Author Interviews, JAMA / 21.11.2014

MedicalResearch.com Interview with: Meera Viswanathan, PhD RTI International, Research Triangle Park North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. Viswanathan: Medications, when used appropriately, can alleviate symptoms. Often, however, they result in side effects, interact with one another, are prescribed incorrectly, or are taken incorrectly. These problems are particularly pronounced for the elderly who may have multiple chronic conditions and may be on numerous medications. We evaluated a variety of research studies and program evaluations regarding a distinct type of health care service known as Medication Therapy Management or “MTM.” The goals of MTM services are to help patients and their clinicians to optimize prescription and nonprescription drug regimens, thereby achieving better health outcomes from drug therapy, and. at the same time to minimize the potential for harms, such as incorrect dosing and duplicate medications. Some have proposed that optimizing drug regimens and preventing adverse drug events may reduce health-care-related costs. Medication Therapy Management services are most often provided directly to patients by pharmacists. Sometimes the same pharmacists who dispense medications to patients offer Medication Therapy Management services as well; in other models, pharmacists working in a nondispensing role within a health care system, health insurance plan administering a prescription drug benefit program, or a centralized pharmacy call center may offer such services Although Medication Therapy Management can vary quite substantially in specifics, Medication Therapy Management programs in general share common elements; these include medication therapy review of all prescription drugs, over-the-counter products, and herbal or dietary supplements; patient education and counseling to solve issues with the drug regimen that a patient may be experiencing, such as side effects or difficulty remembering to take medications; and coordination and communication with the prescribing provider. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allowed Medicare to expand access to Medication Therapy Management services for selected patients through Medicare Part D prescription drug benefits. (more…)
Heart Disease / 21.11.2014

Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical CenterMedicalresearch.com Interview with: Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical Center MedicalResearch.com: What are the main findings of this study? Dr. Rabbat : Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and is responsible for significant morbidity and mortality. Epidemiologic data suggest that obesity as measured by one’s BMI is a risk factor for Atrial fibrillation. But there is more to the story. What may be even more important than overall BMI is how much fat you have around the heart. There are many individuals who, as measured by their BMI, are not considered obese, but they have high volumes of fat around their heart, which may have been a major cause for their atrial fibrillation. Therefore, simple measures such as BMI may fail to completely inform us of a patient’s true CV risk. In a previous study we found that epicardial adipose tissue (EAT), or the fat around the heart, has been associated with the presence and severity of AF independent of known risk factors and body mass index (BMI). The inflammatory mediators released from the fat are metabolically active, and may promote fibrosis in adjacent heart muscle. Fibrosis of the left atrium appears to be a hallmark feature of atrial fibrillation and higher amounts of fibrosis are linked to recurrence of atrial fibrillation. New innovations in cardiac magnetic resonance imaging (CMR) allow LA fibrosis and EAT to be precisely quantified. Our current study is the first of its kind to demonstrate the association of EAT volume and extent of LA fibrosis in human AF independent of LA size, BMI, and other AF risk factors. (more…)
NYU, Pain Research, Pediatrics / 21.11.2014

MedicalResearch.com Interview with: Regina Marie Sullivan PhD Professor Child and Adolescent Psychiatry Nathan Kline Institute The Child Study Center at NYU Langone Medical Center Department of Child and Adolescent Psychiatry One Park Ave 8th Floor, New York, NY 10016 Medical Research: What is the background for this study?  Dr. Sullivan: Managing pain during medical procedures in a critically important issue in medicine today. Our study was designed to better understand one method of reducing pain in young infants - having the caregiver be in contact with the baby during the painful procedure, which reduces the infant's behavioral response to the medical procedure. This study explored the neural basis of the ability of the caregiver to reduce the pain response. (more…)
Author Interviews, General Medicine, Heart Disease, Lipids / 21.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices.  Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines. We used the PINNACLE registry to conduct our investigation.  Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S.  We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients.  We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren't currently prescribed them.  We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren't currently recommended for cholesterol treatment.  Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines. (more…)
Author Interviews, CDC, Pediatrics, Pulmonary Disease / 21.11.2014

