Author Interviews, Telemedicine, University of Michigan / 15.09.2014

Rashid Bashshur, PhD Senior Advisor for eHealth Professor Emeritus, Department of Health Management and Policy Executive Director, UMHS eHealth Center University of Michigan Health SystemMedicalResearch.com Interview with:  Rashid Bashshur, PhD Senior Advisor for eHealth Professor Emeritus, Department of Health Management and Policy Executive Director, UMHS eHealth Center University of Michigan Health System Medical Research: What are the Main findings of the study? Dr. Bashshur: The main findings can be summarized as follows:
  •  The prevalence of chronic disease is increasing due to the changing demographic composition of the population and unhealthy life styles. Chronic diseases are expensive, accounting for about 70% of health care expenditures;  but  they are amenable to telemedicine interventions.  These interventions consist of ongoing monitoring of patients living in their own home environments, engaging them in managing their health,  providing them with educational materials and the necessary tools to manage their life style mostly by avoiding risky behaviors and adopting healthy ones.
  • Telemedicine interventions consist of various configurations of technology (telephone, video, wired or wireless, automated or manual) , human resources (physicians, nurses, combinations, and patient populations at various levels risk levels or severity of illness, The interventions investigated to date also vary in terms of study design, duration of application (during the study period), and frequency of administration of the intervention.  Hence, the findings must be viewed from the perspective of the specific methodological attributes  of the studies that were performed.
  • Using only robust studies from 2000 to the near present, and limited to congestive heart failure, stroke and COPD.  With notable exceptions,  overall there is substantial and fairly consistent evidence of:
  • A decrease in use of service, including hospitalization, rehospitalization, and emergency depart visits as a result of the telemedicine intervention.
  • Improved health outcomes.
  • Improved event timing for stroke patients.
  • Reduced exacerbations of symptoms for COPD patients
  • Some interesting  trends  to be considered:
  • Frail and elderly patients, those with co-morbid conditions, and those in advanced stages of illness are not likely to benefit from telemedicine interventions, as compared to their counterparts.
  • Visual information as in videoconferencing proved superior to telephone only connection for the diagnosis and treatment of stroke patients.
  • There could be a tradeoff between extra nursing time versus reduced physician time in some settings, but the net effect is cost savings.
  • There seems to be a paradoxical telemedicine effect in terms of increasing longevity but no reduction in hospitalization, reported in few studies.
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Author Interviews, Brigham & Women's - Harvard, Nature / 15.09.2014

MedicalResearch.com Interview with: MichDr. Michael Super, Ph.D.ael Super M.Sc., PhD Senior Staff Scientist Advanced Technology Team Wyss Institute at Harvard Center for Life Science, 2nd Floor Boston MA 02115 Medical Research: What is the background for this study? How big a problem is sepsis? Dr. Super:
  • Sepsis is a major problem and is the primary cause of death from infection. The incidence of sepsis is rising.
  • Sepsis affects more than 18 M people each year and at least 1/3 ( 6 million) die every year of sepsis.
  • Sepsis is a disease that affects the very young and old and it is estimated that 60-80% of childhood deaths in the developing world are due to sepsis.
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Author Interviews, Brain Injury, University of Pittsburgh / 15.09.2014

Anthony P. Kontos, Ph.D. Assistant Research Director UPMC Sports Medicine Concussion Program Associate Professor Department of Orthopaedic Surgery University of PittsburghMedicalResearch.com Interview with: Anthony P. Kontos, Ph.D. Assistant Research Director UPMC Sports Medicine Concussion Program Associate Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Research: What are the main findings of the study? Dr. Kontos: Our new Vestibular/Ocular Motor Screening (VOMS) examination was able to accurately identify nearly 90% of patients with a concussion. In our study of 64 concussed patients approximately five days post-injury and 78 healthy control-group patients who were administered VOMS by trained clinicians, we also found that more than 60% of patients with a concussion reported symptoms or had impairment on the VOMS following their injury. The VOMS, which was developed in conjunction with an interdisciplinary team of experts, assesses five areas of the vestibular ocular system: smooth pursuits, saccades (rapid eye movement), horizontal vestibular ocular reflex (VOR), visual motion sensitivity (VMS), and near-point-of-convergence (NPC) distance. (more…)
Author Interviews, Lancet, Lung Cancer, Radiation Therapy / 15.09.2014

