Author Interviews, Cancer Research, JAMA, Surgical Research, Toxin Research / 24.11.2014

MedicalResearch.com Interview with: Naveed Nosrati MD Indiana University School of Medicine Staff Surgeon, Roudebush VAMC Medical Research: What is the background for this study? Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure. Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results. Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance. (more…)
Author Interviews, Emergency Care, Radiology, University of Pittsburgh / 24.11.2014

Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound, Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of MedicineMedicalResearch.com Interview with: Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don't necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices. (more…)
HPV, Vaccine Studies / 24.11.2014

Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science CenterMedicalResearch.com Interview with: Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science Center Medical Research: What is the background for this study? What are the main findings? Dr. Qualls-Hampton: There are currently two vaccines approved by the Food and Drug Administration (FDA)—Gardasil for males and Gardasil and Cervix for females – that protect against the human papilloma virus (HPV). These vaccines are recommended by the ACIP for females ages 9 to 26 years and males ages 9 to 21 years. Both vaccines protect males and females against some of the most common types of HPV.  HPV vaccines are administered in three doses over six months and are considered safe and effective. However, the promise of these vaccines is going unfulfilled as initiation and completion rates for the three doses are suboptimal among females and males. Nationally, although HPV vaccination initiation coverage is increasing, overall vaccine completion rates are at suboptimal levels and below the U.S. Department of Health and Human Services’ Healthy People 2020 initiative target of 80%. Thus, many states are turning to legislative interventions in efforts to increase initiation and completion rates. This study examines HPV vaccination legislative initiatives and their impact, specifically in estimating state legislation’s effects on HPV vaccine initiation, completion and patient care provider recommendations by gender. (more…)
Heart Disease, JAMA / 24.11.2014

Giulio Conte MD Heart Rhythm Management Centre UZ-VUB Brussel, BelgiumMedicalResearch.com with: Giulio Conte MD Heart Rhythm Management Centre UZ-VUB Brussel, Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Conte: The evolution of Brugada syndrome from pediatric to adult age has not been previously evaluated. It has been shown that the electrocardiographic phenotype of Brugada syndrome do not manifest during childhood in the large majority of cases. Drug challenge with ajmaline is recommended to unmask the diagnostic electrocardiogram in patients with family history of Brugada syndrome and normal electrocardiograms. However, the ideal age to perform such screening has not been established yet. With this study we aimed to investigate the clinical value of repeating ajmaline challenge after puberty in pediatric family members with an initial negative drug test. Repeat ajmaline challenge after puberty unmasked Brugada syndrome in 23% of family members with a previously negative drug test. Of the newly positive patients, 30% developed symptoms, 10% ventricular fibrillation and 10% spontaneous Brugada type 1 electrocardiogram. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, OBGYNE / 24.11.2014

MedicalResearch.com Interview with: Karin B. Michels, ScD, PhD Associate Professor of Obstetrics, Gynecology and Reproductive Biology Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Michels: We were interested in studying the long-term effects of oral contraceptive use on mortality. Given the widespread use of oral contraceptives, this is an important question pertaining to millions of women worldwide.  We explored this question in the large Nurses’ Health Study, a cohort of 121,700 women in the US, who have been followed for 38 years. We found that oral contraceptive use does not impact overall mortality. However, breast cancer mortality was slightly increased, especially with long-term use of oral contraceptives. (more…)
Aging, Memory, NYU, Weight Research / 24.11.2014

Stephen D. Ginsberg, Ph.D., Associate Professor Departments of Psychiatry and Physiology & Neuroscience New York University Langone Medical Center Center for Dementia Research Nathan Kline Institute Orangeburg, NY 10962MedicalResearch.com Interview with: Stephen D. Ginsberg, Ph.D., Associate Professor Departments of Psychiatry and Physiology & Neuroscience New York University Langone Medical Center Center for Dementia Research Nathan Kline Institute Orangeburg, NY  10962 Medical Research: What is the background for this study? What are the main findings? Dr. Ginsberg: We tested the hypothesis that long-term calorie restriction positively alters gene expression within the hippocampus, a critical learning and memory area vulnerable in aging and Alzheimer’s disease. To test this hypothesis, we conducted experiments on female mice that were given food pellets 30% lower in calories than what was fed to the control group. The mice ate fewer calories derived from carbohydrates. Analyses were performed on mice in middle and old age to assess any differences in gene expression over time. Our data analysis revealed that the mice that were fed a lower calorie diet had fewer changes in approximately 900 genes that are linked to aging and memory. (more…)
Author Interviews, Hospital Readmissions, UCSD / 24.11.2014