MedicalResearch.com Interview with: Dr. Wanjun Cui, MS PhD Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? What are the main findings? Authors’ response: Asthma is a leading chronic disease among adolescents that adversely affects their health. However, it is unclear how asthma influences their perceived health or health-related quality of life (HRQOL). Because their perceptions of their health may differ from those of their caregivers (such as parents or health professionals), knowing how adolescents with asthma would rate their own health is very important. Our study compares the responses of adolescents with and without asthma about different aspects of HRQOL including their overall health, their recent physical health, their recent mental health, and their recent activity limitations due to health. Unlike previous U.S. studies based on small clinical samples, our study used a nationally representative sample of U.S. adolescents that can be generalized to the whole U.S. adolescent population. We found that asthma is adversely associated with almost all these aspects of HRQOL but only among those with asthma and current symptoms such as wheezing and dry cough. Adolescents with asthma without current symptoms did not report significantly worse HRQOL than those without asthma. For example, compared with those who never had asthma, adolescents with asthma and symptoms of dry cough or wheezing reported significantly more fair or poor self-rated health (14% vs. 8%), 34% more recent physically unhealthy days , and 26% more recent mentally unhealthy days. More importantly, adolescents with asthma who currently smoked cigarettes or reported limited physical functioning reported even worse physical and mental HRQOL. (more…)
Emergency Care, Heart Disease / 21.11.2014

Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of ArizoneaMedicalResearch.com Interview with: Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of Arizona Medical Research: What is the background for this study? What are the main findings? Dr. Bobrow: Out-of-Hospital Cardiac Arrest is a leading cause of death worldwide. There are nearly half a million EMS-assessed Out-of-Hospital Cardiac Arrest s in the United States annually. Bystander CPR (B-CPR) before arrival of EMS can double or even triple survival from OHCA. Yet it occurs in only 1/3 of cases. Telephone CPR - the provision of B-CPR with a 9-1-1 telecommunicator's instructions - is independently associated with increased rates of Bystander CPR and patient survival and requires almost no capital investment. For this reason, we believe Telephone CPR may be THE most effective and efficient way to move the needle on OHCA survival. In order to achieve this potential, however, EMS systems must adopt the latest guideline recommendations for T-CPR and continuously measure system performance. Very few systems do this. The aim of our project was to do just this at multiple 9-1-1 centers in Arizona. We implemented the guidelines and measured the impact on process metrics and patient outcomes. Our findings confirmed what we expected: a significant increase in the proportion of cases where T-CPR was performed, a significant reduction in time from call-receipt to first bystander chest compression, and, most importantly, significant increases in patient survival and survival with positive neurologic outcome. (more…)
Baylor College of Medicine Houston, Rheumatology / 20.11.2014

Dr. Grace Hsiao-Wei Lo Baylor College of Medicine Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine Faculty, Immunology, Allergy, and Rheumatology Section, Michael E. DeBakey VA Medical CenterMedicalResearch.com Interview with: Dr. Grace Hsiao-Wei Lo Baylor College of Medicine Assistant Professor, Section of Immunology, Allergy and Rheumatology,  Department of Medicine, Baylor College of Medicine Faculty, Immunology, Allergy, and Rheumatology Section, Michael E. DeBakey VA Medical Center Medical Research:What is the background for this study? What are the main findings? Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee.  There is concern that chronic repetitive loading of the knee could physically damage structures within the knee.  Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis.  Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable.  Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality. To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6.  Twenty-nine percent of the participants reported that they ran at some time in their lives. Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older. Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA. After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded.  (more…)
Author Interviews, Breast Cancer, JAMA, Surgical Research, Vanderbilt / 20.11.2014

MedicalResearch.com Interview with: Dr. Kristy Lynn Kummerow MD Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center Tennessee Valley Healthcare System, Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center Nashville, Tenn Medical Research: What is the background for this study? What are the main findings? Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer.  It is helpful to understand the historical context of how we treat early breast cancer.  Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area.  Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation.  In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer.  However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women.  This has been found in other institutions as well, and is supported by smaller national studies.  We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States. (more…)
Allergies, Author Interviews, Pediatrics / 20.11.2014