Prof. dr. B.J. Slotman VU University Medical Center Cancer Center Amsterdam NetherlandsMedicalResearch.com Interview wth: Prof. dr. B.J. Slotman VU University Medical Center Cancer Center Amsterdam Netherlands Medical Research: What are the main findings of this study? Prof. Slotman: This randomized trial showed that the use of thoracic radiotherapy in patients with extensive stage small cell lung cancer reduces the risk of intrathoracic progression by about 50% and improves 2 years survival from 3 to 13%. (more…)
Author Interviews, Pain Research, Sexual Health / 15.09.2014

MedicalResearch.com Interview with: Natalie Sidorkewicz, MSc (Kin) PhD (HSG) Student Spine Biomechanics Laboratory School of Public Health and Health Systems, Faculty of Applied Health Sciences University of Waterloo Waterloo, ON Medical Research: What are the main findings of the study? Answer: First, we successfully documented male spine motion and muscle activity during sex -- this biomechanics study was the first of its kind. Second, we used this data to develop general recommendations for low back pain patients whose pain is worsened by motions and postures. The general recommendations focus on changing how people move, and position themselves during sex, as seen on websites similar to Nu-Bay. To make any sex position more spine-sparing, we recommend that the individual controlling the movement use their hips and knees more than their spine and that the individual not controlling the movement maintain a more neutral-spine position. An excellent working example is one of the sex positions that we studied: the missionary position. The man, who is controlling the movement with pelvic thrusting, is recommended to do so with more hip and knee movement than spine movement. The women, who is lying on her back, is recommended to use a back support placed underneath the natural curve of her spine to maintain a more neutral spine position. The general recommendations can be applied to any sex position for both men and women. Finally, we developed specific guidelines for men whose back pain is worsened by two specific types of motion: flexion and extension. If a man's low back pain is worsened by spine flexion movements, such as touching their toes or sitting for long periods of time, we would consider them to be flexion-motion-intolerant. The ideal sex position for a flexion-motion-intolerant patient would then be one that uses minimal spine flexion, so as not to worsen that patient's pain. When we compared the five sex positions, which you can do yourself by checking out some videos on a website such as sex free hd xxx, we found that men used the least amount of spine flexion in doggy-style as well as the missionary position as long as the male was propped up on his hands (as opposed to his elbows). If a man's low back pain is worsened by spine extension movements, such as arching their back or lying on their stomach, we would consider them to be extension-motion-intolerant. The ideal sex position for an extension-motion-intolerant patient would then be one that uses minimal spine extension, so as not to worsen the patient's pain. When we compared the five sex positions, we found that men used the least amount of spine extension in spooning and the missionary position as long as the male was propped up on his elbows (as opposed to his hands). (more…)
Author Interviews, Neurological Disorders / 15.09.2014

Agnieszka Tymula PhD School of Economics, University of Sydney Sydney, New South Wales AustraliaMedicalResearch.com Interview with: Agnieszka Tymula PhD School of Economics, University of Sydney Sydney, New South Wales Australia   Medical Research: What are the main findings of the study? Dr. Tymula: We found that the grey matter volume in the posterior parietal cortex, a region long known to be involved in decision-making, correlates with individual tolerance for financial risks. (more…)
Author Interviews, Mental Health Research, NIH / 15.09.2014

MedicalResearch.com Interview with: Dr Oliver J Robinson Ph.D. Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, NIH, Bethesda, MD, Institute of Cognitive Neuroscience University College London, London, UK Medical Research: What are the main findings of the study? Dr. Robinson: This study is looking at a symptom of anxiety disorders known as “negative affective bias”. This describes the tendency of people with anxiety disorders to focus on negative or threatening information at the expense of positive information. We completed a number of previous studies looking at so called “adaptive” anxiety in healthy individuals – this is the normal, everyday anxiety that everyone experiences; walking home in the dark, for instance (in these prior studies we used unpredictable electrical shocks to make people anxious and stressed). When we made healthy people transiently anxious in this way we showed that this was also associated with negative affective bias and driven by a specific brain circuit: the dorsal medial prefrontal (anterior cingulate) cortex—amygdala aversive amplification circuit. In this study we showed that the same circuit that was engaged by transient anxiety in our healthy sample was actually engaged ‘at baseline’ (i.e. without stress) in our patient group. This suggests that this mechanism which can be temporarily activated in healthy controls becomes permanently ‘switched on’ in our patient group. This might explain why people with anxiety disorders show persistent ‘negative affective biases’. Furthermore, the extent to which this circuit was turned on correlated with self-reported anxiety. That is to say the more anxious an individual said they were, the greater the activity in this circuit. Therefore, there seems to be more of a dimension or scale of anxiety, rather than a simple well/unwell diagnosis. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension / 14.09.2014

