Allergies, Author Interviews, Pediatrics / 06.11.2018

MedicalResearch.com Interview with: David Stukus, MD Associate Professor of Pediatrics Associate Director, Pediatric Allergy & Immunology Fellowship Program Director of Quality Improvement, Division of Allergy and Immunology Nationwide Children's Hospital and The Ohio State University College of Medicine Columbus Ohio 43205 Dr. David Stukus discusses the emerging science behind food allergy prevention. MedicalResearch.com: How many US children are affected by food allergies?  Response: Food allergies affect roughly 5-8% of all U.S. children, which is approximately 6 million children. This translates to about 1 in every 13 children, or an average of two children in every classroom.  MedicalResearch.com: Are food allergies becoming more common? Response: Yes, we know that the prevalence of food allergies have doubled over the past two decades. Unfortunately, there is no single or definitive answer as to why this increase has occurred. (more…)
Author Interviews, Cannabis, Diabetes, JAMA / 06.11.2018

MedicalResearch.com Interview with: Viral Shah, MD Assistant Professor of Medicine & Pediatrics Barbara Davis Center for Diabetes, Adult Clinic School of Medicine University of Colorado Anschutz Medical Campus MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cannabis use is increasing in Colorado and many patients with type 1 diabetes (which is an autoimmune form of diabetes that requires life insulin therapy) are using cannabis. Therefore, we surveyed adult patients with type 1 diabetes to study the association between cannabis use and glycemic control and diabetes acute complications (such as diabetic ketoacidosis) in adults with type 1 diabetes. Main findings of the study:  The risk for diabetic ketoacidosis (a serious condition where body produces high levels of acids called ketones in patients with diabetes)  was two times higher among adults with type 1 diabetes who reported using cannabis in the past 12 months compared to adults with type 1 diabetes who reported not using cannabis. (more…)
Author Interviews, Electronic Records, JAMA, Outcomes & Safety / 06.11.2018

MedicalResearch.com Interview with: "Portable Information station, nurse, computer, hand wipes, 9th floor, Virginia Mason Hospital, Seattle, Washington, USA" by Wonderlane is licensed under CC BY 2.0Timothy Ryan PhD This work was performed while Dr. Ryan was at Precera Biosciences, 393 Nichol Mill Lane Frankluin, Tennessee  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The study design is quite simple.  We measured medication concentrations in patients, then compared empirically detected medications with prescribed medications in each patient’s medical record.  We used this information to estimate how many prescribed medications patients had actually taken and how often they took medications that were not in their medical record.  The later comparison is a particularly novel measure of the number and types of medications taken by patients unbeknownst to healthcare providers who use the medical record as a guide to patient care. Further, the test was performed in blood and not urine, so we could obtain an estimate of how often patients were in range for medications that they did take – at least for medications where the therapeutic range for blood concentrations are well established. In sum, we found that patients do not take all of their medications, the medical records are not an accurate indicator of the medications that patients ingest, and that even when taken as prescribed, medications are often out of therapeutic range.  The majority of out-of-range medications were present at subtherapeutic levels.  (more…)
Author Interviews, Cannabis, Cognitive Issues, OBGYNE / 05.11.2018

MedicalResearch.com Interview with: Ryan J. McLaughlin, PhD Assistant Professor Department of Integrative Physiology & Neuroscience College of Veterinary Medicine Washington State University Pullman, WA 99164-7620 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The use of cannabis during pregnancy is a growing health concern, yet the long-term cognitive ramifications for developing offspring remain largely unknown. Human studies exploring the long-term effects of maternal cannabis use have been sparse for several reasons, including the length and cost of such studies, as well as the fact that experimentally assigning mothers to smoke cannabis during pregnancy is obviously ethically impractical. Animal models of maternal cannabis use have been advantageous in this respect, but they have been limited by the drugs used (synthetic cannabinoids vs. THC vs. cannabis plant) and the way that they are administered. In our study, we used a more translationally relevant animal model of maternal cannabis use that exposes pregnant rat dams to whole plant cannabis extracts using the intra-pulmonary route of administration that is most common to human users. Our preliminary data indicate that twice-daily exposure to a high-dose cannabis extract during pregnancy may produce deficits in cognitive flexibility in adult rat offspring. Importantly, these rats did not experience general learning deficits, as they performed comparably to non-exposed offspring when required to follow a cue in their environment that dictate reinforcer delivery. Instead, deficits were observed only when rats were required to disregard this previous cue-based strategy and adopt a new egocentric spatial strategy in order to continue receiving the sugar reinforcers. (more…)
AstraZeneca, Author Interviews, Kidney Disease / 05.11.2018

