Author: Marie Benz MD FAAD

15 Apr Sleeping Pills: Education Leads to Dose Reduction By Older Adults

Posted at 09:54h in Addiction, Frailty, Geriatrics, JAMA, Pharmacology

MedicalResearch.com Interview with: Cara Tannenbaum, MD, MSc The Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging,Professor of Medicine and Pharmacy University of Montreal Centre de Recherche Institut Universitaire de Gériatrie de Montréal Montreal, QC MedicalResearch.com: What are the main findings of the study? Dr. Tannenbaum: The EMPOWER study showed that providing older patients with information about the harms of sleeping pill use led to discontinuation or dose reduction in 1-in-every 4 patients with longstanding use of benzodiazepines. Receipt of evidence-based information about drug harms resulted in a 8-fold higher likelihood of benzodiazepine cessation. Many physicians think that patients become too dependent on sedative-hypnotics to successfully discontinue. Regardless of age, sex, and duration of use, 27% of patients aged 65-95 in this study successfully completed the recommended 20-week tapering protocol during a 6-month time period and another 11% were in the process of tapering. EMPOWERing patients with evidence-based information therefore results in appropriate risk reduction.

14 Apr Delirium: New Scoring System Relates Severity To Hospital Outcomes

Posted at 22:08h in Annals Internal Medicine, Author Interviews

MedicalResearch.com Interview with: Sharon K. Inouye, MD, MPH Professor of Medicine, Harvard Medical School Director, Aging Brain Center, Institute for Aging Research Hebrew SeniorLife both in Boston, MA Study Co- Authors Cyrus Kosar, Douglas Tommet, Eva Schmitt, Margaret Puelle, Jane Saczynski, Edward Marcantonio and Richard Jones. MedicalResearch.com: What are the main findings of the study? Dr. Inouye: In this study, we developed and validated a new scoring system for delirium severity. Delirium (acute confusional state) is a common and morbid complication of hospitalization for older persons, which often goes undetected. Our new scoring system indicates that the severity of delirium is directly related to hospital outcomes, such as length of stay, nursing home placement, death, and healthcare costs.

14 Apr After Stroke: Pharmacist Led Case Management Improved Blood Pressure Control

Posted at 21:03h in Author Interviews, Blood Pressure - Hypertension, CMAJ, McGill, Stroke

MedicalResearch.com Interview with: Finlay A McAlister MD University of Alberta, Edmonton, Canada MedicalResearch.com: What are the main findings of the study? Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets). The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician. The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians. However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor. Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .

14 Apr Stroke: Fragmentation of Care Leads To More CT Scans, Higher Costs

Posted at 10:14h in AHA Journals, Author Interviews, Cost of Health Care, CT Scanning, Dartmouth, NIH, Stroke

MedicalResearch.com Interview with: Kimon Bekelis, MD Department of Neurosurgery Dartmouth-Hitchcock Medical CenterDr. Bekelis MedicalResearch.com: What are the main findings of the study? Dr. Bekelis: We demonstrated extensive regional and racial variation in the utilization of head CT scans in the first year after ischemic stroke. Increased use paralleled spending in corresponding Hospital Referral Regions. Greater...

13 Apr For Whiplash Treatment: Education and Advice As Good As Prolonged PT

Posted at 11:17h in Accidents & Violence, Exercise - Fitness, Lancet

MedicalResearch.com Interview with: Zoe Michaleff PhD Student, Musculoskeletal Division The George Institute for Global Health Sydney NSW 2000 Australia MedicalResearch.com: What are the main findings of the study? Answer: Our study showed that a 30 minute advice session with two phone call follow ups was as effective for chronic whiplash as the comprehensive physiotherapy exercise program in which participants received twenty, one-hour individually-tailored and supervised exercise sessions over a 12-week period. While people's pain and activity improved in both treatment groups, the most important finding is that there were no differences between groups. This finding held true for all outcome measures except for two secondary outcome measures of self rated recovery (global perceived effect) and functional ability (patient specific functional scale) which were in favour of the comprehensive exercise program however the size of these effects were too small to be considered clinically meaningful.

12 Apr Decreased Cancer Mortality In Patients With Faster Cognitive Decline

Posted at 20:01h in Alzheimer's - Dementia, Author Interviews, Cancer Research, Cognitive Issues

MedicalResearch.com Interview with: Julian Benito-Leon University Hospital “12 de Octubre”, Madrid, Spain MedicalResearch.com: What are the main findings of the study? Dr. Benito-León: It has been suggested that a major problem with epidemiologic studies that have reported an inverse association between Alzheimer’s disease and cancer is the very likely underdiagnosis of cancer once dementia...

