Author: Marie Benz MD FAAD
26 Nov Paid Malpractice Claims Declined Over Past Decade
Posted at 19:22h
in General Medicine
MedicalResearch.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.
26 Nov Inflammatory Gut Microbes May Drive Metabolic Syndrome
MedicalResearch.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.
26 Nov CPAP May Improve Depression In Patients With Sleep Apnea
MedicalResearch.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.
26 Nov COPD: Nutritional Supplements Improved Outcomes and Reduced Costs
MedicalResearch.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.
26 Nov Proton Pump Inhibitors May Decrease Gut Diversity, Increase C. diff Risk
MedicalResearch.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.
26 Nov Full Day Preschool Increased School Readiness
MedicalResearch.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.
26 Nov Guidelines For Surgery After Cardiac Stents Have Improved Adverse Postoperative Outcomes
MedicalResearch.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.
26 Nov First Episode of Psychosis: Stopping Drug Use Improves Prognosis
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.26 Nov Obesity in Midlife Increases Risk of Dementia and Alzheimer’s Disease
MedicalResearch.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.
26 Nov Fitness An Important Predictor of Heart Failure
MedicalResearch.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.
26 Nov Drop in Cardiac Mortality Varies by Subtype and Ethnicity
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.26 Nov Study Addresses Nutritional Support Of Critically Ill Patients
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).25 Nov Reduced Sodium Intake May Improve Heart Failure Prognosis
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.25 Nov Some Diabetics Do Not Benefit From Exercise
MedicalResearch.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.
25 Nov Physicans and Nurses Traumatized By Medical Errors
MedicalResearch.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.
25 Nov Bleeding and Ischemic Events Following Bare Metal vs Drug Eluting Stents
Posted at 12:21h
in Heart Disease
MedicalResearch.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.
25 Nov Three Cases of Cancer Misdiagnosed as Chronic Lyme Disease
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.25 Nov For Weight Control, Focus on Healthy Foods, Not Calories
MedicalResearch.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.
25 Nov Stroke: Golden Hour Thrombolysis Improved Discharge To Home
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.25 Nov Telephone Reminders May Increase Breast Cancer Screening
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.24 Nov UK Drop in Antibiotic Prophylaxis Linked To Increased Number of Heart Infections
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:- There has been a large and significant decline in the use of antibiotic prophylaxis.
- 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.
24 Nov Skin Cancer Lesions Not Affected By Agent Orange Exposure
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.24 Nov More CT Scans Done For Minor Head Trauma Than Guidelines Recommend
MedicalResearch.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.
24 Nov HPV Vaccination Rates Leaves Room For Improvement
MedicalResearch.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.
24 Nov Patients With Type of Familial Sudden Death Need Long Term Follow Up
MedicalResearch.com with:
Giulio Conte MD
Heart Rhythm Management Centre
UZ-VUB Brussel, Belgium
Medical Research: What is the background for this study? What are the main findings?
Dr. Conte: The evolution of Brugada syndrome from pediatric to adult age has not been previously evaluated. It has been shown that the electrocardiographic phenotype of Brugada syndrome do not manifest during childhood in the large majority of cases. Drug challenge with ajmaline is recommended to unmask the diagnostic electrocardiogram in patients with family history of Brugada syndrome and normal electrocardiograms. However, the ideal age to perform such screening has not been established yet. With this study we aimed to investigate the clinical value of repeating ajmaline challenge after puberty in pediatric family members with an initial negative drug test. Repeat ajmaline challenge after puberty unmasked Brugada syndrome in 23% of family members with a previously negative drug test. Of the newly positive patients, 30% developed symptoms, 10% ventricular fibrillation and 10% spontaneous Brugada type 1 electrocardiogram.
24 Nov Long Term Influence of Oral Contraceptives on Mortality
MedicalResearch.com Interview with: Karin B. Michels, ScD, PhD Associate Professor of Obstetrics, Gynecology and Reproductive Biology Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Michels: We were interested in studying the long-term effects of oral contraceptive use on mortality. Given the widespread use of oral contraceptives, this is an important question pertaining to millions of women worldwide. We explored this question in the large Nurses’ Health Study, a cohort of 121,700 women in the US, who have been followed for 38 years. We found that oral contraceptive use does not impact overall mortality. However, breast cancer mortality was slightly increased, especially with long-term use of oral contraceptives.24 Nov Lower Calorie Diets May Slow Aging and Memory Loss
MedicalResearch.com Interview with:
Stephen D. Ginsberg, Ph.D., Associate Professor
Departments of Psychiatry and Physiology & Neuroscience
New York University Langone Medical Center
Center for Dementia Research
Nathan Kline Institute Orangeburg, NY 10962
Medical Research: What is the background for this study? What are the main findings?
Dr. Ginsberg: We tested the hypothesis that long-term calorie restriction positively alters gene expression within the hippocampus, a critical learning and memory area vulnerable in aging and Alzheimer’s disease. To test this hypothesis, we conducted experiments on female mice that were given food pellets 30% lower in calories than what was fed to the control group. The mice ate fewer calories derived from carbohydrates. Analyses were performed on mice in middle and old age to assess any differences in gene expression over time. Our data analysis revealed that the mice that were fed a lower calorie diet had fewer changes in approximately 900 genes that are linked to aging and memory.
24 Nov Hospital Readmissions May Not Be A Good Quality Indicator
MedicalResearch.com Interview with: Ralitza P. Parina, MPH, Senior medical student John Rose, MD MPH Department of Surgery at University of California San Diego Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the association between hospital 30-day readmission rates and 30-day mortality rates. While readmission rates are coming into increasing focus with CMS reimbursement cuts for hospitals with higher than expected rates, they remain a poorly studied metric of quality. High readmission rates have been unequivocally tied to increased costs, but it remains unclear whether they actually represent poor quality of care and worse outcomes for patients. We chose to compare readmission rates as a quality metric to the well-established “gold standard” of mortality. We found that 85% of hospitals did not show a correlation between readmission and mortality, i.e. their rates were not both high or both low. Furthermore, among hospitals that were outliers in at least one of the measures, almost a third were in the category of low or normal readmission rates with higher than expected mortality. The implications are twofold: first, readmission and mortality rates are not strongly correlated. Second, focusing on readmission rates as an outcome will miss a large number of poorly performing hospitals with higher than expected mortality rates but low or expected readmissions.23 Nov US Skin Cancer Costs Top $8 Billion Annually
Medical Research.com Interview with:
Gery P. Guy Jr., PhD, MPH, Health economist
CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch.
Medical Research: What is the background for this study?
Dr. Guy: Skin cancer is the most commonly diagnosed cancer in the United States and is a growing public health problem. Melanoma, the deadliest form of skin cancer, is responsible for more than 12,000 deaths each year and is diagnosed in over 70,000 people per year. The number of skin cancer cases continues to increase every year, however little is known about the economic burden of treatment. The purpose of our study was to examine trends in the number of people treated for skin cancer and the cost of treatment.