MedicalResearch.com Interview with: Danilo Verge MD MBA Vice President, CVRM Global Medical Affairs AstraZeneca MedicalResearch.com: What is the background for this study? Response: Dapagliflozin, an SGLT2 inhibitor (sodium-glucose co-transporter 2), has been shown to improve glycemic control by decreasing glucose reabsorption in the kidneys and inducing urinary glucose clearance. SGLT2 inhibitors have also been shown to be effective in lowering albuminuria and stabilizing eGFR (estimated glomerular filtration rate). The effect of dapagliflozin on UACR (urine albumin-to-creatinine ratio) has been shown to vary among patients. The objective of this post-hoc analysis, based on the pooled data from 11 randomized, placebo-controlled clinical trials, was to assess baseline characteristics and concurrent changes in cardiovascular (CV) risk markers associated with UACR response to dapagliflozin. (more…)
AstraZeneca, Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 05.11.2018

MedicalResearch.com Interview with: Lei Qin MS Director, Health Economics and Payer Analytics AstraZeneca MedicalResearch.com: What is the background for this study? Response: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapies for patients with chronic kidney disease (CKD), but are commonly prescribed at suboptimal doses, which has been associated with worsening clinical outcomes. The objective of our study was to estimate the real-world associations between RAASi dose and adverse clinical outcomes in patients prescribed RAASi therapies with new-onset CKD in the UK. (more…)
AstraZeneca, Author Interviews, Kidney Disease, Mineral Metabolism / 05.11.2018

MedicalResearch.com Interview with: Rahul Agrawal MD PhD VP, Global Medicines Leader AstraZeneca MedicalResearch.com: What is the background for this study?   About the study: HARMONIZE Global is a Phase III, randomized, multicenter, double-blind, placebo-controlled trial involving 267 patients with hyperkalemia (mean potassium levels greater than 5.0 mEq/L) in 47 study locations across the Asia Pacific region, which will support registration in Japan, Taiwan, Korea and Russia. Study design: The trial design of HARMONIZE Global is similar to HARMONIZE (NCT02088073) but evaluated two doses of LOKELMATM (sodium zirconium cyclosilicate) instead of three, as well as patients in different geographical regions. (more…)
Aging, Author Interviews, Frailty, Geriatrics, Nutrition, Protein / 05.11.2018

MedicalResearch.com Interview with: ""Trash Fish" Sustanable Seafood Dinner" by Edsel Little is licensed under CC BY-SA 2.0Nuno Mendonça RD, PhD Campus for Ageing and Vitality Newcastle‐upon –Tyne United Kingdom  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Very old adults, those aged 85 and older, are the fastest growing age group in most western societies and are more likely to develop disability. Dietary protein is a sensible candidate because it may slow decreases in muscle mass and functional decline with aging. Although we know that protein intake is, on average, lower in older adults (a mean of 66 grams per day) compared to younger adults (a mean of 91 grams per day), research exploring protein intake and disability progression in very old adults is limited. We found that our participants from North-East England had four different disability trajectories between the ages of 85 and 90: a) a constant very low disability trajectory (difficulty with none or 1 activity of daily living (ADL))  over the 5 years; b) a low disability trajectory (difficulty with 2 ADLs) that steadily progressed to mild disability (5 ADLs); c) a mild disability score (4 ADLs) at 85 that increased to moderate disability (10 ADLs) by age 90; and d) a moderate disability score (9 ADLs) at baseline that progressed to severe disability (14 ADLs) after 5 years. We found that those with higher protein intake, especially those at or above 1 g per kg of body weight per day (70g of protein per day for a 70 kg person), were less likely to belong to a worse disability trajectory. (more…)
Author Interviews, Brain Injury, Gender Differences, JAMA, Pediatrics / 05.11.2018

