MedicalResearch.com Interview with: Ronnie Fass, M.D., FACG, Professor of Medicine
Case Western Reserve University
Director, Division of Gastroenterology and Hepatology, Head, Esophageal and Swallowing Center, Metro Health Medical Center
MedicalResearch: What are the main findings of the study?Dr. Fass: This is the first study to compare the extent of acid reflux between nighttime sleep and daytime naps in patients with Gastroesophageal reflux disease. The results of our study show that naps are associated with significantly greater esophageal acid exposure compared to sleep. Acid reflux events were more frequent and their total duration was longer during naps when compared with acid reflux events during nighttime sleep. Additionally, the fraction of time that the subjects were experiencing acid reflux with pH < 4 was significantly higher during naps than nighttime sleep and subjects experienced more symptoms due to acid reflux during their nap than their sleep.
MedicalResearch.com Interview with: Professor Louis Appleby
Professor of Psychiatry C.B.E
The University of Manchester in the UK
MedicalResearch: What are the main findings of the study?Professor Appleby: “Patients with mental illness are two and a half times more likely to be victims of homicide than people in the general population according to our research published in The Lancet Psychiatry today.
“In this study, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), based at The University of Manchester, examined data on the victims and perpetrators of all homicides in England and Wales between January, 2003 and December, 2005.
We found that during the 3-year study period, 1496 people were victims of homicide, and 6% (90) of them had been under the care of mental health services in the year before their death. A third (29) of these patient victims were killed by other patients with mental illness.
In 23 homicides in which the victim was a mental health patient killed by another mental health patient, the victim and the perpetrator were known to each other either as partners (9, 35%), family members (4, 15%), or acquaintances (10, 38%). In 21 of these 23 cases, both the victims and perpetrators were undergoing treatment at the same National Health Service Trust.
Alcohol and drug misuse (victims 66%, perpetrators 93%) and a history of violence (victims 24%, perpetrators 24%) were common among both patient victims and perpetrators. The study also found that in the 3 years to 2005, 213 mental health patients were convicted of homicide—accounting for 12% of all homicide convictions.”
MedicalResearch.com Interview with: Sergio R. Ojeda, D.V.M.
Division Head and Senior Scientist Division of Neuroscience
Division of Neuroscience, OR National Primate Research Center/Oregon Health and Science University,
Beaverton OR 97006
MedicalResearch: What are the main findings of the study?Dr. Ojeda:The study shows that a receptor for two growth factors (brain-derived neurotrophic factor [BDNF] and neurotrophin 4/5 [NT4/5]) that are known to be important for development of the nervous system is also essential for maintaining oocyte integrity and survival in the mammalian ovary. Intriguingly, the full-length form of this receptor (known as NTRK2-FL) is not expressed in oocytes until the time of the first ovulation. At this time, the pre-ovulatory gonadotropin discharge stimulates granulosa cells of ovarian follicles to produce not only more BDNF, but also more of a peptide known as kisspeptin, to induce the formation of NTRK2-FL in oocytes. To date, kisspeptin was known to be only critical for the hypothalamic control of reproduction. To induce NTRK2-FL, BDNF binds to truncated NTRK2 receptors (NTRK2-T1), which are abundant in oocytes throughout prepubertal development. Kisspeptin, on the other hand, does so by activating its receptor KISS1R, also expressed in oocytes. Once present after the first ovulation, NTRK2-FL is able to activate a survival pathway in oocytes following gonadotropin stimulation, presumably at every cycle. In the absence of NTRK2-FL, oocytes die, follicular structure disintegrates and a condition of premature ovarian failure ensues.
MedicalResearch.com Interview with: Monika Waszczuk
1+3 PhD Student
MRC SGDP Research Centre
Institute of Psychiatry, King's College London
DeCrespigny Park London UK
MedicalResearch: What are the main findings of the study?Answer:Little is known about the genetic influences on the relationship between depression and anxiety disorders across development. We used two population-based prospective longitudinal twin and sibling studies to investigate phenotypic associations between the symptoms of these disorders, and tested genetic structures underlying these symptoms across three developmental stages: childhood, adolescence and early adulthood.