MedicalResearch.com Interview with: Sourabh Aggarwal, MD University College of Medical Sciences Western Michigan University School of Medicine in Kalamazoo. Medical Research: What are the main findings of the study? Dr. Aggarwal: The main findings were that from 2006 to 2011:
  • ER visits for essential hypertension increased by 25 percent, while the admission percentage for these patients fell by 15 percent.
  • ER visits for hypertension with complication and secondary hypertension increased by 19 percent, while the admission percentage for these patients fell by 12 percent
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Author Interviews, Multiple Sclerosis, Sleep Disorders, UC Davis / 14.09.2014

Steven D. Brass, M.D., M.P.H., M.B.A. PI and Lead Author on the study Director of Neurology Sleep Clinical Program Co-Medical Director of Sleep Medicine Laboratory Associate Clinical Professor in the Department of Neurology UC Davis Health System 4860 Y Street — Suite 3700 Sacramento, CA 95817 MedicalResearch.com Interview with: Steven D. Brass, M.D., M.P.H., M.B.A. PI and Lead Author on the study Director of Neurology Sleep Clinical Program Co-Medical Director of Sleep Medicine Laboratory Associate Clinical Professor in the Department of Neurology UC Davis Health System 4860 Y Street — Suite 3700 Sacramento, CA 95817 Medical Research: What was the primary finding of your study? Dr. Brass : Among the 11,400 surveys mailed out to all members of the Northern California Chapter of the National Multiple Sclerosis Society, 2,810 (24.6%) were returned. Of these, 2,375 (84.5%) met the inclusion criteria. Among the completed surveys, 898 (37.8%) screened positive for obstructive sleep apnea, 746 (31.6%) for moderate to severe insomnia, and 866 (36.8%) for restless legs syndrome.  In contrast, only 4%, 11%, and 12% of the cohort reported being diagnosed by a health care provider with obstructive sleep apnea, insomnia, and restless legs syndrome, respectively. Excessive daytime sleepiness was noted in 30% of respondents based on the Epworth Sleepiness Scale. More than 60% of the respondents reported an abnormal level of fatigue based on the Fatigue Severity Scale.  There was also an increased risk between complaints of Fatigue based on screening positive for the Fatigue Severity Scale  and screening positive for Obstructive Sleep Apnea  (1.850, with a 95% p-value < 0.001). (more…)
Heart Disease, JACC / 13.09.2014

Thomas M. Maddox, MD MSc FACC FAHA Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine, University of Colorado School of MedicineMedicalResearch.com Interview with: Thomas M. Maddox, MD MSc FACC FAHA 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 are the main findings of the study? Dr. Maddox: We were curious to know if the VA, as a provider of PCI at centers without on-site CT surgery, was providing better access to its veterans without compromising their safety.  We were pleased to find that there was evidence of better access, with patients reducing their drive time to PCI facilities by, on average, 90 minutes.  In addition, there was no compromised safety.  Rates of both peri-procedural and 1-year adverse outcomes were low and no different between centers with and without on-site CT surgery. (more…)
Diabetes, Heart Disease / 13.09.2014

