Author Interviews, Heart Disease / 28.11.2014

MedicalResearch.com Interview with: Siobhan Brown, Ph.D. Biostatistician, ROC Clinical Trials Center University of Washington Medical Research: What is the background for this study? What are the main findings? Dr. Brown: There are several observational studies suggesting that patients with out-of-hospital cardiac arrest may be more likely to survive to hospital discharge when emergency medical service provides do not pause for ventilations while performing CPR (i.e., give continuous compressions); however, the American Heart Association recommends that rescuers pause after each 30 compression to give two ventilations (interrupted compressions). We designed and are conducting a randomized clinical trial comparing the two approaches to see which results in better survival. The trial is still ongoing, so watch for results in late 2015! (more…)
Author Interviews, JAMA, Johns Hopkins, Mental Health Research / 28.11.2014

Daniel Safer MD Department of Psychiatry Johns Hopkins University School of Medicine Baltimore, Maryland Medicalresearch.com with: Daniel Safer MD Department of Psychiatry Johns Hopkins University School of Medicine Baltimore, Maryland Medical Research: What is the nature of this study? Dr. Safer: A large national sample of annual physician office-based visits by youth (aged 2-19) covering 12 years (1999-2010), focusing on trends in psychiatric DSM-IV diagnoses, with psychiatric diagnostic data analyzed proportionally comparing diagnoses that were subthreshold (not otherwise specified) with those that met full diagnostic criteria. (more…)
Author Interviews, BMC, Brigham & Women's - Harvard, Diabetes, Nutrition / 27.11.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalresearch.com with: Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public Health Professor of Medicine Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? Dr. Hu: Type 2 diabetes (T2D) affects approximately 26 million people in the United States and 366 million people worldwide, and thus primary prevention of T2D has become a public health imperative. The relation between consumption of different types of dairy and risk of type 2 diabetes remains uncertain.  (more…)
Author Interviews, CMAJ, Orthopedics, Surgical Research / 27.11.2014

MedicalResearch.com Interview with: NatNathan Evaniew MD Division of Orthopaedics McMaster Universityhan Evaniew MD Division of Orthopaedics McMaster University   Medical Research: What is the background for this study? Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results. Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications. (more…)
Author Interviews, CDC, HIV / 26.11.2014

MedicalResearch.com Interview with: Heather Bradley, PhD Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC Medical Research: What is the background for this study? What are the main findings? Dr. Bradley: The key to controlling the HIV epidemic is controlling the virus.  When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Yet, only one-third of the 1.2 million people with HIV in the U.S. have the virus under control.  Among those who did not have the virus under control, approximately two-thirds had been diagnosed but were not in medical care. Young people were least likely to have the virus under control.  Only 13 percent of 18 – 24 year olds were virally suppressed, primarily because half don’t know they are infected.  To close this gap among young people, increased HIV testing is critical. The study did not find statistically significant differences in viral suppression by race or ethnicity, sex, or risk group. (more…)
General Medicine / 26.11.2014

Michelle M. Mello, JD, PhD Professor of Law, Stanford Law School Professor of Health Research and Policy Stanford University School of MedicineMedicalResearch.com Interview with: Michelle M. Mello, JD, PhD Professor of Law, Stanford Law School Professor of Health Research and Policy Stanford University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Mello: In this report, we examined trends in the volume and cost of medical liability claims in the US, as well as liability insurance costs, and reviewed current initiatives to reform the liability system. Examining publicly available data from the National Practitioner Data Bank, we found that the frequency and average cost of paid malpractice claims have been declining.  The rate of paid claims against physicians decreased from 18.6 to 9.9 paid claims per 1,000 physicians between 2002 and 2013, about a 6.3% annual average decrease for MDs. Among claims that resulted in a payment, the median payment increased from $133,799 in 1994 to $218,400 in 2007, but has been declining--by 1.1% annually, on average--since 2007.  In 2013 the median payment was $195,000. When we looked a trends in insurance premiums in several markets, using data from the Medical Liability Monitor’s Annual Rate Survey, we found greater variation from place to place.  However, the overall picture was favorable. None of the locations we examined showed large increases over the last 10 years, and most showed flat or declining premiums. (more…)
Author Interviews, Gastrointestinal Disease, Inflammation, Metabolic Syndrome / 26.11.2014

