MedicalResearch.com Interview with:
Gulshan Sharma, MD, MPH
Division of Pulmonary Critical Care and Sleep Medicine
University of Texas Medical Branch
Galveston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).
Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.
Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.
Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury. (more…)
MedicalResearch.com Interview with:
Philip Riley
Cochrane Oral Health Group, School of Dentistry
The University of Manchester
Manchester, UK
Medical Research: What is the background for this study? What are the main findings?
Response: As tooth decay is still so prevalent worldwide, despite being entirely preventable, it is worth assessing the evidence for other adjunctive ways for the public to help prevent the disease. Manufacturers of xylitol products commonly make the claim that this natural sweetener prevents tooth decay, and we felt that the public deserved to know if the best quality evidence backs up such claims.
We found that there was a lack of evidence from randomised controlled trials (the best type of study design for testing the effects of interventions) to prove that xylitol products can prevent tooth decay. We found some low quality evidence suggesting that xylitol added to fluoride toothpaste may reduce tooth decay in children’s permanent teeth by 13% over a 3 year period when compared to fluoride toothpaste without xylitol. However, these findings should be interpreted with caution and may or may not be generalizable to other populations. There was insufficient evidence to conclude that xylitol in chewing gums, lozenges, candies/sweets, syrups and wipes can prevent tooth decay in children or adults
(more…)
MedicalResearch.com Interview with:
Tanush Gupta, MD
Department of Medicine, Division of Cardiology
New York Medical College, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.
We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.
(more…)
MedicalResearch.com Interview with:
Dr Anne K Detjen, MD
Child Lung Health ConsultantInternational Union Against Tuberculosis and Lung Disease
Medical Research: What is the background for this study? What are the main findings?Dr. Detjen: The bacteriological diagnosis of tuberculosis (TB) in children is challenging due to the difficulty in obtaining specimens such as sputum and the lack of an accurate and accessible diagnostic test. In most cases, diagnosis is made on clinical grounds based on a contact history and a combination of signs and symptoms. We included 15 studies in a systematic review and meta-analysis of Xpert for the diagnosis of pulmonary TB in children.
The accuracy of Xpert for diagnosing TB in children is suboptimal, and the majority of children will still have to be diagnosed clinically. However, in settings where it replaces smear microscopy Xpert will increase the likelihood of bacteriological confirmation of TB as well as MDR TB among children. Xpert does not increase the number of confirmed TB cases among culture-negative children. We also found that smear status highly impacted Xpert results, i.e. a higher yield among smear positive compared to smear negative children. Smear positivity increases with bacillary load and might be a proxy for disease severity. Unfortunately, we were not able to assess the performance among children with different stages of disease severity since this was not classified in any of the studies included.
(more…)
[caption id="attachment_13080" align="alignleft" width="199"] CDC Image: Cardiorespiratory Fitness[/caption]
MedicalResearch.com Interview with:
Susan G. Lakoski, M.D.
Assistant Professor of Medicine, Hematology/Oncology DivisionDepartment of Medicine...
MedicalResearch.com Interview with:
Professor Massimiliano Mazzone and Professor Hans Prenen
Lab of Molecular Oncology and Angiogenesis
VIB Vesalius Research Center
University of Leuven Leuven Belgium
Medical Research: What is the background for this study? What are the main findings?
Response: Monocytes are circulating cells with patrolling behaviour. In case of harmful situations, they go to the site of injury rapidly to ensure immune and wound-healing functions. Once in the inflammation site, they differentiate into macrophages which are versatile cells adopting different phenotypes according to the stimuli they are subjected to. We hypothesized that cancer cells might release signals and soluble factors that educate and change monocytes already when in circulation. In this work, we proved our hypothesis and found that soluble molecules released by colorectal cancer cells imprint a specific signature in the circulating monocytes. Now, by collecting these monocytic cells from the blood, we are able to determine if colorectal cancer cells are present in the body, either at the primary site (in the colon) or in distant organs (where cancer cells give rise to metastases). (M. Mazzone).