Carlos F. Sánchez-Ferrer, M.D., Ph.D. Professor of Pharmacology Universidad Autónoma de Madrid, Spain.MedicalResearch.com Interview with: Carlos F. Sánchez-Ferrer, M.D., Ph.D. Professor of Pharmacology Universidad Autónoma de Madrid, Spain. Medical Research: What are the main findings of the study? Dr. Sánchez-Ferrer: We were studying the possible ways of interaction between high glucose levels, which are found in diabetes mellitus, with vascular damage, which is the most common and devastating consequence of this disease. An intriguing fact is that a very strict control of blood sugar in diabetic patients is not sufficient to avoid the development of such diabetes-induced cardiovascular diseases. We think our results can explain why this is happening. Using cultured smooth muscle cells from the main human artery (aorta) in the presence of high concentrations of extracellular glucose, we observed: 1. In the absence of inflammation, excess glucose in the culture fluid didn’t enter the cells. 2. When extra glucose was forced into the cells, no harm was done in the absence of inflammation. 3. When the inflammation-stimulating protein interleukin-1 (IL-1) was introduced, more glucose entered the cells. 4. With IL-1, the glucose entering the cells was metabolized via chemical pathways that spur escalating inflammation, overwhelming the cells’ ability to counteract it. 5. In the presence of the anti-inflammatory drug anakinra, which blocks the activity of IL-1, the deleterious changes didn’t occur. (more…)
Author Interviews, Gastrointestinal Disease, General Medicine, Surgical Research / 13.09.2014

Dr. Dee Fenner, M.D. Professor of Obstetrics and Gynecology Director of Gynecology University of MichiganMedicalResearch.com Interview with: Dr. Dee Fenner, M.D. Professor of Obstetrics and Gynecology Director of Gynecology University of Michigan MedicalResearch.com Editor’s note: American Medical Systems Inc. (AMS), a subsidiary of Endo International plc (Nasdaq: ENDP) (TSX: ENL), released top-line results from its TRANSFORM study that show the investigational TOPAS™ System improves fecal incontinence in women. The results show that over a 12 month period, 69% of women suffering from fecal incontinence who were implanted with the TOPAS™ System experienced at least a 50% reduction in weekly incontinence episodes and experienced a durable, consistent effect across the study period. The results were presented in Cape Town, South Africa at the International Society of University Colon & Rectal Surgeon (ISUCRS) Congress. Dr. Fenner, a primary investigator of the study, kindly answered the questions below: Medical Research: How common/prevalent is the problem of fecal incontinence in women? Dr. Fenner: Fecal incontinence, also known as accidental bowel leakage (ABL), is estimated to affect nearly 11 million women and 10% of women over the age of 20 in the United States.1,2 Additionally, nearly one in five women over the age of 45 experience ABL at least once a year.3 (more…)
Author Interviews, Diabetes, Diabetes Care, Heart Disease / 12.09.2014

Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 CanadaMedicalResearch.com Interview with: Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 Canada Medical Research: What are the main findings of the study? Dr. Filion: Previous studies have raised concerns that the use of incretin-based drugs, a type of medication used to treat diabetes, may increase the risk of congestive heart failure.  We therefore examined this potential drug safety issue using a large, population-based database, which allowed us to study the safety of these medications in a real world setting.  In doing so, we found that the use of incretin-based drugs was not associated with an increased risk of congestive heart failure among patients with type 2 diabetes.  Similar results were obtained among both classes of incretin-based drugs (glucagon like peptide-1 [GLP-1] analogs and dipeptidyl peptidase-4 [DPP-4] inhibitors), and no duration-response relationship was observed. (more…)
Author Interviews, Diabetes, Diabetologia / 12.09.2014

MedicalResearch.com Interview with: Association Between Arterial Catheter Use and Hospital Mortality in Intensive Care UnitsDr. Sophia Zoungas: Faculty of Medicine, Nursing & Health Sciences Monash University, Clayton   Medical Research: What are the main findings of the study Dr. Zoungas: Our study shows that age (or age at diagnosis) and duration of diabetes disease are linked to the risk of death and marcovascular complications (those in larger blood vessels) whereas only diabetes duration is linked to the risk of microvascular complications (in smaller blood vessels such as those in the kidney and eyes) (more…)
Author Interviews, Diabetes, Obstructive Sleep Apnea / 12.09.2014

