Author: Marie Benz MD FAAD
20 Nov Exercise Improves Outcomes in Dialysis Patients
MedicalResearch.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.
20 Nov DNA Test May Distinguish Primary From Metastatic Lung Cancer
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.
20 Nov Obesity, Sedentary Lifestyle May Increase Risk of Breast Cancer
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.19 Nov Cardiovascular Disease Risk Varies By Demographics and Geography
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 74.19 Nov Genetically Low Vitamin D Levels Linked To Increased Mortality
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.19 Nov Risk of Sudden Cardiac Death Elevated in Law Enforcement Officers
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.19 Nov Assay Rapidly Detects Bacteria in a Single Blood Droplet
MedicalResearch.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.
19 Nov Modified-Release Calcifediol Corrects Vitamin D Deficiency, Secondary Hyperparathyroidism in Chronic Kidney Disease
MedicalResearch.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.
19 Nov Eating Behaviors Predict Long Term Weight Loss After Bariatric Surgery
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.19 Nov Antibiotics May Increase Risk of Juvenile Arthritis
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.19 Nov ACA May Result In More Patients Using Emergency Rooms For Primary Care
MedicalResearch.com Interview with: Alexander Janke BS School of Medicine at Wayne State University Medical Research: What is the background for this study? What are the main findings? Response: Health insurance by itself does not guarantee quality healthcare; patients need accessible primary care options. Without them, patients newly-enrolled in health insurance may not be able...
19 Nov Use of Tobacco Products Remains High Among US Youth
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.19 Nov Cardiovascular Health in Youth Limits Functional Disability Later in Life
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.19 Nov Beta Blockers May Reduce Mortality In Heart Failure with Preserved Ejection Fraction
MedicalResearch.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.
19 Nov Cystic Fibrosis Survival Improved By Decades
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.
19 Nov Early Use of Caffeine In Premature Infants
MedicalResearch.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.
19 Nov Cannabis Extracts Enhance Anti-Tumor Radiation Effects
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.19 Nov Improved School Nutrition Standards May Lower Adolescent Obesity
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.18 Nov Elderly: Who Should and Shouldn’t Take Statins?
MedicalResearch.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."18 Nov Heart Failure Costs To Increase Due To Aging Population and Improved Medical Therapies
MedicalResearch.com Interview with:
Boback Ziaeian MD
Cardiology Fellow, UCLA Division of Cardiology
PhD Candidate, UCLA Fielding School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030. Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited.
Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand.
18 Nov More Fast Food Outlets, More Diabetes?
MedicalResearch.com Interview with:
Dr. Patrice Carter
Diabetes, Nutrition & Lifestyle Research Associate
Diabetes Research Centre (Broadleaf) University of Leicester
Leicester General Hospital Leicester UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Carter: Type 2 diabetes is a growing concern, worldwide prevalence is expected to increase to 552million by 2030. Prevalence is closely linked to increasing obesity rates which are associated to environmental changes that have led to more sedentary lifestyles and poor-quality dietary intake. Consumption of fast food has previously been linked to the obesity epidemic and consumption is associated with low adherence to dietary recommendations.
We analysed data of over 10,000 individuals to investigate the association between screen detected type 2 diabetes and the number of fast food outlets in their neighbourhood.
In summary we found the mean number of fast food outlets in areas with high social deprivation as compared to low social deprivation; mean number of outlets was 3.53 (SD 4.83) and 0.91 (1.89) respectively. The number of fast food outlets was positively associated with screen-detected type 2 diabetes (OR=1.05; 95% CI 1.04, 1.07; p<0.001). In addition, we used these data to calculate that for every additional two outlets we would expect to see one more diabetes case, assuming a 7% prevalence of undiagnosed type 2 diabetes in neighbourhoods with no outlets and approximately 200 residents in a 500m radius, and assuming a causal relationship.
18 Nov “Time-Outs” To Assess Antibiotics Reduce Both Antibiotics Use and Costs
MedicalResearch.com Interview with: Todd Lee MD MPH FRCPC Consultant in Internal Medicine and Infectious Diseases Assistant Professor of Medicine, McGill University Director, General Internal Medicine Consultation Service, Chief of Service, 6 Medical Clinical Teaching Unit, McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs. Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use. Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy. Sometimes this means that no antibiotics should be given. In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions. Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship". This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist. These audits were performed by our senior resident physicians in the context of providing their routine clinical care. We also provided local antibiotic guidelines and regular educational sessions once a rotation. We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority. We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested. Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients.18 Nov Atrial fibrillation: Individualized At-Home Care Reduced Hospital Stays and Prolonged Survival
MedicalResearch.com Interview with:
Prof Simon Stewart PhD
Mary MacKillop Institute for Health Research, Australian Catholic University,
Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
Medical Research: What is the background for this study? What are the main findings?