12 Apr Chronic Hepatitis C: Combination Pill Achieves High Cure Rates

Posted at 11:31h in Author Interviews, Hepatitis - Liver Disease, NEJM

MedicalResearch.com Interview with: Kris V. Kowdley, MD Director of Research & Director of the Liver Center of Excellence Digestive Disease Institute Virginia Mason Medical Center Seattle, WA 98111 MedicalResearch.com: What are the main findings of the study? Dr. Kowdley: A fixed-dose combination of ledipasvir and sofosbuvir in chronic Hepatitis C (HCV) genotype 1 patients without cirrhosis for 8 weeks without ribavirin was equally effective as the same combination with ribavirin added and also a 12 week combination of ledipasvir-sofosbuvir (without ribavirin).

12 Apr Tooth Loss Associated with Risk Factors for Coronary Heart Disease

Posted at 11:22h in Dental Research, Heart Disease

MedicalResearch.com Interview with: Dr Ola Vedin University of Uppsala, Sweden MedicalResearch.com: What are the main findings of the study? Dr. Vedin: That self-reported tooth loss as a marker of periodontal disease is common in patients with established coronary heart disease and is associated with higher levels of LDL cholesterol, glucose levels, systolic blood pressure and waist circumference as well as diabetes and smoking, i.e. risk factors for coronary heart disease. Gum bleeding, another marker of periodontal disease, was associated with higher levels of LDL cholesterol and systolic blood pressure. In summary, patients with few remaining teeth and gum bleeding demonstrated a heavier burden of cardiovascular risk factors.

12 Apr Early Alzheimer’s Detection Using Computerized Cognitive Screening

Posted at 11:05h in Alzheimer's - Dementia, Author Interviews, Cognitive Issues

MedicalResearch.com Interview with: Ioannis Tarnanas M.Sc Senior Researcher Gerontechnology and Rehabilitation Research Group, ARTORG Centre for Biomedical Engineering, University of Bern, 3010 Bern, Switzerland MedicalResearch.com: What are the main findings of the study? Answer: We examined 75 healthy older people and 134 patients with mild cognitive impairment. Our aim was to collect neuropsychological, neurophysiological, neuroimaging and behavioural data by means of a virtual reality serious game, in order to model the profile of the patients who will progress to dementia within the next 2-4 years. We found that the prediction based on the performance at the virtual reality based computerized assessment instrument is comparable to that of more established and widely accepted biomarkers, such as ERP and MRI. This can be explained by the cognitive fidelity and richness of behavioural data collected with virtual reality based measures, which directly reflect neurocognitive processes affected at a very early stage.

11 Apr Meningococcal Vaccine Menveo Response in Adolescents

Posted at 21:37h in Author Interviews, Infections, Kaiser Permanente, Pediatrics, Vaccine Studies

MedicalResearch.com Interview with: Roger Paul Baxter, MD Co-Director Kaiser Permanente Vaccine Study Center Oakland, CA 94612. MedicalResearch.com What are the main findings of the study? Dr. Baxter: Menveo, the currently licensed CRM-conjugate meningococcal vaccine, showed an excellent booster response in adolescents, regardless of which conjugate vaccine they had received previously. Also, although titers from the priming dose waned, at 3 years there were still protective antibodies in the majority of immunized individuals. The other US-licensed meningococcal conjugate vaccine, Menactra, uses a different protein conjugate.

11 Apr Quality Intervention Program To Reduce Unnecessary Radiology Follow-Up Imaging

Posted at 20:13h in Author Interviews, Cost of Health Care, Medical Imaging, NIH

MedicalResearch.com Interview with: Jamie Hui, MD Center for Health Services Research Virginia Mason Medical Center Seattle, Washington MedicalResearch.com: What are the main findings of the study? Dr. Hui: Through a quality improvement intervention aimed at how radiologists report on findings in female pelvic ultrasound examinations, we were able to decrease the number of unnecessary recommendations for follow-up imaging of benign adnexal cysts, preventing duress for these women.