Paul M. Macey, Ph.D. Assistant Professor in Residence Associate Dean for Information Technology and Innovations, Chief Innovation Officer UCLA School of Nursing and Brain Research InstituteMedicalResearch.com Interview with: Paul M. Macey, Ph.D. Assistant Professor in Residence Associate Dean for Information Technology and Innovations, Chief Innovation Officer UCLA School of Nursing and Brain Research Institute Medical Research: What are the main findings of the study? Dr. Macey: People with sleep apnea are less able to control the blood flowing to their brain, in particular when they grip tightly, or have their foot put in cold water. We measured changes in blood flowing through the brain using an MRI scanner while people gripped hard, had their foot placed in cold water, and breathed out hard into a tube with a very small hole in it. These activities all lead to more blood flowing to the brain in healthy people, which probably helps protect the cells from being starved of blood and oxygen. However, people with sleep apnea send less blood that the healthy participants during the gripped and cold foot activities. A further important finding is that women with sleep apnea are worse off than men. The female patients showed much weaker blood flow than the males, even accounting for normal differences between men and women. (more…)
Author Interviews, Ebola, Infections / 12.09.2014

Dr. Gerardo Chowell-Puente Ph.D. Associate Professor School of Human Evolution and Social Change College of Liberal Arts and Sciences Arizona State UniversityMedicalResearch.com: Interview with: Dr. Gerardo Chowell-Puente Ph.D. Associate Professor School of Human Evolution and Social Change College of Liberal Arts and Sciences Arizona State University Medical Research: What are the main findings of the study? Dr. Chowell-Puente: 1.We estimated the effective reproduction number of Ebola virus disease, i.e. average number of secondary cases produced by a single primary case at calendar time t (Rt), for the ongoing epidemic in West Africa from March to August 2014. Estimates of Rt for the Guinea, Sierra Leone and Liberia, countries that are experiencing sustained community transmission were consistently above 1.0 since June 2014. 2.Country-specific estimates of the reproduction number for Liberia and Sierra Leone lied between 1.0 and 2.0, reflecting continuous growth of cases in these countries 3. Effective reproduction number below 2 indicate that control could be attained by preventing over half of the secondary transmissions per primary case (e.g. by means of effective case isolation and contact tracing). (more…)
Author Interviews, Autism / 12.09.2014

Anilkumar Pillai, Ph.D. Associate Professor Department of Psychiatry Medical College of Georgia Georgia Regents University (Formerly Georgia Health Sciences University)MedicalResearch.com: Interview with: Anilkumar Pillai, Ph.D. Associate Professor, Department of Psychiatry Medical College of Georgia, Georgia Regents University (Formerly Georgia Health Sciences University) Medical Research: What are the main findings of the study? Dr. Pillai: GABA receptors are responsible for binding GABA, the main inhibitory neurotransmitter in the human brain. Recent studies have indicated a potential role for alterations in GABAA receptors in the pathophysiology of Autism Spectrum Disorder (ASD). However, the mechanism of regulation of GABAA receptor in Autism Spectrum Disorder is not known. Our study shows that GABAA levels are altered at the protein level, but not at the mRNA level in the middle frontal gyrus of Autism Spectrum Disorder subjects. Our study also finds that Synoviolin 1 (SYVN1) plays a critical role as an E3 ligase in GABAAα1 degradation. SYVN1 has been previously determined to function as a removal system of inappropriately folded or unfolded proteins from the ER to the cytosol of the cell for degradation. Our study ultimately provides a mechanism for GABAAα1 deficits in Autism Spectrum Disorder subjects and possible new treatment strategies to reverse deficits seen in ASD and other related disorders. (more…)
Author Interviews, Cancer Research, NEJM / 12.09.2014

MedicalResearch.com Interview with: Dr. Charles Mullighan, M.D., MBBS(Hons), MSc Department of Pathology St. Jude Children's Research Hospital Memphis, TN 38105 MedicalResearch: What are the most important take home points from this study for practicing clinicians and their patients? Dr. Mullighan: Acute lymphoblastic leukemia (ALL) remains a leading cause of cancer death in children, and the prognosis worsens with increasing age. Current therapies are inadequate for many patients. This study has defined the genetic basis of a recently described subtype of Acute lymphoblastic leukemia called Ph-like ALL. We show that the prevalence increases with rising age, and that in both children and young adults the disease is driven by a diverse range of genetic changes that activate kinase signaling, which fuels the growth of leukemia cells. Ph-like Acute lymphoblastic leukemia currently has a poor outcome. The activated kinases may be inhibited by currently approved tyrosine kinase inhibitors (TKIs). We have shown efficacy of these inhibitors in cell lines and experimental models, and in a series of patients with Ph-like Acute lymphoblastic leukemia treated with TKIs. (more…)
Author Interviews, Cancer Research, Dartmouth, Melanoma, Nature / 12.09.2014