MedicalResearch.com Interview with: Maria Pesonen MD, PhD Specialist in Dermatology Assistant Chief Medical Officer Finnish Institute of Occupational Health Occupational Medicine Helsinki, Finland Medical Research: What is the background for this study? What are the main findings? Dr. Pesonen: Skin prick test is a widely used, established methods in assessing immediate (i.e. immunoglobulin E-mediated) sensitization. However, the knowledge on long-term reproducibility and predictive value of skin prick testing in children has been limited. We assessed the predictive value of skin prick testing in the setting of a follow-up study on healthy, unselected newborns, who were followed up to age 20 years with skin prick testing with 11 common allergens, structured interview and clinical examination at ages 5, 11 and 20 years. The reproducibility of skin prick test positivity at age 5 years was 100% at ages 11 and 20 years, i.e. none of the skin prick positive subjects turned negative during the follow-up. Gaining of new sensitizations to aeroallergens was common. Skin prick test positivity at age 5 years predicted allergic symptoms at ages 11 (sensitivity 28%, specificity 94%) and 20 years (sensitivity 23%, specificity 91%), but not atopic dermatitis. (more…)
Alcohol, Author Interviews / 20.11.2014

MedicalResearch.com Interview with: Kirsten Mehli Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Medical Research: What is the background for this study? Dr. Mehlig: Many studies found that the ‘good’ HDL-cholesterol is associated with lower risk for atherosclerosis, and cardiovascular risk. This finding has not been translated into clinical practice because medical trials with HDL-cholesterol rising medication did rise the HDL-cholesterol but did not prevent CVD. One possible explanation could be that a high level of HDL-cholesterol is but a marker for other factors that truly contribute to reduced cardiovascular risk. One such factor is alcohol consumption, and ethanol intake in grams / day is associated with higher HDL-C in our study, too. Another factor is a certain genotype that has been found to modulate HDL-cholesterol levels. The fact that co-called ‘moderate’ alcohol consumption is beneficial wrt. CVD has been observed and discussed often, and is confirmed in our study. Here, we asked whether the beneficial effect of alcohol was further strengthened by having a favorable CETP genotype wrt. HDL-cholesterol. (more…)
Exercise - Fitness, Kidney Disease / 20.11.2014

Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, ItalyMedicalResearch.com Interview with: Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study. (more…)
Author Interviews, Biomarkers, Lung Cancer / 20.11.2014

Marie-Christine Aubry, M.D. Professor of Laboratory Medicine and Pathology Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with: Marie-Christine Aubry, M.D. Professor of Laboratory Medicine and Pathology Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Minn.   Medical Research: What is the background for this study? What are the main findings? Dr. Aubry: Up to 20% of patients will present with multifocal lung cancer or will develop a second lung cancer.  The main clinical issue is distinguishing between independent primaries from true intrapulmonary metastases since this distinction will drive the therapy of the patient.  Currently no ancillary studies allows for this distinction and the distinction is provider specific based on a combination of clinical, radiologic and pathologic assumptions. Based on our prior research using a method called mate pair sequencing , we observed that the probability of detecting identical chromosomal breakpoints in two unrelated tumors, from 2 different patients was basically zero. Similarly, when assessing different components within a single tumor, we always found identical chromosomal breakpoints between these components.  We thus hypothesized that if two tumors within a patient were related, i.e. true metastasis, we should always find a number of identical chromosomal breakpoints between the tumors. And in contrast, if 2 tumors were truly independent primaries, we should not observe any chromosomal breakpoints in common. We first studied a control group of patients that had 1- a primary lung cancer with a known distant metastasis (usually brain metastasis), 2- two lung cancers of different histologic subtype, adenocarcinoma and squamous cell carcinoma which are accepted as true independent primaries and 3- 1 tumor with different portions of the tumor being analyzed individually and compared as true relatedness. There were thus a total of 11 pairs of tumors with predetermined status of independent primaries versus relatedness (ie metastasis or same tumor).  The mate pair generated data showed a perfect concordance with this status.  We then studied 11 pairs of lung tumors of similar histology (2 adenocarcinomas or 2 squamous cell carcinomas).  The current gold standard for the distinction between independent primaries and intrapulmonary metastasis relies on a pathologist’s comparative morphologic assessment. In order to strengthen this gold standard, 2 pulmonary pathologists independently made this assessment. Interestingly, the pathologists agreed on the status of independent primaries and intrapulmonary metastasis in 9 (of 11) cases demonstrating the shortcomings of this gold standard.  Furthermore, there were discordance between the pathologists’ prediction and the clinicians’ assessment in 3 of the 11 patients and the clinician could not come to a final assessment in 1 patient.  The MP data was concordant with the pathology assessment in 8 of these 9 cases, and supported the pathologists’ prediction in 2 (of the 3) discordance with the clinical assumptions. (more…)
Breast Cancer, Exercise - Fitness / 20.11.2014