We found that depression and anxiety disorder symptoms are largely distinct in childhood and are influenced by largely independent genetic factors. Depression and anxiety symptoms become more associated and shared most of their genetic etiology from adolescence. An overarching internalizing genetic factor influencing depression and all anxiety subscales emerged in early adulthood. These results provide preliminary evidence for different phenotypic and genetic structures of internalizing disorder symptoms in childhood, adolescence and young adulthood, with depression and anxiety becoming more associated from adolescence.
MedicalResearch.com Interview with: Jack Cuzick PhD
Centre for Cancer Prevention
Wolfson Institute of Preventive Medicine
Queen Mary University of London,
Dr. Cuzick offers the manuscript below to put the results of the Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial in focus for MedicalResearch.com.
The Prevention of Breast Cancer
The first human evidence that drug treatment might reduce the incidence of breast cancer was reported in 19851, where it was found that use of tamoxifen in a trial of women with breast cancer to reduce recurrence of existing tumours also had a major impact on new tumours in the opposite breast, reducing them from 10 to 3. That observation has subsequently been confirmed in several other adjuvant trials and an overview of all such trials indicates that after an average of about 8 years of follow up, 5 years of tamoxifen reduced new contralateral tumours by 39%, with similar effects in years 0-5 and 5-10 in women with oestrogen receptor positive or unknown primary tumours2. These observations and positive results from animal studies3, led to the evaluation of 5 years of tamoxifen in women without breast cancer, but at high risk in 4 large trials. A recent overview4 indicates a 33% reduction in all breast cancer after a 10 years follow up, with a larger reduction in years 0-5 (48%), when treatment was given, and a continuing (22%) effect in years 5-10. Reductions were seen for oestrogen receptor positive invasive cancer (44%) and DCIS (28%), but no effect was seen for both oestrogen receptor negative invasive cancer, where in fact a non-significant 13% (P=0.4) increase was observed. Somewhat larger effects were seen for these other selective estrogen receptor modulators (SERMs) – raloxifene, lasofoxifene and arzoxifene – in trials of osteoporotic women, where the primary endpoint was fracture reduction4. A subsequent head-to-head trial of raloxifene vs tamoxifen, showed tamoxifen to be about 20% more effective, but raloxifene had fewer side effects5. Lasofoxifene not only showed benefits for breast cancer reduction but also reduced fracture rates and heart disease6, and this multi-dimensional set of benefits makes it an attractive candidate for prevention.
MedicalResearch Interview with: Jay Giri, MD MPH
Assistant Professor, Perelman School of Medicine
Director, Peripheral Intervention
Interventional Cardiology & Vascular Medicine
University of Pennsylvania
MedicalResearch: What are the main findings of the study?Dr. Giri: Use of thrombolytics was associated with lower all-cause mortality and increased rates of intracranial hemorrhage. These results were also seen in intermediate-risk pulmonary embolism. Finally, it appeared that patients under age 65 might be at less bleeding risk from thrombolytics.
MedicalResearch.com Interview with:Professor June-Hong Kim, Division of Cardiology
Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology,
Pusan National University Yangsan Hospital
Yangsan, South Korea;
MedicalResearch: What are the main findings of the study?Dr. Kim: In vasospastic angina, the cilostazol group significantly reduced relative ireduction of of weekly incidence of chest pain compared with placebo group (−66.5±88.6% vs −17.6±140.1%, respectively, p=0.009).. Other clinical parameters such as a change in the frequency of chest pain (−3.7±0.5 vs −1.9±0.6, respectively, p=0.029), a change in the chest pain severity scale (−2.8±0.4 vs −1.1±0.4, respectively, p=0.003), and the proportion of chest pain-free patients (76.0% vs 33.3%, respectively, p=0.003) also significantly favored cilostazol. (more…)
MedicalResearch.com Interview withProf. Julia I. Newton:
Dean of Clinical Medicine & Professor of Ageing and Medicine
Clinical Academic Office
The Medical School
MedicalResearch: What are the main findings of the study?Prof. Newton: In this study we have explored for the first time the characteristics of patients with Postural tachycardia in the UK
Postural Tachycardia Syndrome patients are predominantly female, young, well educated and have significant and debilitating symptoms that impact significantly upon their quality of life.