Dr. Constance Brinckerhoff Professor of Medicine Professor of Biochemistry Geisel School of Medicine at DartmouthMedicalResearch.com Interview with: Dr. Constance Brinckerhoff Professor of Medicine Professor of Biochemistry Geisel School of Medicine at Dartmouth Medical Research: What are the main findings of the study? Dr. Brinckerhoff: The genetic mutation BRAFV600E , frequently found in metastatic melanoma, not only secretes a protein that promotes the growth of melanoma tumor cells, but can also modify the network of normal cells around the tumor to support the disease’s progression. Targeting this mutation with Vemurafenib reduces this interaction, and suggests possible new treatment options for melanoma therapy. (more…)
Author Interviews, Cancer Research, Genetic Research, University of Pennsylvania / 12.09.2014

Renata Afi Rawlings-Goss, Ph.D. Postdoctoral Fellow Tishkoff Lab, University of PennsylvaniaMedicalResearch.com Interview with: Renata Afi Rawlings-Goss, Ph.D. Postdoctoral Fellow Tishkoff Lab, University of Pennsylvania   Medical Research: What are the main findings of the study? Dr. Rawlings-Goss: We found genetic mutations in key gene regulators that have been linked to ethnic disparities in cancer. Our investigation identified more than 30 previously undescribed mutations in important regulatory molecules called microRNAs. Individual microRNA molecules can regulate large numbers of genes in some cases over 6000 genes at once. Therefore, mutations in these genes have been linked to numerous diseases. By and large, however, microRNA mutations have not been studied in people of diverse ethnic backgrounds. (more…)
Author Interviews, CMAJ / 12.09.2014

Annemarieke de Jonghe Academic Medical Center University of Amsterdam Departement of Internal Medicine Section of Geriatric Medicine F4-218 Amsterdam, The NetherlandsMedicalResearch.com Interview with: Annemarieke de Jonghe Academic Medical Center University of Amsterdam Departement of Internal Medicine Section of Geriatric Medicine F4-218 Amsterdam, The Netherlands Medical Research: What are the main findings of the study? Dr. de Jonghe: We investigated the preventive properties of melatonin versus placebo in a prospective cohort of elderly hip fracture patients (n=378). We found that 3mg melatonin vs placebo, given for 5 days from the day of admission, did not influence the incidence of delirium. However, in a posthoc analysis we found that more patients in the placebo group more often had a longer lasting delirium. (more…)
Author Interviews, CHEST, Infections, Rheumatology / 12.09.2014

MedicalResearch.com Interview with: Theodore Marras, MD, FRCPC, M.Sc. Assistant Professor, University of Toronto Respirologist, Toronto Western Hospital University Health Network Toronto, ON, Canada Medical Research: What are the main findings of the study? Dr. Marras: Mycobacterial infections (TB and nontuberculous mycobacteria (NTM)) are more common in patients with rheumatoid arthritis (RA). Nontuberculous mycobacteria disease was far more common than TB disease in RA patients in Ontario, Canada. Nontuberculous mycobacteria disease was also associated with increased age, COPD, asthma, and GERD. The presence of nontuberculous mycobacteria disease was associated with increased mortality. (more…)
Author Interviews, JAMA, Ophthalmology, Telemedicine / 11.09.2014

Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GeorgiaMedicalResearch.com Interview with: Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine,  Atlanta, Georgia Medical Research: What are the main findings of the study? Dr. Lynch:
  • Since 2006, the VA has been systematically using teleretinal screening of patients with diabetes to screen for retinopathy in the Primary Care Clinics. Under this program, 90% of veterans with diabetes are evaluated on a regular basis. A number of patients who are screened have findings that warrant a face-to-face ophthalmic exam. No information exists on the effect of such a program on medical center resources.
  • 1,935 patients  underwent teleretinal screening through the Atlanta VA over a 6 month period.  We reviewed the charts of the 465 (24%) of the patients who were referred for a face to face exam in the Eye Clinic.
  • Data was collected for these patients to determine the reasons for referral, the accuracy of the teleretinal interpretation, the resources needed in the Eye Clinic of the Medical Center to evaluate and care for the referred patients over a two year period and possible barriers to patient care.
  • Of the 465 patients referred for an exam, 260 (55.9%) actually came in for an exam. Community notes were available for an additional 66 patients. Information was available for 326 (70.1%) of the referred patients.
  • The most common referring diagnoses were nonmacular diabetic retinopathy (43.2% of referrals), nerve related issues (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%) and diabetic macular edema (5.6%).
  • 16.9% of the referred patients had 2 or more concurrent problems that put them at high risk for visual loss.
  • The percentage agreement between teleretinal screening and the ophthalmic exam was high: 90.4%. Overall sensitivity was 73.6%. The detection of diabetic macular edema had the lowest sensitivity.
  • A visually significant condition was detected for the first time through teleretinal screening for 142 of the patients examined (43.6%).
  • The resource burden to care for referred patients was substantial.
  • 36% of patients required 3 or more visits over the ensuing 2 year period.
  • The treatment of diabetic macular edema had the highest resource use involving on average 5 clinic visits, 6 diagnostic procedures and 2 surgical procedures
  • The most common non-refractive diagnostic procedures were visual fields and optical coherence tomography.
  • The average cost to care for the referred patients (in Medicare dollars) in work RVUs alone was approximately $1,000 per patient. The cost to care for a patient with diabetic macular edema was $2673.36.
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Author Interviews, Mental Health Research / 11.09.2014

MedicalResearch.com Interview with: Patrick Corrigan Psy.D. Distinguished Professor of Psychology Illinois Institute of Technology PI: National Consortium on Stigma and Empowerment www.NCSE1.orgPatrick Corrigan Psy.D. Distinguished Professor of Psychology Illinois Institute of Technology PI: National Consortium on Stigma and Empowerment www.NCSE1.org Medical Research:  What are the main findings of this review? Dr. Corrigan: People with serious mental illness often do not seek out services, or drop out early, when in need. Stigma is a major reason for why this happens. Stigma refers to the stereotypes about a group that undermine status and lead to discrimination. Discrimination refers to the behaviors that block the opportunities of group members. Some employers do not hire people with mental illness, some landlords do not rent to them, and some primary care practitioners offer a substandard of care. Stereotypes and discrimination undermine engagement in mental health services in three ways (Corrigan, 2005): Label Avoidance: In order to escape the pernicious effects of stigma, people avoid settings where they are labeled mentally ill; for example, people coming out of a psychiatrist’s office may be perceived as “nuts.” Self-Stigma: Some people who internalize stereotypes suffer diminished self-esteem and self-efficacy leading to the “why try” effect. “Why should I try to get a job? Someone like me is not worthy.” “Why should I try to get mental health treatment? I am not able to benefit from it.” Structural Stigma: Stereotypes and discrimination become institutionalized in the laws and practices of government and business. For example, insurance coverage for mental health services was significantly below that for most other conditions.   (more…)
AHRQ, Author Interviews, BMJ, Outcomes & Safety / 11.09.2014

Yves A. Lussier, MD, Fellow ACMI Professor of Medicine Associate Vice President for Health Sciences (Chief Knowledge Officer) The University of ArizonaMedicalResearch.com Interview with: Yves A. Lussier, MD, Fellow ACMI Professor of Medicine Associate Vice President for Health Sciences (Chief Knowledge Officer) The University of Arizona Medical Research: What are the main findings of the study? Dr. Lussier:  The main finding is that reporting patient safety using ICD-10-CM coding schema rather than ICD-9-CM will change the reported percentage of adverse events reported for half the specific "patient safety indicators" (PSIs), even with a true unaltered frequency of reported events in the medical center. For some patient safety indicators, the reported frequency will appear to increase substantially and for others, it will appear to decrease.  The latter is particularly  worrisome as it may erroneously appease administrators and prospective clients (patients) as their apparent trend is improving, while their institution may inadvertently be under-reporting adverse events. (more…)
Author Interviews, Diabetes, Diabetes Care / 11.09.2014