MedicalResearch.com: Interview Invitation Dr. Wenji Guo University of Oxford Medical Research: What is the background for this study? Response: Previous studies report increased risk for breast cancer in postmenopausal women who have a higher Body Mass Index (BMI) – a measure of body fat based on height and weight. However, BMI is unable to distinguish between excess weight due to fat rather than muscle. More direct measures of fatness, such as body fat percentage, may be better indicators of disease risk. And although probable evidence for the relationship between physical activity and breast cancer now exists, questions still remain over the role of vigorous compared to lower intensity physical activity. (more…)
Author Interviews, CDC, Heart Disease / 19.11.2014

MedicalResearch.com Interview with: Dr. Quanhe Yang PhD CDC’s Division for Heart Disease and Stroke Prevention What is the background for this study? What are the main findings? Dr. Yang: Our study reveals that an individual’s predicted risk of developing cardiovascular disease (CVD), coronary heart disease (CHD) and stroke over the next decade varies significantly from state-to-state, as well as by demographic factors including age, gender, race-ethnicity and household income. Among the key findings: the 10-year risk is higher in the Southeast and lower in northwestern states – and higher among men than women. For men, the 10-year risk of developing CVD was 14.6 percent for the nation as a whole, ranging from a low of 13.2 percent in Utah to a high of 16.2 percent in Louisiana. CHD risk among men ranged from 9.5 percent in Utah to 11.7 percent in Louisiana, while stroke risk was 2.1 percent in Utah and 2.6 percent in Louisiana. Among women, CVD risk was 7.5 percent, ranging from 6.3 percent in Minnesota to as high as 8.7 percent in Mississippi. CHD risk for women ranged from 3.8 percent in Minnesota to 5.3 percent in Mississippi, while stroke risk was as low as 1.5 percent in Minnesota and as high as 2.1 percent in Mississippi. Nationally, we found the risk increased significantly with age and was highest among non-Hispanic blacks, those with less than a high school education and those with household incomes below $35,000 . As part of this study, CDC researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010, as well as the 2009 Behavioral Risk Factor Surveillance System, the world’s largest ongoing telephone health surveillance system. The state-based, random-digit-dialed phone survey included information from almost 300,000 U.S. residents between the ages of 30 and 74. (more…)
Author Interviews, BMJ, Genetic Research, Vitamin D / 19.11.2014

MedicalResearch.com Interview with: Børge G Nordestgaard, MD, DMSc Professor, University of Copenhagen Chief Physician, Herlev Hospital, Copenhagen University Hospital Dept. Clinical Biochemistry Herlev Ringvej Herlev, Denmark Medical Research: What is the background for this study? What are the main findings? Prof. Nordestgaard: Many people take vitamin D supplements with the hope of reducing morbidity and mortality. However, it is unclear whether low vitamin D per se is a direct cause of increased mortality or whether it is simply a marker of poor lifestyle in general and/or underlying hidden disease. Our study involved 95,766 white participants of Danish descent from three cohorts in Copenhagen, who had genetic variants known to affect vitamin D levels. We found that genetically low vitamin D levels were associated with increased all-cause mortality, cancer mortality, and other mortality, but not with cardiovascular mortality. This is important as such genetics studies cannot be explained by poor lifestyle or hidden disease, as neither can change your genes. (more…)
Author Interviews, BMJ, Heart Disease, Occupational Health / 19.11.2014

MedicalResearch.com Interview with: Vasileia Varvarigou MD, Visiting Scientist at Harvard School of Public Health and Senior Medical Resident, St Elizabeth’s Medical Center, Tufts Medical School and Stefanos N Kales MD, MPH, Associate Professor, Harvard School of Public Health, Division Chief of Occupational Medicine, Cambridge Health Alliance/ Harvard Medical School Medical Research: What is the background for this study? Response: Previous epidemiologic studies of firefighters have documented markedly increased risks of acute death from heart disease during strenuous activities such as fire suppression as compared to non-emergency duties. We hypothesized that certain law enforcement tasks could serve as an occupational trigger in susceptible police officers, leading to an increased frequency of sudden cardiac death during stressful duties. Our main objective therefore, was to assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. (more…)
Author Interviews, Biomarkers, Infections, Nature, UCLA / 19.11.2014