Despite this, there is no consistent treatment, high levels of disability and associated comorbidity.
Although individuals presented with symptoms at the same age, those attending a specialist clinic received a diagnosis quicker.
Symptom burden for those with Postural tachycardia is high and comparable to that seen in Chronic Fatigue Syndrome.
Chronic Fatigue Syndrome is recognized by the WHO as a neurological disorder and by the Disability Discrimination Act 2005 as a disability. At the current time those with Postural Tachycardia Syndrome suffer to the same extent as those with Chronic Fatigue Syndrome but do not receive the same protection from the law.
It is important that more work is done to understand the underlying autonomic abnormality in those with Postural Tachycardia Syndrome in order to allow us to develop targeted treatments that are effective and go beyond the currently available simply symptomatic management.
MedicalResearch.com Interview with:
Greg D. Sacks, MD, MPH
Department of Surgery, David Geffen School of Medicine at UCLAMedicalResearch: What are the main findings of this study?
Dr. Sacks: This study evaluated the all-cause readmissions measure developed by the Centers for Medicare and Medicaid Services to penalize hospitals for unplanned readmissions. By evaluating readmissions of surgical patients at a single academic medical center, we found that the readmissions measure was able to identify only a third of the planned readmissions and mislabeled the remaining two thirds of planned readmissions as unplanned. This discrepancy was a result of the measure’s reliance on administrative claims data, which disagreed in 31% of cases with clinical data abstracted from the patient’s chart. Also, almost a third (27%) of the readmissions in this study were for reasons unrelated to the original hospitalization.
MedicalResearch.com Interview with: David J.A. Jenkins
Professor and Canada Research Chair in Nutrition and Metabolism,
Dept. of Medicine and Nutritional Sciences, Faculty of Medicine,
University of Toronto, Toronto, ON, Canada
MedicalResearch: What are the main findings of the study?Prof. Jenkins: The main findings were that inclusion of just over an once (31g) of canola oil in low glycemic index diets of type 2 diabetes study participants, to further reduce the glycemic load (GL), reduced HbAIC more than a high cereal fiber diet, as predicted. However the Canola oil low GL diet also reduced serum TG and LDL-C and thus Framingham risk score for cardiovascular disease. The effect was seen most clearly in those at highest CHD risk and those with features of the metabolic syndrome.
MedicalResearch.com Interview with: Michelle A. Mendez, PhD
Department of Nutrition
University of North Carolina at Chapel Hill
Gillings School of Public Health
Chapel Hill, NC
MedicalResearch: What are the main findings of the study?Dr. Mendez: Using national surveillance data to examine trends in energy intake among children, we found that there was an initial decline in intakes from 2003-4 through 2007-08, which mirrored evidence that child obesity in the US may have begun to decline in that period. Subsequently, however, in 2009-10, energy intake increased in older children aged 12-19y, and reached a plateau in children aged <11y. This shift is consistent with reports that, particularly in older children, the downward trend in obesity levels may have been reversed in recent years.
MedicalResearch.com Interview with:Dr. Richard D. CarvajalMD
Director, Developmental Therapeutics; Elizabeth and Felix Rohatyn Chair for Junior Faculty
Memorial Sloan Kettering Cancer Center
MedicalResearch: What are the main findings of the study?Dr. Carvajal: This is the first study to show that a systemic therapy provides significant clinical benefit in a randomized fashion to patients with advanced uveal melanoma, a population of patients who have very limited treatment options. This clinical benefit has never previously been demonstrated with other agents, both conventional or investigational.