MedicalResearch.com Interview with: Ralitza P. Parina, MPH, Senior medical student John Rose, MD MPH Department of Surgery at University of California San Diego Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the association between hospital 30-day readmission rates and 30-day mortality rates. While readmission rates are coming into increasing focus with CMS reimbursement cuts for hospitals with higher than expected rates, they remain a poorly studied metric of quality. High readmission rates have been unequivocally tied to increased costs, but it remains unclear whether they actually represent poor quality of care and worse outcomes for patients. We chose to compare readmission rates as a quality metric to the well-established “gold standard” of mortality. We found that 85% of hospitals did not show a correlation between readmission and mortality, i.e. their rates were not both high or both low. Furthermore, among hospitals that were outliers in at least one of the measures, almost a third were in the category of low or normal readmission rates with higher than expected mortality. The implications are twofold: first, readmission and mortality rates are not strongly correlated. Second, focusing on readmission rates as an outcome will miss a large number of poorly performing hospitals with higher than expected mortality rates but low or expected readmissions. (more…)
Author Interviews, Melanoma / 23.11.2014

Gery P. Guy Jr., PhD, MPH, Health economist CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch.Medical Research.com Interview with: Gery P. Guy Jr., PhD, MPH, Health economist CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch. Medical Research: What is the background for this study? Dr. Guy: Skin cancer is the most commonly diagnosed cancer in the United States and is a growing public health problem. Melanoma, the deadliest form of skin cancer, is responsible for more than 12,000 deaths each year and is diagnosed in over 70,000 people per year. The number of skin cancer cases continues to increase every year, however little is known about the economic burden of treatment. The purpose of our study was to examine trends in the number of people treated for skin cancer and the cost of treatment. (more…)
Addiction, Author Interviews, Mental Health Research, University of Pittsburgh, Weight Research / 23.11.2014

Michele D. Levine Ph.D. Associate Professor of Psychiatry and Psychology Western Psychiatric Institute and Clinic Department of Statistics, University of Pittsburgh, Pittsburgh PAMedicalResearch.com Interview with: Michele D. Levine Ph.D. Associate Professor of Psychiatry and Psychology Western Psychiatric Institute and Clinic Department of Statistics, University of Pittsburgh, Pittsburgh PA Medical Research: What is the background for this study? What are the main findings? Dr. Levine: Many women quit smoking as a result of pregnancy.  However, psychiatric disorders, which are prevalent among smokers can contribute to weight gain.  Thus, we sought to examine the relationship between maternal psychiatric disorders and gestational weight gain in a sample of pregnant former smokers. Results from the present study demonstrate that the rates of psychiatric disorders were high among pregnant former smokers and that more than half of women gained more weight than recommended by the IOM.  Although a history of having had any psychiatric disorder was not associated with gestational weight gain, a history of alcohol use disorder specifically was positively related to gestational weight gain. (more…)
Author Interviews, Memory, Nature / 23.11.2014

Vijay Ramanan, PhD Indiana University Center for Neuroimaging (CfN) Department of Radiology Indianapolis, IN 46202MedicalResearch.com Interview with: Vijay Ramanan, PhD Indiana University Center for Neuroimaging (CfN) Department of Radiology Indianapolis, IN 46202 Medical Research: What is the background for this study? What are the main findings? Dr. Ramanan: Impairment in episodic memory is one of the first clinical deficits in early Alzheimer’s disease, the most common cause of dementia.  Among other examples, this might be reflected as an inability to recall an article recently read or as difficulty remembering what one had for dinner last night.  Unfortunately, the genetic and environmental mechanisms underlying these deficits are not fully understood.  Our goal was to discover new genes and pathways underlying memory performance to help identify potential drug targets for protecting against and ultimately reversing memory loss in dementia and normal aging. Through studying a large representative sample of older Americans, we discovered a variant (single nucleotide polymorphism or SNP) in the FASTKD2 gene associated with better memory performance and replicated this finding in independent samples.  We then integrated additional data to extend our understanding of the effect of this SNP.  For example, we know that the hippocampus is a vital brain structure for encoding and retrieving memories and it is well-understood that decreased hippocampal volume is a key early marker of Alzheimer’s disease and one that can be measured noninvasively through magnetic resonance imaging (MRI).  We predicted that this new memory-protective SNP would be associated with increased hippocampal volume and this turned out to be true.  We also discovered that carriers of this memory-protective SNP exhibited lower levels of proteins involved in cell death in the cerebrospinal fluid bathing the brain and spinal cord, a striking finding given that FASTKD2 encodes a protein that appears to promote apoptosis (i.e., programmed cell death).  Together, these convergent findings are consistent with a neuroprotective effect of this novel SNP discovery.  More broadly, our results nominate FASTKD2 and its functional pathways as potential targets for modulating neurodegeneration to combat memory loss in older adults. (more…)
Author Interviews, Flu - Influenza, Vaccine Studies / 23.11.2014