MedicalResearch.com Interview with: Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada MedicalResearch.com: What is the background for this study? Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care. The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery. Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. (more…)
Author Interviews, CMAJ, Geriatrics, Global Health / 05.11.2018

MedicalResearch.com Interview with: "Drapeau au Parlement du Canada" by abdallahh is licensed under CC BY 2.0Dr. Justin Lang, PhD Research Analyst, Public Health Agency of Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is based on the Global Burden of Disease Study, which is led by the Institute of Health Metrics at the University of Washington. In this study, we present estimates from the Global Burden of Disease Study to describe the major causes of health loss among Canadians, and how these have changed from 1990 to 2016. In 2016, cancers, cardiovascular diseases, musculoskeletal disorders, and mental and substance use disorders, combined, resulted in over half of the total health loss among Canadians as measured by disability adjusted life years. Disability-adjusted life years is a measure that combines both mortality, through years of life lost, and morbidity, through years lived with disability, into a single measure that allows us to compare health loss from different causes using the same metric. The all-cause age-standardized years of life lost rate declined 12% between 2006 and 2016, while the all-cause age-standardized years lived with disability rate remained stable (+1%) and the all-cause age-standardized disability-adjusted life year rate declined by 5%. Finally, between 1990 and 2016, there has been a shift in what contributes to health loss in Canada from premature mortality to disability. In 1990, 45% of total all-cause disability-adjusted life years were due to years lived with disability. By 2016, this proportion grew to 52%.  (more…)
Author Interviews, Dental Research, Heart Disease, Infections / 05.11.2018

MedicalResearch.com Interview with: Martin H. Thornhill MBBS, BDS, PhD, MSc, FDSRCS(Edin), FDSRCSI, FDSRCS(Eng) Professor of Translational Research in Dentistry Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry  MedicalResearch.com: What is the background for this study?   Response: Infective endocarditis is an infection of the heart valves that has a high death rate (around 30% in the first year). It requires intensive treatment often involving replacement of affected heart valves and frequently results in serious long-term illness and disability in those who survive as well as an increased risk of re-infection and high healthcare costs. In ~40% of cases, bacteria from the mouth are implicated as the causal organism. Because of this, guideline committees around the world recommended that all those at risk of infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures. Due to a lack of evidence for efficacy, however, guideline committees started to limit the use of antibiotic prophylaxis. And in 2007, the American Heart Association (AHA) guideline committee recommended that antibiotic prophylaxis should continue for those at high-risk but should cease for those at moderate risk of endocarditis. Most guideline countries around the world followed suite. Except in the UK, where the National Institute for Health and Care Excellence (NICE) recommended that the use of antibiotic prophylaxis should completely stop in 2008. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 05.11.2018

MedicalResearch.com Interview with: Robin M. Shaw, MD, PhD Wasserman Foundation Chair in Cardiology in honor of S. Rexford Kennamer MD Division of Cardiology, Smidt Heart Institute Department of Medicine, Cedars-Sinai Medical Center, Division of Cardiology, Department of Medicine University of California, Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: At present, doctors do not have a clinical tool that assesses the biochemical health of heart muscle.  Biomarkers are available that tests the amount of fluid in the heart, and whether a heart is overloaded (which can be resolved with diuretics).  However, we don’t have biomarkers that assess the state of heart muscle itself.  As a result, doctors can use biomarkers to determine whether, when a patient has trouble breathing, there is heart failure present. However, biomarkers do not work when the patient does not have symptoms or when we already know the patient has heart failure and are trying to make clinical management decisions about the condition. Current biomarkers also don’t work to assess the health of the heart before symptoms develop which is to detect cellular changes in muscle before overall heart function is impaired. The new biomarker, CS, address the above unmet needs.  CS is based on cBIN1 which is a heart muscle protein that is essential for the heart to both contract and relax.  cBIN1 decrease when hearts are stressed such as in heart failure.  cBIN1 is also released into the blood stream, so it can be detected from a simple blood draw.  CS is determined from the inverse of cBIN1, so low cBIN1 in blood will give a high CS signal.  A low cBIN1, or a high CS, indicates failing heart muscle, and an increased likelihood for being admitted to the hospital with acute heart failure within the next twelve months.  (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Electronic Records, JAMA / 03.11.2018