MedicalResearch.com Interview with: Gerard Ngueta
Population Health and Optimal Health Practices Research Unit,
CHU de Québec Research Centre, Québec
MedicalResearch: What are the main findings of the study?Answer: The main findings of our study are as follows :
1- Contrary to body mass index (BMI), the waist circumference alone (which indicate central obesity or fat distribution) is not associated with cardiometabolic factors under study (i.e., insulin, triglycerides, systolic blood pressure and high-density lipoproteins levels). Thus, the apparent association –as found in previous studies- appears to be mediated through overall obesity (i.e., BMI). In the other words, the association observed in the previous studies between waist circumference and the cardiometabolic risk factors cited above could be mainly due to the strong correlation between waist circumference and BMI.
2- It is possible to estimate the independent contribution of overall fat and central fat on cardiometabolic risk factors by applying the residual model as previously suggested by Willet and Stampfer.
MedicalResearch.com Interview with L. Keoki Williams, MD, MPH
Center for Health Policy and Health Services Research
Department of Internal Medicine
Henry Ford Health System
Detroit, Michigan 48104
MedicalResearch: What are the main findings of the study?Dr. Williams: Metformin is recommended as first line treatment for type 2 diabetes, and these recommendations are based on the results of clinical trials performed almost exclusively in white individuals. This is the first study to specifically assess whether metformin is effective at reducing blood glucose levels in African American individuals. In our large study of over 19,000 individuals, we showed that metformin was consistently more effective at reducing glycated hemoglobin (HbA1c) levels (a measure of long-term blood glucose control) in African Americans when compared with white individuals.
MedicalResearch.com Interview with: Peter Stein, M.D.
Vice president, Clinical Research for Diabetes and Dndocrinology
Merck Research Laboratories.
MedicalResearch: What are the main findings of the study?Dr. Stein: This late-breaking observational study assessed the differences in time to initiation of insulin use and the proportion of the population initiating insulin among patients with type 2 diabetes taking the combination of JANUVIA® (sitagliptin) and metformin, and patients taking the combination of a sulfonylurea and metformin. In this study, patients treated with a combination of JANUVIA and metformin initiated insulin therapy at a slower rate during the period of observation than patients treated with a combination of sulfonylurea and metformin.
In this study, the percentages of patients initiating insulin by years one through six were 3.6, 8.4, 12.9, 17.7, 22.4, 26.6 for patients taking JANUVIA; and 4.1, 9.4, 14.6, 21.0, 27.1, 34.1 for patients taking a sulfonylurea. An analysis of the data overall (Kaplan-Meier method) showed that patients taking JANUVIA progressed more slowly to insulin use than patients taking a sulfonylurea (p=0.0034). The Cox proportional hazard regression analysis indicated that by year six, patients in the JANUVIA group were 24 percent less likely to initiate insulin during the period of observation compared to patients taking a sulfonylurea (HR = 0.76; p = 0.0011).
Similar results were observed in the sub-group of patients with a baseline A1C of less than 9 percent (HR = 0.77; p = 0.0128]; however there was no statistically significant difference in time to insulin initiation in the sub-group with a baseline A1C of greater than or equal to 9 percent (HR = 0.75; p = 0.1818).
MedicalResearch.com: Interview with Tapan Mehta, Ph.D.
School of Health Professions
University of Alabama at Birmingham
MedicalResearch: What are the main findings of the study?Dr. Mehta: Grade 1 obesity’s (body mass index [BMI] 30 to < 35) association with reduced longevity has lessened over calendar time for older white men (age >60) but not for younger middle aged (age ≤60) men. For white women, there is evidence of a decline in the association of obesity, both for Grade 1 obesity and grade 2-3 obesity (BMI ≥35), with reduced longevity across all adult ages.