MedicalResearch.com Interview with: Maryam Darvishian MSc Department of Epidemiology, University Medical Center Groningen, Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, and  Prof Edwin R van den Heuvel Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, Netherlands Medical Research: What is the background for this study? Reply: In most developed countries, seasonal influenza vaccine is the standard care for elderly people, but there exists still discussions on whether vaccination is effective. Conducting RCT is not considered ethical and thus the main body of evidence comes from observational studies. Unfortunately, these studies (e.g. cohort studies) are susceptible to different sources of biases especially selection bias which makes it difficult to judge the effectiveness. In recent years test-negative design (TND) studies has been designed. It is a special type of case-control study which would limit the bias, due to similar health care-seeking behavior in cases and controls. The current study is a meta-analysis of TND case-control studies. It is the first meta-analysis of this type of studies and also the first meta-analysis that combined 35 studies for estimation of influenza vaccine effectiveness. More specifically, the meta-analysis assesses the influenza vaccine effectiveness against laboratory-confirmed influenza (LCI) among the elderly population. (more…)
Emergency Care, Heart Disease / 23.11.2014

Michael J. Ward, MD, MBA K12 Scholar Assistant Professor Vanderbilt University Department of Emergency Medicine Nashville, TN 37232MedicalResearch.com Interview with: Michael J. Ward, MD, MBA K12 Scholar Assistant Professor Vanderbilt University Department of Emergency Medicine Nashville, TN 37232 Medical Research: What is the background for this study? What are the main findings? Dr. Ward: The number of Americans living with cardiovascular disease is only expected to increase in the coming years.  However, we do not know the national effects of increased medication use and preventive efforts to stop the most serious form of a heart attack, called an ST-elevation myocardial infarction (STEMI). In particular, there are no estimates of how often this serious form of a heart attack shows up in the emergency department. Between 2006 and 2011 we found an average of 258,000 STEMIs annually in the U.S. or 8.7 per 10,000 U.S. adults per year. Interestingly, the number of STEMIs has decreased by more than 70,000 per year over this time, a 24% reduction. We found similar annual decreases across every age group and geographic region in the U.S. The decreases were most pronounced among those 85 years and older and in the Midwest. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition / 23.11.2014

MedicalResearch.com Interview with: Wenjie Ma MS Doctoral Student Harvard School of Public Health Medical Research: What is the background for this study? What are the main findings? Response: De novo lipogenesis (DNL) is the process whereby excess carbohydrate and protein are converted into saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs). Emerging animal and in vitro evidence suggests that DNL might play an important role in metabolic regulation and influence the pathogenesis of type 2 diabetes. We used circulating biomarkers SFAs and MUFAs to investigate the prospective associations with incident diabetes in the Cardiovascular Health Study, a community-based cohort of older US adults. We found that circulating palmitic acid and stearic acid were associated with higher risk of incident diabetes, whereas vaccenic acid was associated with lower risk. In contrast, dietary intakes of saturated fatty acids and monounsaturated fatty acids were not associated with diabetes risk. (more…)
Memory, Sleep Disorders, University of Pennsylvania / 22.11.2014

MedicalResearch.com Interview with: Jennifer Choi Tudor, Ph.D. Postdoctoral Fellow Ted Abel Lab Department of Biology 10-17 Smilow Center for Translational Research Philadelphia, PA 19104 Medical Research: What is the background for this study? What are the main findings? Dr. Tudor: We (Dr. Tudor, Dr. Abel, and colleagues) are interested in better understanding the molecular changes that occur with sleep deprivation.  Previously, we found that the expression of over 500 genes changes with sleep deprivation and that many of the genes were involved with protein synthesis.  Upon further investigation, we found that 5 hours of sleep deprivation impairs protein synthesis in the hippocampus, a brain region critical for memory.  This impairment is due to changes in mammalian target of rapamycin (mTOR) signaling and eukaryotic initiation factor 4E binding protein 2 (4EBP2) is critical to this process.  When we boosted levels of 4EBP2 in the hippocampus, mice that were sleep deprived were resistant to the detrimental effects of sleep deprivation on memory. (more…)
University Texas / 22.11.2014