Dr. Heather Stuckey D.Ed Department of Medicine Pennsylvania State University College of Medicine, Hershey, PAMedicalResearch.com: Interview with: Dr. Heather Stuckey D.Ed Department of Medicine Pennsylvania State University College of Medicine, Hershey, PA MedicalResearch: What are the main findings of this study? Dr. Stuckey: The main findings were that people with diabetes had both negative psychosocial and positive (adaptive) ways of coping with diabetes. Negative themes included:  1) Anxiety/fear, worry about hypoglycemia and complications of diabetes, depression and negative moods/hopelessness and 2) Discrimination at work and public misunderstanding about diabetes. Two psychosocial themes demonstrated adaptive ways of coping with diabetes: 1) Having a positive outlook and sense of resilience in the midst of having diabetes and 2) Receiving psychosocial support through caring and compassionate family, friends, healthcare professionals and other people with diabetes. Most diabetes social sciences research focuses on only the negative aspects of having diabetes.  Although this paper discussed negative aspects, it also focused on the adaptive, or positive, ways in which people with diabetes viewed their disease.  "We found that although these negative experiences with diabetes exist, people also held on to the positive aspects.  Some said diabetes made their lives a little richer because they ate healthier foods, or they were able to connect with their family more to overcome challenges. It gave them a better appreciation of what they have.  The discrimination at work and from society was a finding that was unexpected, but was evident throughout both the quantitative and qualitative data. (more…)
Author Interviews, Fish, General Medicine, Hearing Loss / 11.09.2014

Sharon G. Curhan, MD, ScM Channing Division of Network Medicine Department of Internal Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115MedicalResearch.com Interview with: Sharon G. Curhan, MD, ScM Channing Division of Network Medicine Department of Internal Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 Medical Research: What are the main findings of the study? Dr. Curhan: We followed more than 65,000 women who were participants in the Nurses’ Health Study II over 18 years and found that eating 2 or more servings of fish per week was associated with a lower risk of hearing loss. For example, after adjusting for potential confounders in multivariable analyses, in comparison with women who rarely or never ate fish, women who consumed 2 or more servings of fish per week had a 20% lower risk of hearing loss. Eating any type of fish (tuna, dark fish, light fish or shellfish) tended to be associated with lower risk. Also, we found that higher intake of long-chain omega-3 polyunsaturated fatty acids (PUFAs) was inversely associated with risk. For example, in comparison with women with the lowest intake, women with the highest intake of long-chain omega-3 PUFAs had a 22% lower risk of hearing loss. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, PLoS / 11.09.2014

MedicalResearch.com Interview with: Eero Haapala, MSc in Exercise Medicine, BASc PhD student University of Eastern Finland,School of Medicine Institute of Biomedicine, Physiology Kuopio, Finland Medical Research: What are the main findings of the study? Answer: Our study is one of the first studies to investigate the different types of physical activity and sedentary behavior with academic achievement in children. Our main finding was that children who were more physically active during school recess were better readers in Grades 1-3 than less active children. We also found a direct relationship between physically active school transportation, which was mainly walking and cycling, and reading skills in boys. These findings suggest that particularly physical activity within a school day benefits academic achievement and that physical activity benefit academic achievement more in boys than in girls 6-8 years of age. (more…)
Aging, Author Interviews, Frailty / 11.09.2014

Professor Mark L. Wahlqvist, M.D., Ph.D. Institute of Population Health Sciences, National Health Research Institutes, Taiwan National Defense Medical Center, School of Public Health, Taiwan Monash Asia Institute, Monash University Melbourne, AustraliaMedicalResearch.com Interview with: Professor Mark L. Wahlqvist, M.D., Ph.D. Institute of Population Health Sciences, National Health Research Institutes, Taiwan National Defense Medical Center, School of Public Health, Taiwan Monash Asia Institute, Monash University Melbourne, Australia Medical Research: What are the main findings of the study? Prof. Wahlqvist: Poor appetite and dietary quality as judged by diversity separately (each by about 50%) and together (by about 80%) increase the mortality risk in older persons living in the community. (more…)