To the extent that these associations can be taken as indicators of causation, this implies that the harmfulness of obesity-mortality association has declined over calendar time in white women across all ages. However, the decline in the harmfulness of obesity-mortality association is limited to older grade 1 obese white men.
MedicalResearch.com: Interview with:Dr. Patrick Le Goux
Rheumatologist Hôpitaux universitaires Paris Ouest France
French Tennis Federation medical staff
MedicalResearch: What are the main findings of the study?Dr. Le Goux: The therapeutic effect of platelet-rich plasma (PRP) of two ultrasound guided PRP injections at 4 weeks interval compared to two saline injections (as placebo or treatment of reference) is similar on a visual analogic scale for epicondylitis of recent evolution (3 months duration maximum) in a prospective randomized double blind study with 12 months follow up. We have no intrinsic or inherent benefit of the PRP injections.
MedicalResearch.com Interview withDr. Stuart Gordon MD
Henry Ford Hospital
Detroit, MI 48202.
MedicalResearch: What are the main findings of the study?Dr. Gordon: In a large American cohort of Hepatitis B patients, those who took antiviral therapy had a significantly lower risk of developing liver cancer than those who did not take such therapy.
MedicalResearch.com Interview with:Julio A. Chirinos, MD, PhD
Assistant Professor of Medicine
Director, CTRC Cardiovascular Phenotyping Unit
Perelman School of Medicine, University of Pennsylvania
Director of Non-Invasive Imaging
Philadelphia VA Medical Center
MedicalResearch: What are the main findings of the study?Dr. Chirinos: The main findings of the study is that, among patients with obesity and moderate to severe obstructive sleep apnea, obesity, rather than OSA, appears to be the primary cause of inflammation, insulin resistance and dyslipidemia. However, both obesity and obstructive sleep apnea appear to be causally related to hypertension. In this population, weight loss, but not CPAP, can be expected to reduce the burden of inflammation, insulin resistance and dyslipidemia. However, CPAP, among patients who comply with therapy, can be expected to provide a significant incremental benefit on blood pressure. The latter is an important potential benefit of CPAP and should not be disregarded.
MedicalResearch.com Interview with: Evan Thacker PhD
Brigham Young University
MedicalResearch: What are the main findings of the study?Dr. Thacker:In this study of over 17,000 American adults aged 45 and above, we first measured people’s cardiovascular health based on their smoking habits, diet, physical activity, body weight, blood pressure, blood cholesterol, and blood sugar. We then tracked these people for several years with cognitive function tests which measure memory and thinking abilities. The main finding of our study was that people who had the lowest levels of cardiovascular health at the beginning of the study were more likely to experience cognitive impairment – poor performance on the cognitive function tests – at the end of the study. People who had medium to high levels of cardiovascular health were less likely to experience cognitive impairment.
MedicalResearch.com Interview with:
Dr. Marcus de Goffau and Dr. Hermie HarmsenDepartment of Medical Microbiology
University Medical Center Groningen
MedicalResearch: What are the main findings of the study?Dr. Marcus de Goffau: In this study we aimed at analysing the gut microbiota composition of children aged 1–5 years with new-onset type 1 diabetes with the microbiota of age-matched healthy controls with a 16S rRNA based method (HITChip). The reason for this selection is that the increase in the incidence of type 1 diabetes worldwide is particularly sharp under the age of 5 years; recent studies indicate that adverse changes in gut microbiota are associated with the development of type 1 diabetes, but little is known about the microbiota in children who have diabetes at an early age. In this study we found that the differences between healthy controls and diabetics change over time, highlighting the importance of a normal gut microbial development. Diabetic children younger than 3 years old often had lower numbers of the Clostridium clusters XIVa and IV, which contain many of the beneficial butyrate producers, than their healthy age-matched controls. The diabetic children older than 3 years have normal numbers of Clostridium clusters XIVa and IV yet not the right species composition; the ones which produce butyrate were underrepresented. The development of the microbiota of diabetic children appears to be one step behind that of healthy controls and/or appears to be going into an aberrant direction. The abundances of other bacteria such as Bacteroides and streptococci were also found to be aberrant in diabetic children.