MedicalResearch.com Interview with: Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost. We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records. Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning.    (more…)
Author Interviews, Gastrointestinal Disease / 03.11.2018

MedicalResearch.com Interview with: RedHill BiopharmaDror Ben-Asher Co-Founder, Chairman & CEO RedHill Biopharma Ltd. MedicalResearch.com: Your presentation at United European Gastroenterology Week (UEGW) covered top-line data from your recently completed Phase 3 study of RHB-104 in Crohn’s disease. Can you please briefly remind us of the background for this study and what results you previously announced? Response: Crohn's disease is a devastating gastrointestinal disorder that affects millions of people worldwide. Crohn's is a chronic relapsing disorder that plagues people throughout their lives with a variety of symptoms including severe abdominal pain, diarrhea, bleeding, bowel obstruction, fever and weight loss. The existing treatments for Crohn's disease leave a lot to be desired – they are only partially effective in the long-term control of Crohn's and are associated with serious side effects. In addition, the existing therapies only target treating the symptomatic inflammation associated with Crohn's. We began developing RHB-104 with the MAP hypothesis in mind, a theory that suggests Crohn's is caused by infection by a bacteria, Mycobacterium avium subspecies paratuberculosis (MAP), in susceptible patients. RHB-104 is a patent-protected orally-administered combination of three antibiotics (clarithromycin, clofazimine and rifabutin) in a single oral capsule that has demonstrated its potential to benefit Crohn's patients. When we announced top-line results from the MAP US study, our Phase 3 trial of RHB-104 in patients with moderate to severe Crohn's disease, we showed that RHB-104 demonstrated a significant clinical benefit to patients versus placebo control. Patients treated with RHB-104 showed significant increase in remission at 26-weeks post treatment initiation in addition to being generally safe and well tolerated. (more…)
Addiction, Author Interviews, Neurology / 02.11.2018

MedicalResearch.com Interview with: "Be careful what you wish for #drugs #heroin #addiction #camp #church" by Matthew Kang is licensed under CC BY-ND 2.0Michaël Loureiro, PhD Research Assistant - Group Lüscher Dpt. of Fundamental Neuroscience University of Geneva - Faculty of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Addiction refers to the repeated and irrepressible urge to consume a drug even in the light of negative consequences. All addictive drugs are initially rewarding and have powerful reinforcing properties, which drive users to use the drug again and again. Within the scientific community, it has been repeatedly argued that for opioids, this initial reinforcing effect does not involve dopamine, and no consensus was emerging. In our study we used some of the most advanced genetic tools to observe that in less than a minute heroin strongly increased the activity of neurons in the midbrain causing a release of dopamine in the striatum, a brain region essential for reward seeking. We further used neuroanatomical tracing methods and found that dopamine neurons activated by heroin were projecting to the very medial region of the ventral striatum. Finally, when we silenced dopamine neurons, heroin lost its reinforcing power, confirming the validity of the dopamine activation hypothesis for opioids. (more…)
Author Interviews, Gastrointestinal Disease, Parkinson's / 01.11.2018