MedicalResearch.com Interview Invitation with: Dr. Heekyeong Park Assistant Professor of Psychology University of Texas at Arlington Medical Research: What is the background for this study? What are the main findings? Dr. Park: This study shows that music experts with extensive musical training may have altered neural processing related to improved memory. There has been much interest in the beneficial effects of musical training on cognition. Notably, musical training has been reported to boost processing of verbal material. Previous studies have indicated that musical training was related to superior verbal working memory and that these differences in musical training were associated with differences in neural activity in brain regions important for verbal processing. However, it was not clear whether musical training impacts memory in general, beyond working memory for verbal items. By recruiting professional musicians with vast instrumental training, we investigated if extensive musical training has a broad impact on memory with corresponding changes in the brain. For this study, we compared highly trained musicians (10+ years of experience) and individuals with little or no formal musical training on working memory and long-term memory tasks. Each memory task included both verbal and pictorial items. We measured memory accuracy on tasks and scalp-recorded changes in the brain’s electrical activity (ERPs) while participants studied and remembered items. Musicians showed enhanced performance on the working memory task for both words and pictures. For the long-term memory task, musicians also remembered studied pictures better than non-musicians. These behavioral findings demonstrate the relationship between extensive musical training and improved memory broadly. ERP waveforms were also different between musicians and non-musicians while they performed long-term memory tasks. (more…)
Flu - Influenza, Heart Disease / 21.11.2014

MedicalResearch.com Interview with: Harleen Sandhu, MD MPH Senior Researcher University of Texas Health Science Center at Houston Medical Research: What is the background for this study? What are the main findings? Dr. Sandhu: Previous studies have shown a correlation between seasonal variations and occurrence of acute aortic dissection, however, reasons for such associations are unknown. Seasonal flu activity has been associated with the occurrence of cardiovascular diseases such as acute myocardial infarction in the past. This led us to verify this seasonal correlation in our experience with acute aortic dissection patients and to further investigate if its incidence was associated with flu activity. Our results confirmed the seasonal variation in acute aortic dissection as well as demonstrated a positive correlation with seasonal flu activity. (more…)
Author Interviews, JAMA / 21.11.2014

MedicalResearch.com Interview with: Meera Viswanathan, PhD RTI International, Research Triangle Park North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. Viswanathan: Medications, when used appropriately, can alleviate symptoms. Often, however, they result in side effects, interact with one another, are prescribed incorrectly, or are taken incorrectly. These problems are particularly pronounced for the elderly who may have multiple chronic conditions and may be on numerous medications. We evaluated a variety of research studies and program evaluations regarding a distinct type of health care service known as Medication Therapy Management or “MTM.” The goals of MTM services are to help patients and their clinicians to optimize prescription and nonprescription drug regimens, thereby achieving better health outcomes from drug therapy, and. at the same time to minimize the potential for harms, such as incorrect dosing and duplicate medications. Some have proposed that optimizing drug regimens and preventing adverse drug events may reduce health-care-related costs. Medication Therapy Management services are most often provided directly to patients by pharmacists. Sometimes the same pharmacists who dispense medications to patients offer Medication Therapy Management services as well; in other models, pharmacists working in a nondispensing role within a health care system, health insurance plan administering a prescription drug benefit program, or a centralized pharmacy call center may offer such services Although Medication Therapy Management can vary quite substantially in specifics, Medication Therapy Management programs in general share common elements; these include medication therapy review of all prescription drugs, over-the-counter products, and herbal or dietary supplements; patient education and counseling to solve issues with the drug regimen that a patient may be experiencing, such as side effects or difficulty remembering to take medications; and coordination and communication with the prescribing provider. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allowed Medicare to expand access to Medication Therapy Management services for selected patients through Medicare Part D prescription drug benefits. (more…)
Heart Disease / 21.11.2014

Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical CenterMedicalresearch.com Interview with: Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical Center MedicalResearch.com: What are the main findings of this study? Dr. Rabbat : Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and is responsible for significant morbidity and mortality. Epidemiologic data suggest that obesity as measured by one’s BMI is a risk factor for Atrial fibrillation. But there is more to the story. What may be even more important than overall BMI is how much fat you have around the heart. There are many individuals who, as measured by their BMI, are not considered obese, but they have high volumes of fat around their heart, which may have been a major cause for their atrial fibrillation. Therefore, simple measures such as BMI may fail to completely inform us of a patient’s true CV risk. In a previous study we found that epicardial adipose tissue (EAT), or the fat around the heart, has been associated with the presence and severity of AF independent of known risk factors and body mass index (BMI). The inflammatory mediators released from the fat are metabolically active, and may promote fibrosis in adjacent heart muscle. Fibrosis of the left atrium appears to be a hallmark feature of atrial fibrillation and higher amounts of fibrosis are linked to recurrence of atrial fibrillation. New innovations in cardiac magnetic resonance imaging (CMR) allow LA fibrosis and EAT to be precisely quantified. Our current study is the first of its kind to demonstrate the association of EAT volume and extent of LA fibrosis in human AF independent of LA size, BMI, and other AF risk factors. (more…)
NYU, Pain Research, Pediatrics / 21.11.2014

MedicalResearch.com Interview with: Regina Marie Sullivan PhD Professor Child and Adolescent Psychiatry Nathan Kline Institute The Child Study Center at NYU Langone Medical Center Department of Child and Adolescent Psychiatry One Park Ave 8th Floor, New York, NY 10016 Medical Research: What is the background for this study?  Dr. Sullivan: Managing pain during medical procedures in a critically important issue in medicine today. Our study was designed to better understand one method of reducing pain in young infants - having the caregiver be in contact with the baby during the painful procedure, which reduces the infant's behavioral response to the medical procedure. This study explored the neural basis of the ability of the caregiver to reduce the pain response. (more…)
Author Interviews, General Medicine, Heart Disease, Lipids / 21.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices.  Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines. We used the PINNACLE registry to conduct our investigation.  Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S.  We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients.  We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren't currently prescribed them.  We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren't currently recommended for cholesterol treatment.  Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines. (more…)
Author Interviews, CDC, Pediatrics, Pulmonary Disease / 21.11.2014

MedicalResearch.com Interview with: Dr. Wanjun Cui, MS PhD Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? What are the main findings? Authors’ response: Asthma is a leading chronic disease among adolescents that adversely affects their health. However, it is unclear how asthma influences their perceived health or health-related quality of life (HRQOL). Because their perceptions of their health may differ from those of their caregivers (such as parents or health professionals), knowing how adolescents with asthma would rate their own health is very important. Our study compares the responses of adolescents with and without asthma about different aspects of HRQOL including their overall health, their recent physical health, their recent mental health, and their recent activity limitations due to health. Unlike previous U.S. studies based on small clinical samples, our study used a nationally representative sample of U.S. adolescents that can be generalized to the whole U.S. adolescent population. We found that asthma is adversely associated with almost all these aspects of HRQOL but only among those with asthma and current symptoms such as wheezing and dry cough. Adolescents with asthma without current symptoms did not report significantly worse HRQOL than those without asthma. For example, compared with those who never had asthma, adolescents with asthma and symptoms of dry cough or wheezing reported significantly more fair or poor self-rated health (14% vs. 8%), 34% more recent physically unhealthy days , and 26% more recent mentally unhealthy days. More importantly, adolescents with asthma who currently smoked cigarettes or reported limited physical functioning reported even worse physical and mental HRQOL. (more…)
Emergency Care, Heart Disease / 21.11.2014

Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of ArizoneaMedicalResearch.com Interview with: Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of Arizona Medical Research: What is the background for this study? What are the main findings? Dr. Bobrow: Out-of-Hospital Cardiac Arrest is a leading cause of death worldwide. There are nearly half a million EMS-assessed Out-of-Hospital Cardiac Arrest s in the United States annually. Bystander CPR (B-CPR) before arrival of EMS can double or even triple survival from OHCA. Yet it occurs in only 1/3 of cases. Telephone CPR - the provision of B-CPR with a 9-1-1 telecommunicator's instructions - is independently associated with increased rates of Bystander CPR and patient survival and requires almost no capital investment. For this reason, we believe Telephone CPR may be THE most effective and efficient way to move the needle on OHCA survival. In order to achieve this potential, however, EMS systems must adopt the latest guideline recommendations for T-CPR and continuously measure system performance. Very few systems do this. The aim of our project was to do just this at multiple 9-1-1 centers in Arizona. We implemented the guidelines and measured the impact on process metrics and patient outcomes. Our findings confirmed what we expected: a significant increase in the proportion of cases where T-CPR was performed, a significant reduction in time from call-receipt to first bystander chest compression, and, most importantly, significant increases in patient survival and survival with positive neurologic outcome. (more…)
Baylor College of Medicine Houston, Rheumatology / 20.11.2014