MedicalResearch.com Interview with: Emma Maund, PhD student
Nordic Cochrane Centre
MedicalResearch: What are the main findings of the study:
Answer: For statisticians to analyse adverse events recorded in a clinical trial, it is necessary that events described by the original investigators are coded to terms in a specialised medical coding dictionary. Our study assessed the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports of nine randomised controlled trials of duloxetine for the treatment of major depressive disorder. Trials used either the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) or the larger and more recent dictionary MedDRA (Medical Dictionary for Regulatory Activities). We found suicides were clearly identifiable in all formats of adverse event data. Suicide attempts in tables included both definitive and provisional diagnoses. Suicidal ideation and preparatory behaviour were obscured in some tables owing to the lack of specificity of the medical coding dictionary, especially in trials using COSTART where the closest matching term available was depression.
MedicalResearch.com Interview with: Christian Benedict PhD
Department of Neuroscience
MedicalResearch: What are the main findings of the study?Dr. Benedict: By utilizing blood samples collected after an overnight fast, we demonstrated that humans carrying a common risk variant of the fat mass and obesity gene (obesity-associated gene (FTO)) (~16% of the population have two copies of this risk variant) had higher fasting blood concentrations of the hunger hormone ghrelin. In contrast, fasting serum levels of the satiety enhancing hormone leptin were lower.
MedicalResearch.com Interview with Dr. Takuji Toyama MD
Division of Cardiology
Gunma Prefectural Cardiovascular Center
MedicalResearch: What are the main findings of the study? Dr. Toyama: The early start of granulocyte colony-stimulating factor (G-CSF) therapy in acute myocardial infarction ( AMI) patients can improve myocardial perfusion, fatty acid metabolism and cardiac function in subacute and follow-up periods.
MedicalResearch.com: Interview with:Dr. Hsien Seow PhD
Cancer Care Ontario Research Chair in Health Services Research
Asst Professor, Dept of Oncology, McMaster University
MedicalResearch: Why did you conduct this study?Dr. Seow: While palliative care has gained recognition as a service that can improve patient outcomes and reduce health care costs at the end of life, especially in hospitals and hospices, much less attention has focused on providing inter-disciplinary palliative care in the community and home. There have been several randomized trials that showed mixed evidence that inter-disciplinary teams of specialist palliative care providers can reduce acute care utilization in the community; however team size and team composition varied in prior trials. This variation has not been researched as a cause for the mixed outcomes.
MedicalResearch.com: Interview with: Dr Christian Beyer
Department of Internal Medicine 3 - Rheumatology and Immunology
University of Erlangen-Nuremberg, Germany.
MedicalResearch: What are the main findings of the study?Dr. Beyer: Our study aimed to identify specific micro RNAs as preditors for osteoarthritis. Osteoarthritis is a progressive and long-standing disease. It's early and very early stages are clinically silent, which means that patients do not experience symptoms or present with obvious signs of the disease. Preventive measures and early therapies, however, would be probably most effective in treating this very common condition. Thus, markers to identify individuals at risk for osteoarthritis or in early clinical stages are highly important, but are not available for clinical routine yet. Micro RNAs are group of molecules that have signaling functions in the human body and that can reflect states of disease and health. Since they are very stable and easily accessible in the peripheral blood (by venous puncture without complicated procedures like biopsies), the represent promising biomarkers in many different fields of medicine. In this context, we wondered if specific micro RNAs might predict the development of severe osteoarthritis. Indeed, we could identify thre micro RNAs, named mir-454, mir-885-5p and let-7e, out of a total of 377 micro RNAs, that help to predict the risk for developing severe osteoarthritis.