(more…)
MedicalResearch.com Interview with:
Thomas Perls, MD, MPH Professor
Boston University School of Medicine
Medical Research: What is the background for this study?
Dr. Perls: For years now, Gerontology scholars continue to state that 25% of what they interchangeably call aging, longevity, life expectancy and life span is genetic and 75% is due to the environment and health-related behaviors. This assertion is based on Scandinavian twins reared apart, but the oldest participants in those studies lived to their 70s and 80s. Part of the problem here is the lack of consistency in what people mean by the terms Aging, Life Span and Longevity.
In fact, the Seventh Day Adventists, who generally have a high prevalence of healthy behaviors (vegetarian, daily exercise, eat in moderation, abstain from tobacco and alcohol, and activities that help manage stress well) have an average live expectancy of approximately 88 years. Yet, 7th Day Adventists are ethnically and racially heterogeneous and thus it appears that those healthy behaviors explain the vast majority of the variation in how old these people live to be. This finding is consistent with the optimistic view of the twin studies, that much of living to one's 80's is in our hands. Living to only our 50s-70's is also in our hands (e.g. 75% behaviors) if we choose to smoke, eat red meat frequently, be obese, not exercise, be exposed to gun violence, have unsafe sex, do IV drugs, etc. So it is safe to say, in my opinion, that 75% of the variation in how old we live to be, is on average due to our behavior and exposure choices. The empowering and important point is that if we all lived like the Seventh Day Adventists, average life expectancy would increase almost 8 years and health costs would markedly decline because we would be getting to these older ages because we are healthier not because we are pouring more resources into more effectively treating diseases.
The New England Centenarian Study, which I direct, and a number of other studies of nonagenarians (people in their 90s) have demonstrated via direct genetic studies as well as studies of family trees where at least some family members get to these very old ages, that with older and older ages of survival beyond age ~95 years, variations in genetic profiles explain a greater and greater proportion of the variation in how old people live to be at these ages. So much so that I believe the findings to date are consistent with the roles of genes and environment being reversed for survival to age 106+ years, that is, 75% genetics and 25% environment/behaviors. This supposition is based upon several observations:
(1) as people reach the age of 105+ years, they become more and more alike in terms of what age-related diseases they get and when they get them. Consistent with Jim Fries; "Compression of Morbidity" hypothesis, people who survive to ages 110+ (called supercentenarians) and who therefore approximate the limit of human lifespan are on average disease and disability-free up until the last 5 or so years of their lives. This increasing homogeneity, especially compared to the increasing heterogeneity in the rates of aging and incidences of age-related diseases at younger percentiles or ages of survival, suggests underlying genetic similarities (similar genetic profiles) amongst groups of these supercentenarians; and
(2) the New England Centenarian Study previously discovered genetic signatures (made up of longevity-associated variations of about 130 genes) that were associated with surviving to age 106+ years with 80% accuracy, but with only 60% accuracy for accurately picking out people living to ~100 years. This increasing accuracy with older and older ages also suggests a stronger and stronger genetic influence upon survival to these rarest percentiles of survival.
With the above background, we set out in this study and subsequent paper, to
(1) assess sibling relative risk using the largest-ever collection of validated pedigrees of centenarians,
(2) to assess the risk of a sibling achieving the same age as their very old sibling (e.g. ages 95, 100, or 105+ years) relative to average people born around the same time, and
(3) to look at how when a person was born (eg before or after 1890) made a difference in these relative risks.
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MedicalResearch.com Interview with:
Andrew Blauvelt, M.D., M.B.A.
President and Investigator
Research Excellence & Personalized Patient Care
Portland, OR 97223
Medical Research: What is the background for this study? What are the main findings?