Weian Zhao PhD Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine. Founder of Velox BiosystemsMedicalResearch.com Interview with: Weian Zhao PhD Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine. Medical Research: What is the background for this study? Dr. Zhao: Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The extremely high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages. The present gold standard to detect a blood infections, is a blood culture and it takes 2-5 days for the detection and the identification of the bacteria. Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with blood infections.  Therefore, less expensive and less technically demanding methods are urgently needed for the rapid and sensitive identification of blood infections. (more…)
Endocrinology, Kidney Disease, Vitamin D / 19.11.2014

Stuart M. Sprague, DO, FACP, FASN, FNKF Chairperson, Division of Nephrology and Hypertension NorthShore University HealthSystem Evanston, Illinois 60201MedicalResearch.com Interview with:with Stuart M. Sprague, DO, FACP, FASN, FNKF Chairperson, Division of Nephrology and Hypertension NorthShore University HealthSystem Evanston, Illinois 60201 Medical Research: Congratulations, Dr. Sprague, on your presentation of another successful phase 3 clinical trial program at the recently concluded Annual Meeting of the American Society of Nephrology. Your presentation unveiled a new vitamin D repletion therapy that effectively controls secondary hyperparathyroidism in chronic kidney disease. Can you give us a little background for the presented studies? Dr. Sprague: Thanks! Vitamin D insufficiency is a big problem in chronic kidney decease (or CKD): it afflicts more than 20 million adults in the United States who have stages 1 through 4 CKD. Its prevalence increases with CKD severity and it drives secondary hyperparathyroidism. The studies which I presented evaluated a novel therapy to treat secondary hyperparathyroidism (SHPT) arising from vitamin D insufficiency in patients diagnosed with stage 3 or 4 CKD. This new therapy is a modified-release formulation of calcifediol. Medical Research: Can you tell us more about vitamin D insufficiency? Dr. Sprague: Vitamin D insufficiency is a condition in which the body has low vitamin D stores. It is characterized by inadequate blood levels of the vitamin D, known as 25-hydroxyvitamin D. An estimated 70-90% of CKD patients have vitamin D insufficiency, which can lead to SHPT and resultant debilitating bone diseases. Vitamin D insufficiency has also been associated with increased mortality in CKD. (more…)
Author Interviews, Psychological Science, Weight Research / 19.11.2014

MedicalResearch.com Interview with: Hanna Konttinen, PhD, Docent Post-doctoral researcher Department of Social Research University of Helsinki Medical Research: What is the background for this study? Dr. Konttinen: Bariatric surgery yields significant weight reduction for the majority of severely obese individuals with accompanied improvements in health status and health-related quality of life. Nonetheless, slow weight regain over time is frequent and there is a need for a better understanding on the factors that influence long-term post-surgical weight outcomes. To our best knowledge, this was the first study to examine whether psychological aspects of eating behavior predicted weight changes 10 years after surgical and conventional treatment for severe obesity. The participants were from the Swedish Obese Subjects intervention study: 2010 obese subjects who underwent bariatric surgery and 1916 contemporaneously matched obese controls who received conventional treatment. (more…)
Antibiotic Resistance, Author Interviews, Pharmacology, Rheumatology / 19.11.2014

MedicalResearch.com Interview with: Dr. Daniel B Horton, MD Division of Pediatric Rheumatology Department of Pediatrics Nemours Dupont Pediatrics Wilmington, Delaware
Medical Research: What is the background for this study? What are the main findings? Dr. Horton: The reasons why children develop juvenile arthritis (JIA) are unclear. To date, genetic variation accounts for only a minority of disease incidence, and no environmental factor has consistently been associated with juvenile arthritis. There is growing understanding about the role of microbiome disturbance in the development of multiple diseases, including obesity, inflammatory bowel disease, and rheumatoid arthritis. Exposure to antibiotics, a known disruptor of the human microbiome, has been linked to pediatric conditions including inflammatory bowel disease, asthma, and obesity. We showed that antibiotic prescriptions are associated with the development of new JIA diagnosis in a large general pediatric population, after accounting for history of infection and other relevant factors. This association is stronger for those who have received multiple courses of antibiotics and appears specific for antibacterial antibiotics, such as penicillins and sulfa drugs. (more…)
Author Interviews, CDC, Tobacco Research / 19.11.2014