Prof. Stewart: Atrial fibrillation (AF) is the most common irregular heart beat and a major cause of deadly and disabling stroke and chronic heart failure. Atrial fibrillation has become a major public health issue that is putting increasing pressure on health care systems worldwide. In an attempt to reduce re-hospitalisations and death due to Atrial fibrillation, we designed the randomised controlled trial the Standard versus Atrial Fibrillation-spEcific managemenT strategY (SAFETY); a home-based, nurse-led, AF-specific management programme delivered to patients who have been hospitalised with Atrial fibrillation and involved individualised AF management. Half of participants (n=168) were given this intervention and the other half (n=167) underwent standard post-hospital management. All participants were followed-up over 24 months with specific clinic visits scheduled at 12 months and 24 months. We found that patients in the intervention group had proportionately more days alive and out of hospital compared to patients who received standard management (reflecting a combination of less hospital stay and prolonged survival). Further, when intervention patients did go to hospital, the length-of-stay of their admission was shorter than for patients under standard management.
17 Nov Atrial Fibrillation: Over/Under Anticoagulation Increases Risk of Dementia
MedicalResearch.com Interview with:
Dr. T. Jared Bunch, M.D
Medical Director for Heart Rhythm Services
Intermountain Healthcare network.
Medical Research: What is the background for this study? What are the main findings?
Dr. Bunch: Approximately 5 years ago we found that atrial fibrillation was associated with all forms of dementia, including Alzheimer's disease. At that time we did not know the mechanisms behind the association. One hypothesis that we had was brain injury in patients with atrial fibrillation is in a spectrum, large injuries result in strokes and repetitive small injuries result in dementia. In this regard, we anticipated that anticoagulation effectiveness and use may impact dementia risk. Early this year we published in HeartRhythm Journal that atrial fibrillation patients with no history of dementia that have used warfarin, but had high percent times outside of the therapeutic range were much more likely to develop dementia. We gained some insight from this trial in that we saw much higher risks of the patients were either over or under anticoagulated.
Amongst our atrial fibrillation patients using warfarin nearly one third are also taking aspirin, typically due to the presence of coronary artery disease or a prior myocardial infarction. We hypothesized since these patients were using two agents that increase risk of bleed that over anticoagulation with warfarin may be an even great risk for dementia. This is was we found. The patients over anticoagulated greater than 30 percent of the time were nearly 2 and a half times more likely to develop dementia compared to those that were over anticoagulated less that 10 percent to the time.
17 Nov Mechanical Chest Compressions Did Not Enhance CPR Outcomes
MedicalResearch.com Interview with:
Prof Gavin D. Perkins MD
Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research;
Warwick Medical School and Heart of England NHS Foundation Trust
Medical Research: What is the background for this study?
Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital cardiac arrests and less than one in twelve of those returns home alive. Early high quality Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to survival. However maintaining high quality chest compressions during resuscitation is difficult for crews of emergency vehicles, especially if they are on their own, because of fatigue and the need to perform other actions. Chest compression is particularly difficult in moving vehicles.
A number of mechanical devices, suitable for out of hospital use, have been developed over the years to improve the quality of chest compressions and therefore attempt to improve patient outcomes. Some NHS organisations decided to purchase devices to use although there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS would cost tens of millions of pounds plus costs for on-going training and maintenance. This prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the purchase of further mechanical chest compression devices until further research had been carried out.
The aim of this trial was to compare the effects of the mechanical chest compressions (LUCAS-2) device versus standard manual chest compressions (crew using their hands) on survival.
17 Nov Heart Attack Treated With PCI: Who Gets Acute Kidney Injury?
MedicalResearch.com Interview with: Dr. Yacov Shacham MD Department of Cardiology Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel. Medical Research: What is the background for this study? What are the main findings? Dr. Shacham: Acute kidney injury (AKI) is a common complication among ST elevation (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive STEMI patients who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission. We evaluated the relation between systolic and diastolic parameters and AKI. We demonstrated that the occurrence of AKI following primary PCI was associated with worse left ventricular systolic and diastolic function, however only left ventricular EF emerged as an independent predictor of AKI. For every 1% reduction in EF, the risk of AKI increased (OR 1.1, 95% CI 0.86-0.96; p=0.001)17 Nov Early PCI Valuable for Out-of-Hospital Cardiac Arrest
Posted at 14:29h
in Heart Disease
MedicalResearch.com Interview with:
Dr Guillaume Geri, MD
Medical Intensive Care Unit
Cochin Hospital Paris, France
Medical Research: What is the background of the study? What are the main findings?
Dr. Geri: Culprit coronary artery occlusion is the main cause of out-of-hospital cardiac arrest. This has been well demonstrated since pioneer study of Spaulding et al in the New England Journal of Medicine in 1997. Several studies highlighted the favorable prognostic impact of an immediate successful PCI in cardiac arrest patients but inclusion biases or the lack of data on in-hospital management limit the generalization of such findings.