Dr. Blauvelt: A2303E1 is a multicenter, double-blind, randomized withdrawal extension to the FIXTURE and ERASURE pivotal phase III studies. The purpose of this extension study was to collect additional long term efficacy, safety, and tolerability data on secukinumab (i.e., Cosentyx) in patients who demonstrated a PASI 75 response to Cosentyx at Week 52 of these core studies in moderate-to-severe plaque psoriasis.
In the extension phase, 995 patients who achieved Psoriasis Area Severity Index (PASI) 75 responses after 52 weeks of therapy received either Cosentyx 300 mg, Cosentyx 150 mg, or placebo for an additional year (Week 104). After two full years of therapy in patients treated with Cosentyx 300 mg, almost 9 out of 10 (88.2%) patients maintained their PASI 75 response, 7 out of 10 (70.6%) had clear or almost clear skin (PASI 90), and 4 out of 10 (43.9) had clear skin (PASI 100) at Week 104. For patients treated with Cosentyx 150 mg, 75.5% maintained their PASI 75 response, 44.6% had clear or almost clear skin (PASI 90), and 23.5% had clear skin (PASI 100) at Week 104. In addition, 94.8% of patients who initially received placebo (at the start of the extension), and were switched to receive Cosentyx 300 mg after relapse, were able to achieve PASI 75 and 70.3% achieved PASI 90 within 12 weeks of re-starting Cosentyx. (more…)
MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.
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MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN
Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University
Medical Research: What is the background for this study? What are the main findings?
Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.
Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.
(more…)
MedicalResearch.com Interview with:
Dr Fiona McQuaid
Clinical Research Fellow
University of Oxford, United Kingdom
Medical Research: What is the background for this study?Response: Meningococcal B disease is a common cause of sepsis and meningitis
with significant mortality and morbidity. A multicomponent vaccine
against serogroup B meningococcus has been licensed for use in the
Europe, Australia, Canada and recently the USA (though only in the
10-25 years age group) but questions remain about how long the
bactericidal antibodies induced by infant vaccination persist and the
likely breath of strain coverage. This was a follow on study looking
at a group of children aged 5 years who had been vaccinated as infants
and a different group who were vaccinated for the first time at 5
years of age.
Medical Research: What are the main findings?Response: The percentage of children with protective antibody levels who had
been immunized as infants fell in the 20 months since their last
immunization but this varied by the strain of meingococcus B tested
and by the different infant/toddler vaccination schedules.
The children who were vaccinated for the first time at 5 years of age
showed a good antibody response, but most reported pain and redness
around the site of vaccination and 4-10% had a fever.
(more…)
MedicalResearch.com Interview with:
Peter Muennig, MD, MPH
Columbia University
Mailman School of Public Health
NYC 10032
Medical Research: What is the background for this study? What are the main findings?Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.
We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.(more…)
MedicalResearch.com Interview with:
Mohammad Kazem Fallahzadeh Abarghouei, M.D.
Baylor University Medical Center, Dallas, TX
Medical Research: What is the background for this study?
Response: Uremic pruritus (itch) is a common problem in hemodialysis patients. No effective treatment exists for uremic pruritus due to its complex pathogenesis. Systemic inflammation and elevated serum levels of interleukin-2 (IL-2) are implicated in the pathogenesis of uremic pruritus. Senna is an herbal drug commonly used for treatment of constipation. Senna also has anti-inflammatory properties. We performed this randomized double-blind placebo-controlled trial to evaluate the effect of senna on reduction of uremic pruritus and serum levels of IL-2 in hemodialysis patients.
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MedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD, Nephrology Fellow
Program director: Suzanne Norby, MD
Project mentors: Stephen B. Erickson, MD
and John C. Lieske, MD
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN
MedicalResearch: What is the background for this study? Dr.Cheungpasitporn: Kidney stones are very common urologic problems. In addition, once someone has a kidney stone, the likelihood of having another episode increases to 50% within 5 years. Increased fluid intake has been suggested as a simple strategy for kidney stone prevention. However the data on conclusions regarding the benefit, adherence and safety of high fluid intake for the primary or secondary prevention of stones were limited. Thus, we conducted this meta-analysis to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. Our data presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings may help improve clinicians’ ability to manage kidney stones.