MedicalResearch.com Interview with: Viviane Labrie, Ph.D. Assistant Professor Center for Neurodegenerative Science Van Andel Research Institute Grand Rapids, Michigan MedicalResearch.com: What is the background for this study? Response: Our lab has an interest in the early events and initiation of neurodegenerative diseases. Parkinson’s disease for a long time was thought to be a movement disorder driven by the destruction of dopamine neurons in a specific area of the brain, the substantia nigra. In the last 10 years it has become evident that Parkinson’s disease is not just a movement disorder but hosts a whole range of non-motor systems. One of the most common non-motor symptoms in Parkinson’s patients is issues with the gastrointestinal (GI) tract. GI symptoms often occur early in Parkinson’s disease; for many patients, GI symptoms precede the onset of motor symptoms by as many as 2 decades. Moreover, the GI is not only involved in the early signs of Parkinson’s but has been proposed to be a place in the body where Parkinson’s disease begins. The hallmark pathology of Parkinson’s disease in the brain is Lewy bodies, which contains a clumped form of a protein called alpha-synuclein. There is evidence that Parkinson’s disease pathology, this clumped alpha-synuclein protein, is detectable in the GI tract, even many years before the onset of Parkinson’s motor symptoms. Clumped alpha-synuclein is also capable of traveling across nerve cells. There is evidence that clumped alpha-synuclein can travel up the nerve that connects the GI tract to the brain and enter the brain. This could be disastrous because clumped alpha-synuclein can seed and spread in the brain, which has neurotoxic effects and can eventually lead to Parkinson’s disease. In fact, in the brain of Parkinson’s patients, one of the first places where alpha-synuclein clumps are detected is at the terminal where the gut nerve connects to the brain, and this pathology advances from this point to other brain areas as the disease progresses. This intriguing connection of the GI tract to the early processes of Parkinson’s disease had us interested in trying to understand how the gut could be involved in triggering Parkinson’s. But the GI tract is a very big place, and we first asked ourselves, where should we look to better understand GI involvement in Parkinson’s disease? (more…)
Author Interviews, CDC, Hospital Acquired / 01.11.2018

MedicalResearch.com Interview with: "Hospital Room" by Kyle Taylor is licensed under CC BY 2.0Dr. Shelley Magill, MD Medical Officer and CDC lead for the hospital HAI (hospital acquired infections) and antimicrobial use prevalence survey MedicalResearch.com: What is the background for this study? Response: The prevalence survey effort began in 2009. The goal was to obtain a snapshot of all healthcare-associated infections affecting hospital patients, not limited to those commonly reported to the National Healthcare Safety Network. We conducted our first full-scale hospital prevalence survey in 2011, in collaboration with the Emerging Infections Program, a network of 10 state health departments and academic and other partners. Data from that survey showed that about four percent of patients had a healthcare-associated infection—or, on any given day, about 1 in 25 patients. We repeated the survey in a similar group of hospitals in 2015 to see whether changes had occurred. (more…)
Author Interviews, BMJ, Pediatrics, Weight Research / 01.11.2018

MedicalResearch.com Interview with: "babies (365-222)" by Robert Couse-Baker is licensed under CC BY 2.0Dr. Christopher M Stark Department of Pediatrics William Beaumont Army Medical Center El Paso, Texas Department of Pediatrics Walter Reed National Military Medical Center Bethesda, Maryland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Rates of pediatric obesity have increased over the past decade, which has led researchers to search for modifiable risk factors that may explain this increase. Recent studies have identified an association between native gut bacteria alterations and the development of obesity. Several population-based studies have evaluated whether or not there is an association between antibiotic exposure and the development of obesity, with mixed results. No studies have previously evaluated if acid suppressing medications are associated with developing obesity. We found that young children prescribed antibiotics, acid suppressants, and combinations of these medications in the first two years of life are more likely to develop obesity after two years of age. Our study represents the largest study to evaluate pediatric antibiotic prescriptions and obesity risk, with nearly ten times as many patients as the next largest study. (more…)
Author Interviews, Autism, JAMA, OBGYNE / 01.11.2018

MedicalResearch.com Interview with: Magdalena Janecka PhD Department of Psychiatry Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Our paper explored the association between maternal use of medication during pregnancy and the rates of autism in a large cohort from Israel. This followed on from a number of earlier studies reporting that the use of certain medications - for example antidepressants - during pregnancy is associated with higher rates of autism in children. However, rather than test the effects of any particular drug, or a set of drugs aggregated based on maternal condition, our large dataset allowed us to group all medications prescribed to pregnant women based on their drug target, and in the subsequent analyses focus on over 50 groups that included drugs with neurotransmitter-relevant targets - for example agonists and antagonists of their receptors. (more…)
Author Interviews, Occupational Health, Rheumatology / 01.11.2018