Dr. Andrew Gewirtz PhD Professor & Associate Chair Department of Biology Georgia State UniversityMedicalResearch.com Interview with: Dr. Andrew Gewirtz PhD Professor & Associate Chair Department of Biology Georgia State University Medical Research: What is the background for this study? Dr. Gewirtz: 2010 science paper that discovered that loss of toll-like receptor 5 altered gut microbiota to drive metabolic syndrome Medical Research: What are the main findings? Dr. Gewirtz: It is loss of tlr5 on epithelial cells that alters the microbiota to make it more pro-inflammatory that drives metabolic syndrome. (more…)
Author Interviews, Depression, Obstructive Sleep Apnea, PLoS / 26.11.2014

Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, CanadaMedicalResearch.com Interview with: Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Povitz: Both depression and obstructive sleep apnea are important causes of illness and have overlapping symptoms. Both feature poor quality sleep, difficulty with concentration and memory as well as daytime sleepiness or fatigue. Previous research showed that depression is common in individuals with sleep apnea, but studies investigating the effect of treating sleep apnea on depressive symptoms have had conflicting results. Our study combined the results of all randomized controlled trials of participants who were treated for sleep apnea with CPAP or mandibular advancement devices where symptoms of depression were measured both before and after treatment. We found that in studies of individuals without a lot of symptoms of depression there was still a small improvement in these symptoms after treatment with CPAP or mandibular advancement device. In 2 studies of individuals with more symptoms of depression there was a large improvement in symptoms of depression. (more…)
Author Interviews, CHEST, Nutrition, Pulmonary Disease / 26.11.2014

Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with: Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina University Medical Research: What is the background for this study? What are the main findings? Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation. In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Mayo Clinic / 26.11.2014

Dr. John K. DiBaise MD Gastroenterology and Hepatology Mayo Clinic, Scottsdale ArizonaMedicalResearch.com Interview with: Dr. John K. DiBaise MD Gastroenterology and Hepatology Mayo Clinic, Scottsdale Arizona Medical Research: What is the background for this study? What are the main findings? Dr. DiBaise: Despite nearly 25 years of safe and effective use of proton pump inhibitors (PPI), in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use.  One such association with PPI use has been Clostridium difficile infection (CDI) which can cause severe and recurrent episodes of diarrhea.  Previous reports evaluating the microbes present within the gastrointestinal tract (ie, gut microbiome) of individuals with CDI have shown a reduction in overall microbial community diversity.  We studied the gut microbiome in healthy individuals both before and after using a proton pump inhibitors for one month and found a similar reduction in microbial diversity while taking the PPI that did not entirely revert back to the ‘normal’ baseline after being off the medication for a month.  While this does not demonstrate a causal association between proton pump inhibitors use and CDI, it demonstrates that PPI use creates a situation in the gut microbial environment that may increase the individual’s susceptibility to CDI. (more…)
Author Interviews, Education, JAMA / 26.11.2014

Dr. Arthur Reynolds PhD, Professor Humphrey School of Public Affairs University of Illinois at ChicagoMedicalResearch.com Interview with: Dr. Arthur Reynolds PhD, Professor Institute of Child Development Humphrey School of Public Affairs University of Minnesota Medical Research: What is the background for this study? What are the main findings? Dr. Reynolds: Given the high national priority on enhancing early childhood development, evidence about the relationship between full-day preschool participation and school readiness is meager. The study found that among about 1000 children attending 11 schools in low-income neighborhood. participation in full-day preschool at ages 3 or 4 for 7 hours per day was associated with significantly higher school readiness skills at the end of preschool in language and literacy, socio-emotional development, math, and physical health than part-day participation for 3 hours per day.  This translate to about a half of a year of growth in learning. Full-day preschool was also associated with significantly higher attendance and lower rates of chronic absences. No differences were found in parent involvement in school. (more…)
Author Interviews, Heart Disease, JAMA / 26.11.2014