MedicalResearch: What are the main findings?Dr.Cheungpasitporn: Our meta-analysis included 9 studies with 273,954 patients. According to the findings of our study, individuals with daily high fluid intake (to achieve a urine volume of at least 2.0‒2.5 L per day) had lower risk of new kidney stones by approximately 50%. High fluid intake provided the same benefit in men and women. In addition, high fluid intake reduced the risk of recurrent kidney stones by 40%. Overall, high fluid intake is safe with low adverse events.
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MedicalResearch.com Interview with:
Dr. Tanjim Sultana MD
Department of Nephrology
Lenox Hill Hospital New York
Medical Research: What is the background for this study? What are the main findings?
Response: Almost all dialysis patients are anemic. One quarter of patients requiring High dose Epogen have functional iron deficiency, which means they have adequate iron store but unable to utilize it. Vitamin C has been shown to mobilize iron from their storage and making it available to use in red blood cell production. Prior studies showed intravenous high dose vitamin C could increase hemoglobin levels and decrease epogen requirement. In our study we used daily low dose oral vitamin C in functional iron deficient patients to achieve the same goals. Patients taking daily low dose vitamin C for 3 months had significant decrease in their epogen dose compared to the control group.
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MedicalResearch.com Interview with: Dr. José L. Górriz
Department of Medicine and Nephrology
Valencia Hospital Universitario
Valencia. Spain
MedicalResearch: What is the background for this study? What are the main findings?Dr. Górriz: The background of the study is that several studies have reported on the high prevalence of vascular calcification in chronic kidney disease (CKD) patients not on dialysis. Vascular calcification (VC) has been associated with high cardiovascular mortality in patients on dialysis, but there are no studies in patients in stages before dialysis which analyse the prognostic significance of the presence of Vascular calcification assessed by simple X-ray.
Vascular calcification can occur in both the intima and media of the vessel wall. Intimal calcification is an indicator of atherosclerosis and is associated with ischemic heart disease and medial calcification is associated with arterial stiffness, systolic hypertension, and left ventricular hypertrophy.
Although Vascular calcification can be assessed by various methods, such as ultrasonography, tomography, and arteriography, simple radiology has the advantages of being simple, inexpensive, and commonly applicable in daily clinical practice.
OSERCE 2 is an observational, multicentre and 3-year prospective study performed in 39 Nephrology centres in Spain, which analyzes the presence of Vascular calcification in CKD patients stages 3 and 4 (eGFR between 15-59 ml/min/1,73 m2) and its effect on morbimortality (death, hospitalization and renal progression).
The main findings of the study were that Vascular calcification is highly prevalent in patients with chronic kidney disease, and Vascular calcification assessment using AS independently predicts death and time to hospitalization.
Therefore, it could be a useful index to identify patients with chronic kidney disease at high risk of death and morbidity as previously reported in patients on dialysis.
(more…)
MedicalResearch.com Interview with:
Michelle Wilkinson, MPH
Doctoral Candidate Epidemiology
The University of Texas Health Science Center at Houston School of Public Health
Houston, TX 77030Medical Research: What is the background for this study? What are the main findings?
Response: Cell phone use (CPU) while driving impairs visual awareness and reaction time, increasing frequency of near-collisions, collisions, and accidents with injuries. National prevalence estimates of driver cell phone use range from 5-10%. Medical and academic centers have large concentrations of young, ill, or elderly pedestrians and drivers, who are often unfamiliar with the congested environment. Drivers distracted by Cell phone use are a safety threat to pedestrians and drivers in these demanding environments. This study aimed to describe the prevalence and correlates of cell phone use among Texas drivers in major medical and academic centers, 2011-2013. This study found the overall prevalence of cell phone use while driving was 18%. The prevalence of Cell phone useand talking declined, while texting increased during the study period. Cell phone users were more likely to be female, <25 years old, and driving without a passenger.