MedicalResearch.com Interview with: Brian King, Ph.D. Senior Scientific Advisor with the CDC Office on Smoking and Health. MedicalResearch: What is the background for this study? What are the main findings? Dr. King: This study presents data from the 2013 National Youth Tobacco Survey, an annual school-based survey of U.S. middle and high school students in grades 6 through 12. The data show that more than 1 in 5 high school students and more than 1 in 20 middle school students have used a tobacco product in the past 30 days; and nearly half of high school students and almost 1 in 5 middle school students have used a tobacco product at least once in their life. Nine of ten high school tobacco users used a combustible tobacco product such as a cigarette, cigar, hookah, pipe, bidi, or kretek; there was lower use of only noncombustible tobacco products or only electronic cigarettes among both current and ever tobacco users. (more…)
Author Interviews, Heart Disease / 19.11.2014

MedicalResearch.com Interview with: Thanh Huyen T Vu MD, PhD Research Assistant Professor Preventive Medicine-Epidemiology Northwestern University Feinberg School of Medicine Medical Research: What is the background for this study? Response: Ideal levels of all major cardiovascular disease (CVD) risk factors (RF), i.e., low risk (LR), in younger age are associated with lower subsequent CVD morbidity and mortality in older age. However, data are limited on the long-term relationships of LR profile in younger age with functional disability in older age. (more…)
Author Interviews, Heart Disease, JAMA / 19.11.2014

Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, Sweden Medical Research: What is the background for this study? Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and there is no therapy. Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction. (more…)
Author Interviews, Pulmonary Disease / 19.11.2014

Anne Stephenson MD, PhD Division of Respirology The Toronto Adult Cystic Fibrosis Centre St. Michael's Hospital Toronto, ON MedicalResearch.com Interview with: Anne Stephenson MD, PhD Division of Respirology The Toronto Adult Cystic Fibrosis Centre St. Michael's Hospital Toronto, ON Medical Research: What is the background for this study? What are the main findings? Dr. Stephenson: Cystic Fibrosis is progressive genetic disease that results in very thick secretions in various organs such as the lungs, pancreas, and digestive tract. Over time, these thick secretions damage organs in particular, the lungs, which results in respiratory failure due to recurrent chest infections. Cystic Fibrosis patients are also at high risk for malnutrition due to the inability to absorb food which is associated with poor survival. In the 1960s, people with Cystic Fibrosis died at a very young age and in fact, parents who had a child born with Cystic Fibrosis at that time were told that there was a 50% chance their child would not live to attend kindergarten. Over the last several decades, we have seen a significant increase in the survival of individuals with CF. Individuals born with Cystic Fibrosis today can expect to not only attend kindergarten, but complete high school, perhaps attend college or university, have a career, get married or have children as people are living well into adulthood with this disease. The median age of survival in Cystic Fibrosis today is approximately 50 years of age in Canada which is quite remarkable. (more…)
Author Interviews, JAMA, Pediatrics / 19.11.2014

Dr. Abhay Lodha, MBBS, MD, DM, MSC Assistant Professor, Department of Pediatrics and Community Health Sciences, University of Calgary, Staff Neonatologist and Clinical Epidemiologist, Section of Neonatology, Alberta Health Services, Chairman, CME Foothills Medical Centre, Calgary, Alberta, CanadaMedicalResearch.com Interview with: Dr. Abhay Lodha, MBBS, MD, DM, MSC Assistant Professor, Department of Pediatrics and Community Health Sciences, University of Calgary, Staff Neonatologist and Clinical Epidemiologist, Section of Neonatology, Alberta Health Services, Chairman, CME Foothills Medical Centre, Calgary, Alberta, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Lodha: Apneic episodes (cessation of breathing) occur in the premature infants. Caffeine is the most commonly used medication for apnea of prematurity. Normally caffeine started on day 3 of life for apnea. However, there is no strong evidence that starting caffeine on day 1 or 2 life has some extra advantages in premature infants. Our study has a large number of premature infants. Our study determined the association of early initiation of caffeine therapy in very preterm neonates and neonatal outcomes. The main finding of our study was that early use of caffeine was associated with a reduction in the rate of death or bronchopulmonary dysplasia and patent ductus arteriosus. We did not find any adverse impact on any other outcomes. (more…)
Author Interviews, Cancer Research, Cannabis / 19.11.2014