11 Apr Rheumatoid Arthritis Patients Have Higher Risk of Kidney Disease

Posted at 13:50h in Author Interviews, Kidney Disease, Mayo Clinic, Rheumatology

MedicalResearch.com Interview with: Eric Matteson, M.D. Chairman of Rheumatology Mayo Clinic, Rochester, Minn MedicalResearch.com: What are the main findings of the study? Dr. Matteson: “The main points are that kidney disease is more common in patients with rheumatoid arthritis than in the general population and that moderate reduction in kidney function was more likely to be associated with cardiovascular disease in these patients as well. Patients with more active disease week are also at higher risk for kidney disease. “

11 Apr Mental Illness Raises Risk of HIV Infection

Posted at 11:29h in Author Interviews, HIV, Mental Health Research, University of Pennsylvania

MedicalResearch.com Interview with: Michael B. Blank, PhD Associate Professor of Psychology in Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3309 MedicalResearch.com: What are the main findings of the study? Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection.

11 Apr Heart Failure Treatment with Diuretic Spironolactone

Posted at 10:59h in Author Interviews, Heart Disease, NEJM

MedicalResearch.com Interview with: Marc A. Pfeffer, M.D., Ph.D. Dzau Professor of Medicine Harvard Medical School Cardiovascular Division Brigham and Women's Hospital MedicalResearch.com: What are the main findings of the study? Dr. Pfeffer: We randomized 3445 patients with symptomatic heart failure and a left ventricular ejection fraction greater than or equal to 45% (heart failure with preserved ejection fraction or diastolic heart failure) to spironolactone or placebo and followed them for over 3 years. Our primary outcome the composite of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for management of heart failure was not significantly reduced in the group randomized to spironolactone. We did, however, observe that fewer patients in the spironolactone group were hospitalized for the management of heart failure following randomization. Spironolactone therapy was associated with higher incidence of hyperkalemia and rises in serum creatinine.

11 Apr Breast Cancer: High Fat Diet Raises Risk of Hormone Sensitive Cancer

Posted at 10:25h in Author Interviews, Breast Cancer, JNCI, Nutrition

MedicalResearch.com Interview with: Sabina Sieri, PhD Epidemiology and Prevention Unit Department of Preventive & Predictive Medicine Fondazione IRCCS Istituto Nazionale dei Tumori 20133 Milan – Italy MedicalResearch.com: What are the main findings of this study? Dr. Sieri: In our study we found that there was an increased risk of developing breast cancer from high saturated fat intake. High total and saturated fat intake were associated with greater risk of ER PR positive breast cancer. High saturated fat intake was also associated with a greater risk of HER2 negative disease. So, a high-fat diet increases breast cancer risk and, most conspicuously, a high saturated fat intake increases the risk of developing hormone-sensitive diseases, suggesting saturated fat involvement in the etiology of hormone-sensitive breast cancer.

11 Apr New Marker to Predict Recurrence of Hepatocellular Carcinoma

Posted at 00:44h in Author Interviews, JAMA

MedicalResearch.com Interview with: Wei-ping Zhou, MD, PhD Department of Hepatic Surgery Eastern Hepatobiliary Surgery Hospital Shanghai, China MedicalResearch.com: What are the main findings of the study? Answer: The main finding is that Quantitative HBsAg can be used as a new prognostic factor of Hepatocellular Carcinoma recurrence after partial hepatectomy in patients with a low HBV-DNA level.

10 Apr Alzheimer’s Disease: Pathology Starts 10-20 Years Before Diagnosis

Posted at 15:41h in Alzheimer's - Dementia, Author Interviews, Genetic Research, NIH

MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk Head,Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Universitätsklinikum Erlangen, Department of Psychiatry and Psychotherapy, 91054 Erlangen, Germany MedicalResearch.com: What are the main findings of the study? Prof. Dr. med. Piotr Lewczuk: In our study, we investigated the concentrations of four isoforms of amyloid beta peptides in the blood of healthy young volunteers without memory complains. The participants were stratified into three groups according to their apolipoprotein E (APOE) genotype, which is the mostly investigated and generally accepted genetic risk factor for sporadic Alzheimer’s Disease (AD). It is known that the alterations of the amyloid beta metabolism are the earliest changes in the course of AD, occurring many years (or even decades) before the onset of the clinical symptoms, but it is actually not known how early these alterations start. Correspondingly, we wanted to investigate if healthy persons with genetic risk factor show changes in their amyloid beta metabolism already 30-40 years before the age when AD is usually diagnosed. We did not find any differences between the groups with and without APOE-driven risk, which might be carefully interpreted as no signs of Alzheimer’s Disease pathology in persons at risk at such an early life stage. Taken together, we think that the Alzheimer’s Disease pathology starts some 10-20 years before the beginning of the clinical symptoms, but not earlier.