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MedicalResearch.com Interview with:
Melinda C Power, ScD
Post-Doctoral Research Fellow
Epidemiology Department, Johns Hopkins Bloomberg School of Public Health
Neurology Department, Johns Hopkins School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Power: Air pollution may be related to mental health, particularly anxiety, through effects on oxidative stress and systemic inflammation or through promotion or aggravation of chronic diseases. However, there has been very little research on the relation between air pollution exposures and anxiety in people. Our study found that those with higher exposures to fine particulate matter, a type of air pollution, were more likely to experience elevated anxiety symptom levels. Our study also suggests that recent exposures to find particulate matter air pollution are potentially more relevant to anxiety symptom levels than long-term past exposures.
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MedicalResearch.com Interview with:
Susan Swetter, MD
Professor of Dermatology and Director, Pigmented Lesion and Melanoma Program
Stanford University Medical Center and Cancer Institute.
Medical Research: What is the background for this study?
Dr. Swetter: This retrospective cohort study sought to explore the role of the topical immunomodular - imiquimod 5% cream - as both primary and adjuvant therapy (following optimal surgery) for patients with the lentigo maligna subtype of melanoma in situ. Assessment of alternative treatments to surgery for this melanoma in situ subtype are warranted given the increasing incidence of lentigo maligna in older, fair-complexioned individuals in the United States. Surgical management of lentigo maligna is complicated by its location on cosmetically sensitive areas such as the face, histologic differentiation between lentigo maligna and actinic melanocytic hyperplasia in chronically sun-damaged skin, and potential surgical complications in the elderly who may have medical co-morbid conditions.
Medical Research: What are the main findings?
Dr. Swetter: We conducted a retrospective review of 63 cases of lentigo maligna in 61 patients (mean age 71.1 years) who used topical 5% imiquimod cream instead of surgery (22 of 63 cases, 34.9%) or as an adjuvant therapy following attempted complete excision (63 cases, 65.1%), in which no clinical residual tumor was present but the histologic margins were transected or deemed narrowly excised. Our study showed overall clinical clearance of 86.2% in the 58 patients analyzed for local recurrence at a mean of 42.1 months of follow-up (standard deviation 27.4 months), with primarily treated cases demonstrating 72.7% clearance at a mean of 39.7 months (standard deviation 23.9 months), and adjuvant cases showing 94.4% clearance at a mean of 39.7 months (standard deviation 23.9 months). We found a statistically significant association between imiquimod-induced inflammation and clinical or histologic clearance in primary but not adjuvant cases, although this latter finding may be explained by a lack of residual atypical melanocytes or true LM in the adjuvant setting, in which wide local excision had already been performed.
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MedicalResearch.com Interview with:
Dr. Bradley S. Peterson, M.D
Director of the Institute for the Developing Mind
The Saban Research Institute of Children’s Hospital
Los Angeles Children’s Hospital Los Angeles
Medical Research: What is the background for this study?
Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.
Medical Research: What are the main findings?
Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy. We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression. Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability. (more…)
MedicalResearch.com Interview with:
Dr Anoop Shah
Cardiology Research fellow
Centre of Cardiovascular sciences
University Of Edinburgh Edinburgh
Medical Research: What is the background for this study? What are the main findings?
Response: Stroke accounts for five million deaths each year and is a major cause of disability. The incidence of stroke is increasing, particularly in low and middle income countries, where two thirds of all strokes occur. The global burden of stroke related disability is therefore high and continues to rise. This has been primarily attributed to an aging population in high income countries and the accumulation of risk factors for stroke, such as smoking, hypertension, and obesity, in low and middle income countries. The impact of environmental factors on morbidity and mortality from stroke, however, might be important and is less certain.
