dabigatran, the average level of FPA was 208 ng/mL, an approximate 95 percent decrease compared to baseline.
  • On day four, 2.5 hours after the volunteers took dabigatran and 30 minutes after they were infused with 1 g, 2 g or 4 g of idarucizumab, FPA levels were 24 percent, 45 percent and 95 percent, respectively, of the average baseline level.
The restored fibrin production at the wound site after idarucizumab dosing with 2g or 4g also correlated with reversal of the dabigatran-anticoagulation activity in circulating blood. (more…)
Heart Disease / 04.12.2014

dr_John-SeegerMedicalResearch.com Interview with: Dr. John Seeger, PharmD, DrPH Department of Medicine, Brigham and Women’s Hospital Dr. Seeger: What is the background for this study? What are the main findings? Response: This study is part of an ongoing research program initiated in 2013 to assess prescribing patterns and real-world safety and effectiveness of oral anticoagulants, including dabigatran, for the reduction of stroke risk. The study program is expected to run through the end of 2016. Boehringer Ingelheim and Brigham and Women’s Hospital are aiming to gather data from more than 100,000 U.S. NVAF patients. Using a sequential matched cohort design, the safety and effectiveness of dabigatran compared to warfarin among patients with non-valvular atrial fibrillation (NVAF) receiving these medications in routine care settings can be assessed periodically. The interim findings at this stage come from 38,378 non-valvular atrial fibrillation patients in two health insurance databases, MarketScan (31,058 patients) and UnitedHealth (7,320 patients). The primary analysis follows patients from start of therapy until a switch or discontinuation of the anticoagulant, an outcome event, or disenrollment. The average follow-up was five months for patients in the dabigatran group and four months for those taking warfarin. The primary outcomes measured in the analysis are stroke and major hemorrhage. Interim findings from the combined databases showed a 25 percent reduction in the rate of major hemorrhage (hazard ratio [HR] 0.75, 95 percent confidence interval [CI] 0.65-0.87, 354 vs. 395 events) and a 23 percent reduction in strokes (HR 0.77, CI 0.54-1.09, 62 vs 69 events) for dabigatran compared to warfarin among these patients with NVAF. The database-specific results indicate a reduction in the rate of major hemorrhage with dabigatran (MarketScan: HR 0.78, CI 0.67- 0.91; UnitedHealth: HR 0.56, CI 0.36-0.86). In the larger MarketScan database, dabigatran reduced the stroke rate by 36 percent (HR 0.64, CI 0.44-0.95), while in the smaller UnitedHealth database, stroke rates were not different between the two anticoagulants, as there were only 26 strokes in total which led to wide confidence intervals (HR=1.62, CI 0.72-3.66). (more…)
Breast Cancer, UCSF / 04.12.2014

Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA 94115MedicalResearch.com Interview with: Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA  94115 MedicalResearch: What is the background for this study? What are the main findings? Dr. Price: Screening mammography recommendations for the 40 - 49 age group is very controversial. 2009 USPTF guidelines emphasized taking patient context into account when making decisions for these young women. Recent publications have suggested risk-based screening strategies.  Family history and breast density are important are easily accessible risk factors. Had we been using this risk-based approach to screening mammography at our institution, we would have missed more than 3Ž4 of the screen detected breast cancers in the 40-49 age group, thereby foregoing most of the survival benefit from screening mammography. (more…)
Author Interviews, Lung Cancer, PLoS / 03.12.2014

dr_Martin_C_TammemägiMedicalResearch.com Interview with: Dr. Martin C. Tammemägi Professor (Epidemiology), Brock University Department of Health Sciences St. Catharines, Ontario, Canada L2S 3A1 Medical Research: What is the background for this study? What are the main findings? Dr. Tammemägi: Lung cancer is the leading cause of cancer death in North America and the world. Lung cancer survival following diagnosis is generally poor, in the range of 10% to 15%, and has improved little over the last four decades. The biggest recent breakthrough for reducing lung cancer mortality came with the findings of the National Lung Screening Trial (NLST), a large, well-conducted randomized screening trial, which demonstrated that low dose computed tomography (LDCT) screening versus chest X-ray (CXR) screening can reduce lung cancer mortality by 20%. Currently, most guidelines for selecting screenees for lung screening use the NLST enrolment criteria of 30 or more pack-years smoked, former smokers must have quit smoking within 15 years and ages between 55 and 74, or use a variant of the NLST criteria. The US Preventive Services Task Force (USPSTF) essentially recommends using the NLST criteria but extended the inclusion age to 80 years. The current study applied the PLCOm2012 lung cancer risk prediction model1 to NLST data and identified that the risk above which lung cancer mortality is consistently lower in the LDCT arm compared to the CXR arm, is ≥1.51% 6-year risk (65th percentile). The USPSTF and the PLCOm2012 risk ≥0.0151 criteria were then applied to the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) intervention arm smokers (the PLCOm2012 was developed in PLCO controls) to determine who would be selected for lung cancer screening. Compared to USPSTF criteria, the PLCOm2012 risk ≥0.0151 threshold selected 8.8% fewer individuals, but identified 12.4% more lung cancers (sensitivity 80.1% vs. 71.2%), and had fewer false positives (specificity 66.2% vs. 62.7%). 26% of smokers who were USPSTF criteria positive had risks below the PLCOm2012 risk ≥0.0151 threshold. Of PLCO former smokers who quit more than 15 years ago, 8.5% had PLCOm2012 risk ≥0.0151, suggesting that they might benefit from screening (2.9% of them developed lung cancer in 6 year). None of 65,711 never-smokers in the PLCO had PLCOm2012 risk ≥0.0151, indicating that never-smokers should not be screened. Individuals age ≥65–80 years had significantly higher risks and more lung cancers than those 55-64 years. (more…)
Author Interviews, BMJ, OBGYNE, Weight Research / 03.12.2014