10 Apr Breast Cancer: Frozen Section Analysis During Lumpectomy Decreases Need For Reoperation

Posted at 15:10h in Author Interviews, Breast Cancer, Mayo Clinic

MedicalResearch.com Interview with Dr. Judy C. Boughey MD Professor of Surgery Mayo Clinic, Rochester MN MedicalResearch.com: What are the main findings of the study? Dr. Boughey: This study showed that the rate of reoperation after lumpectomy for breast cancer was significantly lower at Mayo Clinic in Rochester compared to national data. Mayo Clinic in Rochester uses frozen section analysis of margins at time of lumpectomy to direct any margin re-excisions during the surgery and therefore has a significantly lower rate of need for a second operation to ensure clean margins. The rate of reoperation was four times higher in the national data set than in the Mayo Clinic data set.

10 Apr Diet-Induced Obesity: EPO Has Anti-Inflammatory Effect on White Adipose Tissue

Posted at 11:56h in Author Interviews, Weight Research

MedicalResearch.com Interview witih: Dr. Constance Tom Noguchi, Ph.D. Molecular Medicine Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892 and Dr. Mawadda Al-Naeeli Department of Biological Sciences, Ohio University MedicalResearch.com: What are the main findings of the study? Answer: The main findings of our study are: 1) EPO treatment has an anti-inflammatory effect on white adipose tissue macrophage population during diet-induced obesity in addition to its associated metabolic improvements on glucose tolerance and insulin sensitivity in vivo. 2) In this model of obesity, EPO treatment was found to reduce M1-like [pro-inflammatory] and increased M2-like [anti-inflammatory] macrophages in visceral white adipose tissue depot. 3) In addition, EPO decreased circulating inflammatory monocytes. 4) These anti-inflammatory effects of EPO were found to be driven, at least in part, by direct EPO-R response in macrophages via Stat3 activation, where EPO effects on M2 but not M1 macrophages required interleukin-4 receptor/Stat6 axis. 5) The anti-inflammatory effects of EPO are not restricted to treatment with exogenous high dose EPO (1000U/kg), but also include endogenous physiological EPO levels as demonstrated by the series of studies conducted using ΔEpoR mice with EPO-R restricted to erythroid cells.

10 Apr Autism: Brain Imaging Shows Mitochondrial Dysfunction In Some Patients

Posted at 11:37h in Author Interviews, Autism, JAMA

MedicalResearch.com Interview with: Bradley S. Peterson, MD Director of the Center for Developmental Neuropsychiatry Director of the Center for Developmental Neuropsychiatry, New York State Psychiatric Institute Suzanne Crosby Murphy Professor in Pediatric Neuropsychiatry, Columbia University, NY MedicalResearch.com: What are the main findings of the study? Dr. Peterson: We detected the presence of lactate in the brains of 13% of 75 participants who had ASD (Autism Spectrum Disorder), compared with 1% of the brains of 96 typically developing control participants. The presence of lactate was especially more common in adults who have ASD. Lactate is a product of anaerobic metabolism, which generally should not occur in healthy, living brains under normal circumstances. The presence of lactate in the brains of persons with Autism Spectrum Disorder therefore suggests the presence of deficient production of energy stores by a component of brain cells called “mitochondria”. We detected lactate most commonly in the cingulate gyrus, a region that supports the higher-order control of thought, emotion, and behavior, and that has been implicated previously in Autism Spectrum Disorder.

09 Apr Why Do Some Patients Fail To Get Their Prescriptions Filled?

Posted at 15:46h in Annals Internal Medicine, Author Interviews, Compliance, Cost of Health Care, McGill, Pharmacology

MedicalResearch.com Interview with: Robyn Tamblyn BScN Msc PhD James McGill Chair Departments of Medicine and Epidemiology and Biostatistics McGill University and Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research MedicalResearch.com: What are the main findings of the study? Dr. Tamblyn: Higher drug costs are associated with a higher probability of primary non-adherence, whereas better follow-up by the prescribing physician, and a policy to provide medication at no cost for the very poor increase the likelihood of adherence