From 103 studies and across 6.2 million fatal and non-fatal strokes, our findings suggest a strong association between short term exposure to both gaseous (except ozone) and particulate air pollution, and admissions to hospital for stroke or mortality from stroke. These associations were strongest in low and middle income countries, suggesting the need for policy changes to reduce personal exposure to air pollutants especially in highly polluted regions.
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MedicalResearch.com Interview with:
Brian K. Ahmedani, PhD, LMSW
Research ScientistHenry Ford Health System
Center for Health Policy & Health Services Research
Detroit, MI 48202
Medical Research: What is the background for this study? What are the main findings?
Dr. Ahmedani: The Centers for Medicare and Medicaid Services (CMS) have begun penalizing hospitals for excessive all-cause hospital readmissions within 30 days after discharge for pneumonia, heart failure, and myocardial infarction. We wanted to determine the influence of comorbid mental health and substance use conditions on the rate of 30-day hospital readmissions for individuals with these conditions. Overall, individuals with a comorbid mental health condition were readmitted to the hospital within 30-days approximately 5% more often than those without one (21.7% versus 16.5%). Comorbid depression and anxiety were associated with a 30-day readmission rate of more than 23% each, overall.
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MedicalResearch.com Interview with: Barry L. Carter, PharmD
Professor of Pharmacy
Professor of Family Medicine
U Iowa Carver College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control. In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines. However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care. All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months. We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments. All of these variables typically make it much more difficult to achieve BP control. BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups.
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MedicalResearch.com Interview with:
Melissa Murray, Ph.D
Assistant Professor of Neuroscience
Mayo Clinic
Medical Research: What is the background for this study? What are the main findings?
Dr. Murray: Our study investigates two of the hallmark brain pathologies that underlie Alzheimer’s disease, abnormally accumulated tau and amyloid proteins. While both are integral to diagnosing Alzheimer’s disease postmortem, their exclusive relationship with cognitive decline has been debated. Using a large series from our brain bank we found that while an increase in abnormal accumulation of both proteins shares a close relationship with a decline in cognition, tau is the key driver of decline. This was important for us to understand as the second part of our study investigated amyloid brain scanning. We found that amyloid brain scanning closely represents amyloid deposits and not tau in postmortem brain tissue. One particular aspect we focused on is the cutoff for what would be a amyloid-positive brain scan that indicates Alzheimer’s disease. Our study supports that currently available cutoffs correspond to a level of amyloid accumulation that occurs before Alzheimer’s disease has too far advanced.
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MedicalResearch.com Interview with:
Timothy N. Showalter, MD, MPH
Associate Professor & Residency Program Director
Department of Radiation Oncology
University of Virginia School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Showalter: Early radiation therapy has been shown to be an effective curative treatment for prostate cancer patietns with a rising PSA blood test after radical prostatectomy and for men with locally advanced prostate cancer who are at high risk of recurrence after prostatectomy. Despite evidence that radiation therapy is more effective when delivered early (or when the PSA is low), radiation therapy delivery is often delayed to allow more time for patients to recover urinary and sexual function. In order to provide evidence regarding whether delaying radiation therapy does reduce the risks of side effects of treatment, my colleagues and I evaluated outcomes of for a large cohort of patients who received treatment in the Emilia Romagna Region of Italy. We identified a total 0f 9,786 prostate cancer patients who received prostatectomy, including 22% of whom received post-prostatectomy radiation therapy. We found that earlier delivery of radiation therapy was not associated with increased risk of any adverse events, including gastrointestinal, urinary or sexual complications.
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MedicalResearch.com Interview with:
Richard G. Stevens, Ph.D.,
Professor, Cancer Epidemiologist
UConn Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Stevens: Since first introducing the concept of a possible connection between exposure to light at night and breast cancer in the mid-80s, we’ve seen growing evidence of how artificial light can suppress the circadian hormone melatonin and bring about physiological changes.