MedicalResearch.com Interview with: Dr. W. Benjamin Nowell, Ph.D. Director of Patient-Centered Research CreakyJoints, study co-author Co-principal investigator of ArthritisPower MedicalResearch.com: What is the background for this study? What are the main findings? Response: Rheumatoid Arthritis (RA) can diminish patients’ work productivity and increase the risk of long-term disability, economic insecurity and worsening health, but limited research informs these issues. The purpose of our study was to examine associations between patients’ RA disease activity and their productivity and workplace support, using real-world data from the ArthritisPower research registry. Our study looked at a sample of participants with RA who had a history of or current treatment with non-biologic and/or biologic disease-modifying antirheumatic drugs (DMARD) (n=296). Among the study sample, 74 percent had high disease activity (HDA) as determined by RAPID3 (>12), a common measure of disease activity in RA.
  • High disease activity was associated with lower education (p<0.001) and higher likelihood of disability (9%, p<0.001) compared to those without high disease activity.
    • Patients with HDA missed more days of work than non-HDA patients (mean: 6.1 vs 3.8 days, respectively; p=0.03), but non-HDA participants reported more days off due to medical appointments (2.6 vs 1.2 days, respectively) while HDA patients missed more days due to RA treatment side effects (mean: 0.5 vs 0.1 days, respectively).
  • Based on scores from the Work Productivity and Activity Impairment (WPAI) questionnaire, RA seems to affect work productivity to a greater extent in participants with HDA than without (WPAI scores 5.3 and 3.3, respectively; p<0.001). Participants who were not currently employed reported having more physically demanding tasks (e.g. heavy load lifting) and less workplace flexibility (e.g. working from home) in their most recent paid position than currently employed participants.
  • However, in a multivariate regression analysis, we found that participants who could request changes in work start and stop times on a daily basis were 2.9 (95% CI: 1.53, 5.46) times more likely to be unemployed (adjusting for age, disease activity, and satisfaction with social participation) than those unable to make this request (p<0.0001).
About ArthritisPower: Created by CreakyJoints and supported by a multiyear, multimillion dollar investment by the Patient-Centered Outcomes Research Institute (PCORI), ArthritisPower is the first-ever patient-centered research registry for joint, bone, and inflammatory skin conditions. The free ArthritisPower mobile and desktop application allows patients to track and share their symptoms and treatments while also participating in voluntary research studies in a secure and accessible manner. ArthritisPower Patient Governors serve as gatekeepers for researchers who seek access to registry data or solicit the community to participate in unique, voluntary studies. To learn more and join ArthritisPower, visit www.ArthritisPower.org.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease, UT Southwestern / 31.10.2018

MedicalResearch.com Interview with: Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 Dr. Wanpen Vongpatanasin, M.D. Professor of Medicine Program Director, Hypertension Fellowship Program UT Southwestern Medical Center in Dallas MedicalResearch.com: What is the background for this study? What are the main findings? Response: The new US hypertension guideline places a greater emphasis on out-of-office blood pressure measurement, and maintains that a clinic BP of 130/80 mm Hg is equivalent to the same reading for home BP monitoring or daytime ambulatory BP monitoring. That is based, however, on data from non-US cohorts, primarily from Japanese cohorts and some European populations. None has been studied in the US population until now. To find out, we analyzed large multi-ethnic studies of primarily young and middle-aged adults in Dallas, Texas, and Durham, N.C., that compared home blood pressure to clinic measurements, using the regression correlation (i.e. regression approach). To confirm the findings, we use another approach called “outcome approach” by determining risks of stroke, MI, and death associated with a clinic systolic blood pressure reading of 130 mmHg from the 3,132 participants in the Dallas study during an 11-year follow up. Then, we determined the home blood pressure levels that carried the same heart disease risk and stroke risk as the clinic systolic 130 mm Hg reading. We found that the level of home blood pressure of 130/80 mm Hg actually best correlates with blood pressure taken at the doctor’s office of 130/80 mmHg. This is true for whites, blacks and Hispanic patients in both treated and untreated population.  (more…)
Asthma, Author Interviews, FDA, Regeneron / 31.10.2018