In this large French cohort of out-of-hospital cardiac arrest patients who were admitted after successful return of spontaneous circulation from 2000 to 2012, those who received immediate PCI had better short- and long-term survival than those who did not undergo the procedure, new data presented here concluded.
The researchers examined the association between immediate PCI and survival at 30 days, 2 years and 10 years, and evaluated other potential predicting factors. Furthermore, they used a propensity score method to analyze the impact of PCI on 30-day and long-term survival in matched patients.
Overall, 1,722 patients (71.5% male; median age, 59.9 years) were analyzed during a median 2 year follow-up. OHCA (out-of-hospital cardiac arrest ) was witnessed in 86.7% of patients, and occurred in a public space in 32.2% of patients and with an initial shockable rhythm (eg, ventricular fibrillation/ventricular tachycardia) in 54.6% of cases.
17 Nov Drug Researched To Help Curb Binge Eating
MedicalResearch.com Interview with:
Pietro Cottone, Ph.D.
Associate Professor
Departments of Pharmacology and Psychiatry
Laboratory of Addictive Disorders
Boston University School of Medicine Boston, MA 02118
Medical Research: What is the background for this study? What are the main findings?
Dr. Cottone: Binge-eating disorder affects over ten million people in the USA and it is characterized by excessive consumption of junk food within brief periods of time, accompanied by loss of control, uncomfortable fullness and intense feelings of disgust and embarrassment. Increasing evidence suggests that binge-eating disorder can be regarded as an addiction behavior.
Memantine, a neuroprotective drug which blocks the glutamatergic system in the brain, is an Alzheimer's disease medication, and it has been shown potential to treat a variety of addictive disorders.
We first developed a rodent model of binge eating by providing a sugary, chocolate diet only for one hour a day, while the control group was given the standard laboratory diet. Rats exposed to the sugary diet rapidly develop binge eating behavior, observed as a 4 fold increase in food intake compared to controls. Furthermore, binge eating rats are willing to work to a much greater extent to obtain just the cue associated with the sugary food (not the actual food), as compared to controls. In addition, binge eating subjects exhibit compulsive behavior by putting themselves in a potentially risky situation in order to get to the sugary food, while the control group obviously avoids that risk.
We then tested whether administering memantine could reduce binge eating of the sugary diet, the strength of cues associated with junk food as well as the compulsiveness associated with binge eating. In addition, we studied which area of the brain was mediating the effects of memantine, by injecting the drug directly into the brain of binge eating rats.
Our data show that memantine was able to block binge eating of the sugary diet, the willingness to work to obtain a cue associated with junk food, as well as the risky behavior of rats when the sugary diet was provided in a potentially unsafe environment. When we injected the drug directly into the nucleus accumbens of rats, they stopped binge eating. Importantly, the drug had no effects in control rats eating a standard laboratory diet.
17 Nov Secondhand Marijuana Smoke May Be As Bad For You As Tobacco
MedicalResearch.com Interview with: [caption id="attachment_68847" align="alignleft" width="150"] Dr. Springer[/caption]
Matthew L. Springer, Ph.D.
Associate Professor of Medicine
Division of Cardiology
Cardiovascular Research Institute
Broad Center of Regeneration Medicine and Stem Cell Research
Center for Tobacco Control Research & Education
Helen Diller Family Comprehensive Cancer Center
University of California, San Francisco
Medical Research: What is the background for this study? What are the main findings?
Dr. Springer: The general public is aware that cigarette secondhand smoke is harmful. However, many people who actively avoid tobacco secondhand smoke don't feel the need to avoid marijuana secondhand smoke; they don't consider it harmful because there's no nicotine and because we who tell them to avoid tobacco smoke don't tell them to avoid marijuana smoke. However, secondhand smoke from tobacco and marijuana is very similar in chemical composition (4000-7000 chemicals depending on whom you ask), aside from the nicotine and the THC (the psychoactive drug in marijuana).
We and others have shown that brief exposure to tobacco secondhand smoke, such as 30 minutes, at real-world levels impairs vascular function in humans. We developed a way to study vascular function (measured as arterial flow-mediated dilation; FMD) in living rats, and recently published that even one minute of sidestream smoke from the burning tips of tobacco cigarettes, a well-accepted model for secondhand smoke, is enough to start detecting impairment of FMD. The main findings of the current study are that in laboratory rats, FMD was substantially impaired by a 30 minute exposure to marijuana secondhand smoke, when measured 10 minutes after the end of exposure. Impairment was comparable to that resulting from exposure to tobacco sidestream smoke, although whereas impairment from tobacco smoke was temporary and had normalized by 40 minutes later, FMD was still impaired 40 minutes after the end of exposure to marijuana smoke. Smoke from marijuana lacking THC still impaired FMD, showing that