The extent of this “circadian disruption” varies by the type of light and the time of day. Humans evolved with a body clock that followed the solar clock. Nature intended us to be awake in daylight and at rest in the dark of night. Therefore, the intense, short-wavelength light of the sun in the morning triggers us to become awake and alert, just as the absence of sunlight in the evening allows our body to produce melatonin. Even with the use of fire to provide light in the evening, the circadian impact was relatively minimal because of firelight’s place on the red end of the visible spectrum.
Humans survived under this simple formula for many thousands of years. Then electric light started to take an increasingly strong foothold in everyday life. Today we are typically surrounded at all hours of the day and night by artificial light – in many cases it’s not bright enough during the day to match the sun, and it’s too bright at night to be conducive to the natural sleep/wake cycle. Think computer screens, tablets, smart phones, e-readers, etc. These devices emit enough short-wavelength, or blue, light to disrupt our body clocks in the evening. So do fluorescent and LED lights.
Our paper – I worked with Dr. Yong Zhu from Yale on this – represents a new analysis and synthesis of what we know up to now on the effect of lighting on our health. We don't know for certain, but there's growing evidence that the long-term implications of this may have ties to breast cancer, obesity, diabetes, and depression, and possibly other cancers.
Exposure to electric light started about 130 years ago, which is a tiny period of time in evolutionary terms. In other words, not long enough to undo human evolution. (more…)
MedicalResearch.com Interview with:
Timothy J. Kieffer Ph.D. | Professor
Laboratory of Molecular & Cellular Medicine
Department of Cellular & Physiological Sciences
Department of Surgery | Life Sciences Institute
The University of British Columbia
Vancouver BC Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Kieffer: Previously we have examined the therapeutic potential of pancreatic precursor cells derived from human stem cells for insulin replacement in models of type 1 diabetes (PMID: 22740171 & PMID: 23771205). Here we sought to test the efficacy of cell-based insulin replacement in a model of type 2 diabetes, which is by far the most common form of diabetes. Key aspects of type 2 diabetes could be mimicked in immunodeficient mice, namely hyperglycemia and insulin resistance accompanied by excess body weight, by placing the mice on high fat diets. These diabetic mice were transplanted with human stem cell derived pancreatic precursor cells contained within macroencapsulation devices. The diabetic setting did not negatively impact the ability of the transplanted cells to mature into insulin-producing cells. Moreover, the cell transplants were able to significantly improve glucose homeostasis, particularly when combined with low doses of traditional anti-diabetic drugs. Intriguingly, the combined therapy also induced weight loss, such that treated mice were similar in weight to control mice reared on a low fat diet. (more…)
MedicalResearch.com Interview with:
Grace Lu-Yao, PhD, MPH, Professor of Medicine
Cancer epidemiologist at the Cancer Institute of New Jersey
Rutgers Robert Wood Johnson Medical School
Medical Research: What is the background for this study? What are the main findings?
Response: Prostate cancer is the most common non-skin cancer and the second most common cause of cancer death in the United States. Because of widespread prostate specific antigen (PSA) screening, most contemporary men are diagnosed with localized disease. Data from large well executed trials have shown improvement in overall mortality for men <65 years of age undergoing surgery for localized prostate cancer but no significant benefit for men 65 years of age or older. More than half of prostate cancer patients are diagnosed at age 65 or older. Despite that the majority of elderly patients with low-risk prostate cancer might be over-treated, only a small percentage of men in the United States have their prostate cancer managed conservatively. This study was undertaken to provide crucial long-term outcomes data so that prostate cancer patients can use these data for treatment decision.
(more…)
MedicalResearch.com Interview with:
Michael J. Beck MD, FAAP, SSGB
Department of Pediatrics
Milton S. Hershey Medical Center and the Pennsylvania State University College of Medicine, Hershey, PennsylvaniaMedical Research: What is the background for this study? What are the main findings?