MedicalResearch.com Interview with: RegeneronNeil Graham,  M.B.B.S., M.D., M.P.H VP of Immunology & Inflammation Regeneron MedicalResearch.com: What is the background for this announcement?  Response: Patients with moderate-to-severe asthma often have uncontrolled, persistent symptoms despite standard-of-care therapy that may make them suitable for treatment with a biologic therapy. They live with coughing, wheezing and difficulty breathing, and are at risk of severe asthma attacks that may require emergency room visits or hospitalizations. [i],[ii] Oral corticosteroids can provide relief for severe, short-term symptoms. However, their chronic use is limited to the most severe patients due to the potential for serious side effects. [iii],[iv] A particular type of inflammation contributes to the cause of uncontrolled symptoms in multiple inflammatory diseases such as asthma and atopic dermatitis.[v] Dupixent is a medicine that inhibits the overactive signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13), two key proteins that contribute to this type of inflammation. This inhibits cytokine-induced inflammatory responses, including the release of proinflammatory cytokines, chemokines, nitric oxide, and IgE; however, the mechanism of action of Dupixent in asthma has not been definitively established. (more…)
Author Interviews, Cognitive Issues, Critical Care - Intensive Care - ICUs, NEJM, Vanderbilt / 31.10.2018

MedicalResearch.com Interview with: Brenda Truman Pun, DNP, RN Program Clinical Manager Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Delirium is a serious problem in Intensive Care Units around the world. Approximately 80% of mechanically ventilated patients develop delirium, acute confusion, while in the ICU. Once thought to be a benign side effect of the ICU environment, research now shows that delirium is linked to a myriad of negative outcomes for patients which include longer ICU and Hospital stays, prolonged time on the ventilator, increased cost, long-term cognitive impairment and even mortality. For a half a century clinicians have been using haloperidol, an typical antipsychotic, to treat delirium in the ICU. However, there has never been evidence to support the use of haloperidol or its pharmacologic cousins, the atypical antipsychotics, to treat delirium. These drugs have serious side effects that include heart arrhythmias, muscle spasms, restlessness and are associated with increased mortality when given for prolonged periods in the outpatient settings leading to a black box warning for their use in this setting. The MIND-USA study was a double blind placebo controlled trial which evaluated the efficacy and safety of antipsychotics (i.e., haloperidol and ziprasidone) in the treatment delirium in adult ICU patients.   (more…)
Author Interviews, Heart Disease, Surgical Research / 31.10.2018

MedicalResearch.com Interview with: Akram Elgendy MD Division of Cardiovascular Medicine University of Florida   MedicalResearch.com: What is the background for this study? Response: Recent clinical trials have demonstrated that percutaneous patent foramen ovale closure is associated with lower risk of stroke recurrence in cryptogenic stroke patients. However, new-onset atrial fibrillation (AF) has been reported as a safety concern. To better understand the risk of new-onset AF, we performed a meta-analysis of PFO closure trials in patients with cryptogenic stroke and migraine. (more…)
Author Interviews, Brain Injury, Heart Disease, JAMA, Neurology / 31.10.2018

MedicalResearch.com Interview with: Marion Moseby-Knappe, MD Neurologist and Researcher Center for Cardiac Arrest at Lund University and Skane University Hospital Lund, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research focuses on improving methods for examining unconscious patients treated on intensive care units after cardiac arrest. If a patient does not wake up within the first days after cardiac arrest, physicians need to evaluate how likely it is that the patient will awaken at all and to which extent there is brain injury. According to European and American guidelines, decisions on further medical treatment of cardiac arrest patients should always be based on a combination of examinations and not only one single method. Various methods are combined when assessing the patient such as examining different neurologic reflexes, head scans (computed tomography or magnetic resonance imaging), other specialist examinations (electroencephalogram or somatosensory evoked potentials) or blood markers. Our research focuses on patients included in the largest cardiac arrest trial to date, the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial. (more…)
Author Interviews, Cost of Health Care, JAMA, Kidney Disease / 31.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH Associate Professor of Health Services, Policy and Practice Associate Professor of Medicine Brown University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown. Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.      (more…)