Stefan Johansson, MD PhD consultant neonatologist Stockholm, SwedenMedicalResearch.com Interview with: Stefan Johansson, MD PhD consultant neonatologist Stockholm, Sweden Medical Research: What is the background for this study? Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce. (more…)
Author Interviews, General Medicine, Genetic Research, Nature / 03.12.2014

Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, SwitzerlandMedicalResearch Interview with: Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, Switzerland   MedicalResearch: What is the background for this study? What are the main findings? Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms. (more…)
Author Interviews, JAMA, Osteoporosis, Pharmacology, Testosterone / 03.12.2014

MedicalResearch.com Interview with: Shabbir M. H. Alibhai, MD, MSc and Husayn Gulamhusein, BHSc Department of Medicine, University Health Network Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture). (more…)
Author Interviews, Cost of Health Care / 02.12.2014

Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CAMedicalResearch.com Interview with: Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CA MedicalResearch: What is the background for this study? What are the main findings? Dr. Romley: We've known for a long time now that there is tremendous variation in how much Medicare spends across the country, and that these differences are not necessarily related to quality of care.  Researchers have devoted great time, energy and intellect to understanding the drivers of Medicare spending.  While progress has been made, our understanding remains limited.  We also have had less insight into how private health care varies across the country. We used new information on how much private health plans pay health care providers over and above cost, and found that areas with low private payment levels tended to have substantially higher Medicare spending and utilization. (more…)
Author Interviews, Ophthalmology, Statins / 02.12.2014

B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic.MedicalResearch.com Interview with: B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic. MedicalResearch: What are the main findings of this study? Dr. Mancini: The main findings are that we found evidence of a relationship between statin use and the need for cataract surgery. The unique nature of the study is that it looked for the association in two distinctly different populations (a Canadian database and a separate, American database) and found a consistent association in both populations. (more…)
Author Interviews, Infections / 02.12.2014

Jack A Gilbert PhD Department of Ecology & Evolution Graduate Program in Biophysical Sciences University of Chicago, Chicago, IL 60637,MedicalResearch.com Interview with: Jack A Gilbert PhD Department of Ecology & Evolution Graduate Program in Biophysical Sciences University of Chicago, Chicago, IL 60637 MedicalResearch: What is the background for this study? What are the main findings? Dr. Gilbert: We have performed extensive analysis of the microbial distribution between humans and home surfaces in peoples houses. And are still exploring how bacteria are distributed around hospitals. Here we wanted to explore how bacteria from humans were distributed into a space in real time. By taking samples every hour post sterilization and seeing how the community stabilized, who remained active and whether they were pathogenic. We found that communities stabilized on a skin-associated microbiome within 5 hours, that staphylococcus remained active and yet none of these were particularly pathogenic. Yet we were able to identify pathogenic MRSA on surfaces around the bathroom, but they were extremely rare. (more…)
Author Interviews, Cancer Research / 02.12.2014

Dr. Pan Pantziarka Anticancer Fund, Brussels Belgium The George Pantziarka TP53 Trust, London, UKMedicalResearch.com Interview with: Dr. Pan Pantziarka Anticancer Fund, Brussels Belgium The George Pantziarka TP53 Trust, London, UK MedicalResearch: What is the background for this study? Dr. Pantziarka: The background of this study is that it is part of a series of investigations by the Repurposing Drugs in Oncology (ReDO) project into well-known non-cancer drugs which have evidence of activity that may be useful in cancer therapies. These drugs include mebendazole, itraconazole, diclofenac, nitroglycerin and cimetidine. (more…)
Annals Internal Medicine, Author Interviews, Hospital Readmissions / 02.12.2014

Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705MedicalResearch.com Interview with: Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kind: By way of background: Socioeconomic disadvantage is a complex theoretical concept which describes the state of being challenged by low income, limited education and substandard living conditions for both the person and his or her neighborhood or social network. It is plausible that disadvantage would influence rehospitalization because vulnerable patients depend upon their neighborhood supports for stability, generally, and these needs are likely to be increased after a hospitalization. Yet, it is difficult to assess socioeconomic disadvantage during clinical encounters, yet the ADI provides an option for beginning such a discussion. ADI or Area Deprivation Index is a composite measure of neighborhood disadvantage, similar to other geographic measures of disadvantage employed in other countries for resource planning and health policy development. (more…)