Dr. Mary T. Hawn Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center University of Alabama at Birmingham, BirminghamMedicalResearch.com Interview with Dr. Mary T.  Hawn MD Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center University of Alabama at Birmingham, Birmingham Medical Research: What are the main findings? Dr. Hawn: The main findings of the study are that the recommendations made in the guidelines published by the American College of Cardiology / American Heart Association in 2007 were effective at reducing postoperative major adverse cardiac events following noncardiac surgery in patients with a cardiac stent.1  These guidelines recommended the delay of noncardiac surgeries in patients with a drug-eluting stent for 365 days if the surgery was not emergent or the delay of surgery for 4 to 6 weeks among patients with a bare metal stent.  In addition to a 26% reduction in postoperative major adverse cardiac events, we also found an increase in the time between drug-eluting stent placement and non-cardiac surgery consistent with the guideline recommendations. (more…)
Addiction, Mental Health Research / 26.11.2014

MedicalResearch.com Interview with: Melissa Anne Elin Authen Weibell Consultant Psychiatrist Helse Stavanger HF Medical Research: What is the background for this study? Dr. Weibell: Little is known about the effect of different patterns of substance use on outcomes in first-episode psychosis and the few studies that exist are often cross-sectional and heterogeneous. This new study investigated different patterns of substance use in an epidemiological first-episode psychosis (FEP) sample longitudinally, with the hypothesis that continuous use would predict poorer outcomes compared to never users or stop users. The study included 301 patients aged 16-65 with first episode non-affective included (1997-2001) from three separate catchment areas in Norway and Denmark. Four patterns of substance use were defined; never used (153 patients), persistent use(43), completely stopped use having previously used (36), and on-off use (48) during the first 2-years of follow-up. 184 patients were followed up at 10 years and compared on symptom levels and remission status. (more…)
Author Interviews, Cognitive Issues, Weight Research / 26.11.2014

Nicolas Cherbuin PhD ARC Future Fellow - Director of the NeuroImaging and Brain Lab Centre for Research on Ageing, Health and Wellbeing Research School of Population Health - College of Medicine Biology and Environment Australian National UniversityMedicalResearch.com Interview with: Nicolas Cherbuin PhD ARC Future Fellow - Director of the NeuroImaging and Brain Lab Centre for Research on Ageing, Health and Wellbeing Research School of Population Health - College of Medicine Biology and Environment Australian National University Medical Research: What is the background for this study? What are the main findings? Dr. Cherbuin: A number of modifiable risk factors for cognitive aging dementia and Alzheimer’s disease have been identified with a high level of confidence by combining evidence from animal research and systematic reviews of the literature in humans that summarise the available findings without focusing on extreme findings that come about from time to time in research. One such risk factor is obesity for which we have previously conducted a systematic review (Anstey et al. 2011). This showed that obesity is associated with a two-fold increased risk of dementia and a 60% increased risk of Alzheimer’s disease. What was surprising is that this effect was only detectable for obesity in middle age but not old age. This might suggest that the obesity only has an adverse effects on brain health earlier in life and that this effect fades at older ages. This is unlikely because a number of animal studies have shown that the biological mechanisms linking obesity with brain pathology do not disappear with older age but in fact appear to increase. Moreover, human studies show that thinking abilities decline faster in obese individuals. An alternative explanation is that human epidemiological studies investigating this question in older individuals include participants who do not have clinical dementia but in whom the disease is developing. Since dementia and Alzheimer’s disease pathology is associated with weight loss it is possible that estimated effects in humans have been confounded by this issue. Another possible confounder is that older people tend to lose muscle mass (sarcopenia) this may lead to the paradoxical condition in aging where a person has a normal weight but has excessive fat mass. Since it is fat tissue that is linked to risk to cerebral health it may have led to the apparently contradictory findings that obesity may not be a risk in older age. It is therefore of great interest to clarify whether obesity in early old age in individuals free of dementia is associated with poorer cerebral health. The hippocampus is one of the structures most sensitive stressors. Because obesity is known to lead to a state of chronic inflammation which is deleterious to the hippocampus, it was a logical structure to investigate. Moreover, the hippocampus is needed for memory function and mood regulation and is directly implicated in the dementia disease process. This study investigated 420 participants in their early 60s taking part in a larger longitudinal study of aging taking place in Canberra, Australia and who underwent up to three brain scans over an 8-year follow-up. These individuals were free of dementia and other neurological disorders. Associations between obesity and shrinkage of the hippocampus were investigated with longitudinal analyses which controlled for major confounders. The main findings were that overweight and obese participants had smaller volume of the hippocampus at the start of the study. In addition, the hippocampus shrunk more in these individuals over the follow-up period. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 26.11.2014