MedicalResearch.com Interview with: Dr Wai Liu Senior Research Fellow St George's University of London London,  SW17 Medical Research: What is the background for this study? What are the main findings? Dr. Liu: It has been known for some time that certain chemicals called cannabinoids that are isolated from the cannabis plant possess anticancer action through the ability to enhance/engage apoptosis and autophagy. These effects are both dependent and independent upon the cognate receptors. These are found at relatively high levels in brain cells. Brain tumors tend to express these at high levels and so we felt these would be good candidates. The main findings of the current study is the ability that combining the cannabinoids THC and CBD with irradiation can cause a reduction in tumor that is greater than the sum of the individual treatments. That is, when using doses of irradiation or cannabinoids individually, the effects were minimal; however, if they were used simultaneously, the effect was synergistic, and tumor growth was significantly impeded. (more…)
Author Interviews, Nutrition, University of Michigan, Weight Research / 19.11.2014

MedicalResearch.com Interview with: Yvonne M. Terry-McElrath, MSA Research Associate, Survey Research Center, Institute of Social Research University of Michigan Tobacco Research Center Medical Research: What is the background for this study? What are the main findings? Dr. Terry-McElrath: The United States Department of Agriculture (USDA) recently improved nutrition standards for federally-reimbursable school lunch and breakfast programs. Most lunch standards were implemented at the beginning of the 2012-13 school year and changes in breakfast began with the 2013-14 school year. Beginning in 2014, schools participating in federally-reimbursable meal programs were also required to improve nutrition standards for foods and beverages sold in vending machines, stores/snack bars/carts, and à la carte cafeteria lines. The new standards limit fats, sodium, sugar, and calories; and will eventually remove candy; regular-fat salty snacks/sugary treats; higher-fat milks; high-fat, high-calorie savory foods; and sugar-sweetened beverages, like regular soda, fruit drinks and high calorie sports drinks. They were developed in response to rising overweight/obesity among US children and adolescents. This study uses five years of data from nationally-representative samples of middle and high school students—and their school administrators—to examine three research questions: What percentage of US secondary students attended schools in 2008-2012 where foods and beverages met at least some of the USDA standards that were to begin phased implementation starting in 2012-13? Is there evidence that those standards were associated with student overweight/obesity? Is there evidence of the effect of those standards on racial/ethnic minorities and students from lower income families? Using data from schools even before the new USDA standards went into effect can indicate potential effect of the standards once they have been in effect for several years. The research was conducted through two studies: The Monitoring the Future study, supported by a grant from the National Institute on Drug Abuse, and the Youth, Education and Society study, part of a larger research initiative funded by the Robert Wood Johnson Foundation, titled “Bridging the Gap: Research Informing Policy and Practice for Healthy Youth Behavior.” Study findings show that from 2008-2012, few middle or high school students attended schools where food and beverage standards would be judged to meet at least some of the USDA school nutrition standards that began to be implemented in 2012-13. Significant increases in the number of standards over time were seen for middle but not high school students. Among high school students, having fruits and vegetables available wherever foods were sold, the absence of higher-fat milks, and increasing the number of positive nutrition standards were associated with significantly lower odds of overweight/obesity. Not having sugar-sweetened beverages was associated with lower overweight/obesity for middle and high school minority students. (more…)
Author Interviews, General Medicine, JAMA, Statins / 18.11.2014

Dr. Mike Miedema MD, MPH Minneapolis Heart InstituteMedicalResearch.com Interview with: Dr. Mike Miedema MD, MPH Minneapolis Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. Miedema: " Released in November 2013, the ACC/AHA guidelines for the treatment of blood cholesterol attempt to target individuals that are most likely to benefit from cholesterol-lowering statin therapy. These guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat. Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits. In addition to recommending statin therapy for individuals with known cardiovascular disease, diabetes, or markedly elevated cholesterol levels, they also recommend statin therapy for individuals without these conditions but with an elevated estimated risk of a heart attack or stroke in the next 10-year based on a risk calculator that factors in an individual’s age, gender, race, and risk factors. Patients with an estimated 10-year risk > 7.5% are recommended to consider statin therapy. While I believe the scientific evidence supports this “risk-based” approach, one potential concern is that the risk-calculator relies heavily on age to determine an individual’s risk, so we wanted to examine the implications for these guidelines in an older sample of adults." (more…)