MedicalResearch.com Interview with: Tetyana Kendzerska MD, PhD
Institute for Clinical Evaluative Science,
Sunnybrook Health Sciences Center, Toronto, ON
MedicalResearch: What are the main findings of the study?Dr. Kendzerska: Based on a large sample of more than 8,500 participants with suspected sleep apnea, our study shows that among people with obstructive sleep apnea (OSA), and controlling for risk factors for diabetes development, initial OSA severity predicted risk for incident diabetes. Measures of the physiologic consequences of OSA (e.g., low level of oxygen, sleep deprivation) were also risk factors for diabetes in this population.
MedicalResearch.com Interview with: William D. Chey, MD, AGAF, FACG, FACP, RFF
Professor of Medicine
Director, GI Physiology Laboratory
Co-director, Michigan Bowel Control Program
University of Michigan Health System
MedicalResearch: What are the main findings of the study?Dr. Chey: Opiate analgesics are the most commonly prescribed medications in the US. GI side effects are common in patients who opiates. Constipation is the most common and most bothersome GI side effect of opiates. Peripherally acting mu opioid antagonists have been shown to benefit a subset of patients with opiate induced constipation. In 2 large, randomized, placebo controlled phase III trials, the peripherally acting, mu-opioid antagonist naloxegol was found to improve constipation in patients taking opioid analgesics for noncancer pain. Response rates were significantly higher with 25 mg of naloxegol than with placebo (intention-to-treat population: study 04, 44.4% vs. 29.4%, P = 0.001; study 05, 39.7% vs. 29.3%, P = 0.02) in both studies. Benefits were seen with the lower 12.5 mg dose in one of the studies (intention-to-treat population, 40.8% vs. 29.4%, P = 0.02). An interesting aspect of this study was the a priori inclusion of patients who had tried and failed to respond to other laxatives prior to enrollment. Response rates in this population were similar to the overall population (patients with an inadequate response to laxatives: study 04, 48.7% vs. 28.8%, P = 0.002; study 05, 46.8% vs. 31.4%, P = 0.01). Pain scores and daily opioid dosing were similar among the three groups before and after treatment.
MedicalResearch.com Interview with:Stephanie F. Polites, MD
Department of Surgery and
Michael B. Ishitani, MD
Department of Pediatric Surgery
Mayo Clinic, Rochester, Minnesota
MedicalResearch: What are the main findings of the study?Answer: Though most injuries were in boys, 20% of the injuries occurred in girls. Extremity fractures and head injuries were the most common injuries with older children and boys more likely to sustain extremity fractures while younger children and girls were more likely to have head injuries or concussions. Life threatening injuries were rare, which is reassuring.
MedicalResearch.com Interview with: Laurie Lambert, PhD
Unité d'évaluation en cardiologie
Institut national d'excellence en santé
et en services sociaux (INESSS)
MedicalResearch: What are the main findings of the study?Dr. Lambert: Patients with ST-elevation myocardial infarction (STEMI) are frequently transferred for percutaneous coronary reperfusion from a hospital without this capability. Favourable outcomes depend on minimizing delays to treatment. A major component of delay is the time from the patient’s arrival at the first hospital’s emergency department to departure to the hospital where percutaneous reperfusion will be performed, the ‘door-in-door-out’ time or DIDO. We characterized this component of delay in a systematic field evaluation of STEMI treatment over a large and populous geographic area.
The major contributors to DIDO time were the delays
(1) from the initial in-hospital ECG acquisition to transfer activation by the emergency physician and
(2) from arrival of the transfer ambulance at the first hospital to departure of the ambulance for the primary percutaneous coronary intervention center. When the DIDO interval was timely (30 minutes or less as recommended by guidelines), reperfusion treatment was far more frequently within guideline-recommended delays (90 minutes or less). In fact, this benchmark of DIDO time was met in only 14% of cases. We identified a number of factors associated with untimely DIDO, an important one being an ambiguous presenting ECG. DIDO times were faster when patients arrived at the first hospital by ambulance particularly when retransfer to the second hospital was with the same ambulance that had remained on standby.
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