Carl "Chip" Lavie MD, FACC Medical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular DiseasesMedicalResearch.com Interview with: Carl "Chip" Lavie MD, FACC Medical  Director, Cardiac  Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical  School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular Diseases Medical Research: What are the key points of your editorial? Dr. Lavie: 1) The importance of higher fitness to predict a lower rate of developing Heart Failure; 2) improvements in fitness over  time  predict a lower rate of developing  Heart Failure, and 3) Once Heart Failure develops, higher fitness predicts a more favorable prognosis. (more…)
Author Interviews, Heart Disease, JAMA / 26.11.2014

MedicalResearch.com Interview with: Matthew D. Ritchey, DPT Division for Heart Disease and Stroke Prevention US Centers for Disease Control and Prevention, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Ritchey: This study analyzes the contribution of heart disease subtypes – such as coronary heart disease, heart failure, hypertensive heart disease and arrhythmia – to overall trends in heart disease death rates between 2000 and 2010. Our research revealed that overall heart disease-related deaths declined during that time frame at a rate of almost four percent annually. Most of this decline appears to be driven by decreases in coronary heart disease mortality, which includes deaths due to heart attacks. However, not all heart disease subtypes saw similar decreases. Arrhythmia and hypertensive heart disease death rates increased annually during this period. In addition, there were differences depending on age group, subtype, gender and race/ethnicity. For example, hypertensive heart disease rates were much higher (more than double) among non-Hispanic blacks in 2010 than among non-Hispanic whites. That could be due to factors including uncontrolled blood pressure and obesity among younger adults. Also, the increase in arrhythmia mortality was highest among non-Hispanic whites, women and adults age 75 and over. That increase might be linked to the growing aging population, the result of individuals living longer with heart failure, increases in chronic kidney disease and hypertensive heart disease prevalence and changes in how the condition is reported. To determine these findings, we examined de-identified death certificates of U.S. residents ages 35 and up who died from 2000 to 2010. The data was pulled from the CDC WONDER database, which contains death certificate information from every U.S. state and the District of Columbia. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, NEJM, Nutrition / 26.11.2014