Dr. Beck: Many hospitals are trying to improve patient discharge times. The benefits of this result will improve several valuable metrics within the organization’s value chain, namely improved access, reduced lost referrals, reduce emergency department boarding, to name a few.
As our region’s only tertiary care children’s hospital, that serves an expanding demographics and geographic population, access to our facility is becoming both a priority and challenge. Since many hospitals and hence hospital service lines work with a fixed number of beds, serving a growing population is going to lead to or exacerbate hospital access issues and emergency department boarding. The latter of which may carry financial penalties in the future based on Joint Commission standard LD 04.03.01 (revised 2013). We sought to applying elements of Lean and constraint theory, which postulate that flow can be created by eliminating waste, and that a process can move only as fast as its scarcest resource, respectively. From a lean perspective, why should “dischargeable” patients who were seen on AM work rounds still be occupying a valuable bed at 3 or 4PM when they were deemed safe for discharge hours earlier? Why should patients and organizations continue to tolerate this waste? Applying Lean thinking forced our service to reconfigure, re-sequence, and re-staff rounds in a way that could better meet patients’ and our organization’s needs and requirements. Since the discharge process output is an open bed, not having an open bed when it is needed, creates an organizational constraint. One constraint to creating an open bed, is the attending physician, ie a patient cannot be discharged until he/she is seen by the attending physician. However, another constraint is the model that one attending sees in excess of 13 patients per day (patient: provider ratio of 13:1). We hypothesized that by adding an attending to reduce the patient: provider ratio by 50% during predictable high volumes, we could do all of the discharge paperwork on rounds, at the time the decision to discharge is made by the attending. By advancing discharge order entry time, we should be able to advance the time patients get discharged, create an open bed earlier in the day, and ultimately reduce lost referrals and emergency department boarding.
Our service line median time of discharge order entry and time of patient discharge was compared to our own historical controls and to the same discharge behaviors of the remainder of our hospital services. The main intervention was staffing reallocation, creation of standard workflow expectations, and a discharge checklist. Finally, we also implemented a discharge huddle to occur before the day of anticipated day discharge.
Over the 6 month intervention period, the median time of discharge entry decreased from 2:05PM to 10:45 AM and the median time of patient discharge decreased from 3:58PM to 2:15 PM. The hospital control group did not change from baseline.
Our LOS went form 3.1 days to 3.0 days, and our 7, 14, and 30 day readmission rates did not increase. Emergency department boarding time was decreased by 30%, and lost referrals decreased 70% during the study period.
(more…)
MedicalResearch.com Interview with:
Arisa Ortiz, MD, FAAD Assistant Clinical Professor
Director, Laser and Cosmetic DermatologySenior author: Brian Jiang, MD and
First author Tiffany Loh, BS
Department of Dermatology UC San Diego
Medical Research: What is the background for this study? What are the main findings?Response: Non-melanoma skin cancers (NMSCs) are the most common type of malignancy in the United States, affecting an estimated 3.5 million people each year. Previous perception has remained that skin cancer risk in Hispanics and Asians is lower than that of Caucasians. However, despite historically lower rates of skin cancer, in recent years, the incidence of skin cancer in these groups has reportedly been increasing in the United States. As Hispanics and Asians constitute two of the most rapidly expanding ethnic groups in the US, the rise in NMSCs in these populations is particularly concerning.
The finding from our study were as follows: Hispanic patients were significantly younger than Caucasians and Asians (p=0.003, 0.023 respectively). The majority of Non-melanoma skin cancers in Caucasians occurred in men, while this gender ratio was reversed for both Hispanics and Asians. There were significantly more cases of Non-melanoma skin cancers occurring in the “central face” area in Hispanics. Race was not a significant predictor for specific NMSC type (BCC or SCC).
(more…)
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MedicalResearch.com Interview with:
Gulshan Sharma, MD, MPH
Division of Pulmonary Critical Care and Sleep Medicine
University of Texas Medical Branch
Galveston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).
Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.
Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.
Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury. (more…)