09 Apr Aspirin Found Generally Not Effective in Reducing Pregnancy Loss

Posted at 15:31h in Author Interviews, Lancet, OBGYNE

MedicalResearch.com Interview with: Enrique F. Schisterman, Ph.D. Chief and Senior Investigator Epidemiology Branch, DIPHR Eunice Kennedy Shriver National Institute of Child Health and Human Development Rockville, MD 20854 MedicalResearch.com: What are the main findings of the study? Dr. Schisterman: Our results indicate that aspirin is not effective for reducing the chances of pregnancy loss in most cases. For the total number of women in the study, 13 percent of women who took aspirin and became pregnant subsequently experienced another loss, compared with 12 percent who took the placebo. Ultimately, 58 percent of women taking aspirin and 53 percent of the placebo group got pregnant and later gave birth. However, additional research is needed to investigate the finding that women who had experienced a single, recent pregnancy loss (before 4 1/2 months of pregnancy and within the past year) had an increased rate of pregnancy and live birth while on aspirin therapy. Among this group, 78 percent of those who took aspirin became pregnant, compared with 66 percent of those who took the placebo. For this subset of women, 62 percent of the aspirin group and 53 percent of the placebo group gave birth.

09 Apr Eating Disorders in Men Under Recognized

Posted at 12:31h in Author Interviews, BMJ, Eating Disorders, Weight Research

MedicalResearch.com Interview with Ulla Räisänen Senior Researcher HERG Health Experiences Research Group Department of Primary Care Health Sciences University of Oxford Oxford OX1 2ET MedicalResearch.com : What are the main findings of the study? Answer: We conducted a qualitative interview study exploring how young men (aged 16-25) recognise eating disorder symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care in the UK. Our data suggest that the widespread perception of eating disorders as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an eating disorder. Many presented late in their illness trajectory when eating disorder behaviours and symptoms were entrenched, and some felt that opportunities to recognise their illness had been missed because of others’ lack of awareness of eating disorders in men. In addition, the men discussed the lack of gender-appropriate information and resources for men with eating disorders as an additional impediment to making sense of their experiences, and some felt that health and other professionals had been slow to recognise their symptoms because they were men.

09 Apr NSAIDS Associated with Atrial Fibrillation

Posted at 12:25h in Author Interviews, BMJ, Erasmus, Heart Disease

MedicalResearch.com Interview with: Bruno Stricker, MB PhD Professor of Pharmaco-epidemiology Professor of Pharmacoepidemiology Erasmus MC MedicalResearch.com: What are the main findings of the study? Dr. Stricker: NSAIDs/painkillers may cause atrial fibrillation. MedicalResearch.com: What should patients and provider take away from this study? Dr. Stricker: Atrial fibrillation is the main risk factor of stroke. Patients with cardiovascular disease should...

09 Apr Aerobic Exercise May Increase Memory Performance

Posted at 10:52h in Author Interviews, BMJ, Cognitive Issues, Exercise - Fitness, Memory

MedicalResearch.com Interview with: Teresa Liu-Ambrose, PhD, PT Associate Professor, Canada Research Chair Department of Physical Therapy Aging, Mobility, and Cognitive Neuroscience Laboratory Vancouver Coastal Health Research Institute & University of British Columbia Vancouver, BC MedicalResearch.com: What are the main findings of the study? Dr. Liu-Ambrose: With respect to dementia risk, the hippocampus is a brain structure...

08 Apr Higher Social Class Linked To Lower Risk of Bone Fractures

Posted at 23:57h in Author Interviews, Gender Differences, Orthopedics, Race/Ethnic Diversity, UCLA

MedicalResearch.com Interview with: Dr. Carolyn Crandall, M.D. Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, 90024, USA MedicalResearch.com: What are the main findings of the study? Dr. Crandall: We found that higher social class was linked with a lower risk of fractures among non-Caucasian women. Compared with non-Caucasian women who had no more than a high school education, those with at least some postgraduate education had nearly 90% lower rates of non-traumatic fracture. These results were present even after we accounted for income.

08 Apr Restless Legs Syndrome Linked to Decreased Physical Function

Posted at 23:44h in Author Interviews, Neurology

MedicalResearch.com Interview with: Xiang Gao, MD, PhD Assistant Professor in Medicine Harvard Medical School Associate Epidemiologist Brigham and Women's Hospital MedicalResearch.com: What are the main findings of the study? Dr. Gao: In this study including 12,556 men in the Health Professionals Follow-up Study, we found that the participants with Restless Legs Syndrome at baseline had significantly lower physical function (PF) score 6 years later than those without RLS, after adjusting for potential confounders. The magnitude of difference in physical function score for RLS symptoms ≥15 times/month vs no Restless Legs Syndrome was more than that of a 5-year increase of age or moderate amount of smoking. We also found that having daily daytime sleepiness and sleep duration ≥9 hours/day were associated with lower mean physical function value than not having these symptoms .