MedicalResearch.com Interview with: Sheila E. Harvey, Ph.D. CTU Manager/Senior Research Fellow ICNARC Napier House London Medical Research: What is the background for this study? Dr. Harvey: The CALORIES trial was set-up in the context of concerns about malnutrition in critically ill patients in NHS hospitals and conflicting evidence as to the optimal route for delivery of early nutritional support to critically ill patients. The enteral route is the mainstay of nutritional support in the critically ill but it is frequently associated with gastrointestinal intolerance and underfeeding. In contrast, the parenteral route, though more invasive and expensive, is more likely to secure delivery of the intended nutrition but has been associated with more risks and complications (e.g. infectious complications) compared with the enteral route. In light of the uncertainty surrounding the most effective route for delivery of early nutritional support and, given recent improvements in the delivery, formulation and monitoring of parenteral nutrition, the UK National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme put out a “call” for a large pragmatic randomised controlled trial to be conducted in critically ill patients to determine the optimal route of delivery of early nutritional support. CALORIES was set up to test the hypothesis that early nutritional support delivered via the parenteral route is superior to early nutritional support delivered via the enteral route in adults who had an unplanned admission to an intensive care unit and who could be fed via either route. The primary outcome was all-cause mortality at 30 days. The secondary outcomes included infectious and non-infectious complications (hypoglycaemia, elevated liver enzymes, nausea requiring treatment, abdominal distension, vomiting, new or substantially worsened pressure ulcers). (more…)
Author Interviews, Heart Disease / 25.11.2014

MedicalResearch.com Interview with: Dr. Eloisa Colin-Ramirez, BSc, PhD and Justin A. Ezekowitz, MBBCh MSc Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart Institute Medical Research: What is the background for this study? What are the main findings? Response: The SODIUM-HF study is a randomized control trial on sodium restriction in patients with chronic heart failure (HF). Sodium restriction has been broadly recommended as part of the self-care strategies in heart failure yet is based on little high-quality evidence. This study reports the results of the pilot SODIUM-HF trial in 38 patients with chronic HF. Nineteen patients were prescribed a low sodium containing diet (1500 mg/day) and 19 a moderate sodium containing diet (2300 mg/day). Both interventions were based on a structured and individualized meal plan to achieve the targeted sodium intake, and all patients were followed for 6 months with monthly phone call to reinforce adherence to the diet. We found a meaningful reduction in sodium intake to less than 1500 mg/day at 6 months in both groups. Additionally, we observed that patients that achieved a sodium intake less than 1500 mg/day at 6 months of follow-up had reduced BNP levels, a biomarker of volume overload and surrogate prognostic marker in heart failure, and increased overall and clinical scores of the Kansas City Cardiomyopathy Questionnaire, compared to those with a sodium intake greater than 1500 mg/day. (more…)
Author Interviews, Diabetes, Exercise - Fitness / 25.11.2014

Lauren Marie Sparks, PhD Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FLMedicalResearch.com Interview with: Lauren Marie Sparks, PhD Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FL Medical Research: What is the background for this study? What are the main findings? Dr. Sparks: As a clinical scientist focused on exercise effects on muscle metabolism in diabetes, I have seen first-hand a significant minority of individuals with diabetes not improve their glucose control (HbA1c) after 9 months of supervised exercise. They poured their hearts out on those treadmills 3-4 days a week for 9 months and still ended up no better than when they started. I have also seen similar data from some of my colleagues’ studies. So I really want diabetes research to invest the intellect and dollars into discovering what these roadblocks are—I happen to believe it is in the DNA (genetics) and the way that DNA is “read” or expressed (epigenetics). So it’s a bit of a ‘call to action’ for researchers to start looking into some of their data to find these people and better understand this phenomenon and for hopefully the funding sources to recognize this as a viable area of research. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety / 25.11.2014

Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-ComtéMedicalResearch.com Interview with : Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-Comté Medical Research : What is the background for this study? What are the main findings? Dr. Laurent: Human error among healthcare professionals is a subject of current affairs and especially in ICUs which are among the services with a high risk of error. If the error affects the patient and his/her family, it will also have an impact on the caregivers involved, their colleagues, and even the entire service. In an editorial in the BMJ, Wu introduced the term “the second victim” to define a caregiver implicated in and traumatised by an medical error for which he/she feels personally responsible. Therefore, it’s important to improve understanding of the psychological repercussions of error on professionals in ICUs, and to identify the defense mechanisms used by professionals to cope with errors. In the month following the error, We found that the professionals (doctors and nurses) described feelings of guilt and shame. These feelings were associated with: anxiety states with rumination and fear for the patient; a loss of confidence; an inability to verbalize one’s error; questioning oneself at a professional level; and anger towards the team. (more…)
Heart Disease / 25.11.2014

Dean J. Kereiakes, MD FACC, FSCAI The Lindner Research Center The Christ Hospital Health Network Cincinnati, Ohio 45219MedicalResearch.com Interview with: Dean J. Kereiakes, MD FACC, FSCAI The Lindner Research Center The Christ Hospital Health Network Cincinnati, Ohio 45219 Medical Research: What is the background for this study? Dr. Kereiakes: Bare metal stents (BMS) are a commonly used alternative to drug eluting stents (DES) particularly for patients presenting with acute coronary syndromes or in whom dual antiplatelet therapy (DAPT) has perceived increased bleeding risks. We aimed to determine whether the risks of stent thrombosis and major adverse clinical cardiovascular and cerebrovascular (MACCE; composite of death, MI or stroke) events differ for BMS versus DES and whether the optimal duration of dual antiplatelet therapy differs for BMS or DES. To answer these objectives we performed a propensity matched BMS to DES 0-33 month comparison as well as an analysis of treatment effect among BMS treated patients randomly assigned to 12 versus 30 months of DAPT. (more…)
Author Interviews, CDC, JAMA, Lyme / 25.11.2014

MedicalResearch.com Interview with: Christina Nelson, MD, MPH, FAAP Medical Epidemiologist Centers for Disease Control and Prevention Division of Vector-Borne Diseases | Bacterial Diseases Branch Fort Collins, CO Medical Research: What is the background for this study? Dr. Nelson: Evidence-based guidelines for the diagnosis and treatment of Lyme disease have been provided by the Infectious Diseases Society of America for many years. These comprehensive guidelines have been vetted by external review panels as the best option for patient care. In endemic areas, patients with the typical rash (erythema migrans) can be diagnosed with Lyme disease clinically. Otherwise, the guidelines recommend that diagnosis be based on a history of possible exposure, compatible clinical features, and positive two-tier serologic testing. Some patients who have been treated for Lyme disease may develop post-treatment Lyme disease syndrome (PTLDS) – fatigue, arthralgias, or other symptoms that persist after completing antibiotic treatment. Although the exact cause of post-treatment Lyme disease syndrome is unknown, it is thought to be due to an altered immune response or residual damage to tissues during the acute infection. A diagnosis of exclusion, PTLDS should only be diagnosed after the patient has been thoroughly evaluated and other potential causes of symptoms ruled out. On the other hand, “chronic Lyme disease” is a loosely defined diagnosis that has been used to describe a variety of ailments. A small cadre of providers use unconventional methods to diagnose patients with chronic Lyme disease, and sometimes there is no objective evidence that the patient ever had Lyme disease. Multiple factors contribute to this phenomenon, including misconceptions about serologic testing, use of unvalidated diagnostic tests, and clinical diagnosis of Lyme disease based on nonspecific symptoms alone. We know that patients have been – and continue to be – harmed by treatments for chronic Lyme disease. Patients have suffered from emboli, severe allergic reactions to antibiotics, neutropenia, and infections such as Clostridium difficile. This is terrible and should never happen. However, there is another important danger related to these alternative practices. Some patients who have been diagnosed and treated for chronic Lyme disease later discover that another condition is the root of their physical problem. We wanted to highlight some of these cases in order to help educate providers and patients about this issue. (more…)
Author Interviews, Nutrition, Weight Research / 25.11.2014

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteMedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. DiNicolantonio: Focusing on calories misdirects eating away from healthy foods (that are higher in calories - such as nuts, salmon, and avocados) and towards harmful foods (e.g. rapidly absorbable carbohydrates - including added sugars such as table sugar and high fructose corn syrup). Treating obesity should not focus on decreasing caloric intake, rather, it should focus on eating quality foods.  Lower calorie foods - that are high in rapidly absorbable carbohydrates - drive increased hunger throughout the day, whereas higher calorie foods (such as full-fat milk and eggs) leads to satiety.  Consuming rapidly absorbable carbohydrates leads to increased total caloric intake throughout the day (driven by insulin resistance and leptin resistance).  These metabolic consequences derived from overconsuming these types of foods leads us to eat more and exercise less.  In essence, eating more and exercising less doesn't cause obesity, overconsuming rapidly absorbable carbohydrates causes us to eat more and exercise less, which then causes obesity - a subtle but important distinction. (more…)
Author Interviews, JAMA, Stroke / 25.11.2014

MedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Berlin | Germany Medical Research: What is the background for this study? What are the main findings? Response: Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That's because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial - both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities. (more…)
Author Interviews, Breast Cancer / 25.11.2014

MedicalResearch.com Interview with Dr. Jonathan Myles Centre for Cancer Prevention, Queen Mary, University of London Wolfson Institute of Preventive Medicine, Charterhouse Square, London Medical Research: What is the background for this study? What are the main findings? Dr. Myles: Breast cancer screening uptake is low in areas of high social deprivation and large populations of some ethnic groups.  The main  finding of this study is that an intervention in the form of contacting women by telephone a few days before the date of their screen, reminding them of their appointment and answering any queries they may have, significantly increases uptake. (more…)
Author Interviews, Heart Disease, Infections, Lancet / 24.11.2014

MedicalResearch.com Interview with: Dr. Martin Thornhill PhD Department of Cardiology, Taunton and Somerset NHS Trust Taunton, Somerset, UK Medical Research: What is the background for this study? What are the main findings? Dr. Thornhill: In 2008 NICE introduced controversial new guidance recommending that antibiotic prophylaxis to prevent infective endocarditis should no longer be used. It was a rational decision, given the evidence for the effectiveness of antibiotic prophylaxis and potential concerns about costs, the development of antibiotic resistance and possible side effects from antibiotics, but it went against other guidelines from around the world that existed at the time. The main findings are that in England:
  1. There has been a large and significant decline in the use of antibiotic prophylaxis.
  2. There has been a significant increase in the number of cases of infective endocarditis, above the baseline trend, using hospital coding data, corrected for changes in the size of the English population.
(more…)
Author Interviews, Cancer Research, JAMA, Surgical Research, Toxin Research / 24.11.2014

MedicalResearch.com Interview with: Naveed Nosrati MD Indiana University School of Medicine Staff Surgeon, Roudebush VAMC Medical Research: What is the background for this study? Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure. Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results. Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance. (more…)
Author Interviews, Emergency Care, Radiology, University of Pittsburgh / 24.11.2014

Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound, Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of MedicineMedicalResearch.com Interview with: Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don't necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices. (more…)
HPV, Vaccine Studies / 24.11.2014

Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science CenterMedicalResearch.com Interview with: Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science Center Medical Research: What is the background for this study? What are the main findings? Dr. Qualls-Hampton: There are currently two vaccines approved by the Food and Drug Administration (FDA)—Gardasil for males and Gardasil and Cervix for females – that protect against the human papilloma virus (HPV). These vaccines are recommended by the ACIP for females ages 9 to 26 years and males ages 9 to 21 years. Both vaccines protect males and females against some of the most common types of HPV.  HPV vaccines are administered in three doses over six months and are considered safe and effective. However, the promise of these vaccines is going unfulfilled as initiation and completion rates for the three doses are suboptimal among females and males. Nationally, although HPV vaccination initiation coverage is increasing, overall vaccine completion rates are at suboptimal levels and below the U.S. Department of Health and Human Services’ Healthy People 2020 initiative target of 80%. Thus, many states are turning to legislative interventions in efforts to increase initiation and completion rates. This study examines HPV vaccination legislative initiatives and their impact, specifically in estimating state legislation’s effects on HPV vaccine initiation, completion and patient care provider recommendations by gender. (more…)