Dr. Grace Hsiao-Wei Lo Baylor College of Medicine Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine Faculty, Immunology, Allergy, and Rheumatology Section, Michael E. DeBakey VA Medical CenterMedicalResearch.com Interview with: Dr. Grace Hsiao-Wei Lo Baylor College of Medicine Assistant Professor, Section of Immunology, Allergy and Rheumatology,  Department of Medicine, Baylor College of Medicine Faculty, Immunology, Allergy, and Rheumatology Section, Michael E. DeBakey VA Medical Center Medical Research:What is the background for this study? What are the main findings? Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee.  There is concern that chronic repetitive loading of the knee could physically damage structures within the knee.  Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis.  Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable.  Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality. To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6.  Twenty-nine percent of the participants reported that they ran at some time in their lives. Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older. Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA. After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded.  (more…)
Author Interviews, Breast Cancer, JAMA, Surgical Research, Vanderbilt / 20.11.2014

MedicalResearch.com Interview with: Dr. Kristy Lynn Kummerow MD Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center Tennessee Valley Healthcare System, Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center Nashville, Tenn Medical Research: What is the background for this study? What are the main findings? Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer.  It is helpful to understand the historical context of how we treat early breast cancer.  Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area.  Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation.  In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer.  However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women.  This has been found in other institutions as well, and is supported by smaller national studies.  We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States. (more…)
Allergies, Author Interviews, Pediatrics / 20.11.2014

MedicalResearch.com Interview with: Maria Pesonen MD, PhD Specialist in Dermatology Assistant Chief Medical Officer Finnish Institute of Occupational Health Occupational Medicine Helsinki, Finland Medical Research: What is the background for this study? What are the main findings? Dr. Pesonen: Skin prick test is a widely used, established methods in assessing immediate (i.e. immunoglobulin E-mediated) sensitization. However, the knowledge on long-term reproducibility and predictive value of skin prick testing in children has been limited. We assessed the predictive value of skin prick testing in the setting of a follow-up study on healthy, unselected newborns, who were followed up to age 20 years with skin prick testing with 11 common allergens, structured interview and clinical examination at ages 5, 11 and 20 years. The reproducibility of skin prick test positivity at age 5 years was 100% at ages 11 and 20 years, i.e. none of the skin prick positive subjects turned negative during the follow-up. Gaining of new sensitizations to aeroallergens was common. Skin prick test positivity at age 5 years predicted allergic symptoms at ages 11 (sensitivity 28%, specificity 94%) and 20 years (sensitivity 23%, specificity 91%), but not atopic dermatitis. (more…)
Alcohol, Author Interviews / 20.11.2014

MedicalResearch.com Interview with: Kirsten Mehli Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Medical Research: What is the background for this study? Dr. Mehlig: Many studies found that the ‘good’ HDL-cholesterol is associated with lower risk for atherosclerosis, and cardiovascular risk. This finding has not been translated into clinical practice because medical trials with HDL-cholesterol rising medication did rise the HDL-cholesterol but did not prevent CVD. One possible explanation could be that a high level of HDL-cholesterol is but a marker for other factors that truly contribute to reduced cardiovascular risk. One such factor is alcohol consumption, and ethanol intake in grams / day is associated with higher HDL-C in our study, too. Another factor is a certain genotype that has been found to modulate HDL-cholesterol levels. The fact that co-called ‘moderate’ alcohol consumption is beneficial wrt. CVD has been observed and discussed often, and is confirmed in our study. Here, we asked whether the beneficial effect of alcohol was further strengthened by having a favorable CETP genotype wrt. HDL-cholesterol. (more…)
Exercise - Fitness, Kidney Disease / 20.11.2014

Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, ItalyMedicalResearch.com Interview with: Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study. (more…)
Author Interviews, Biomarkers, Lung Cancer / 20.11.2014

Marie-Christine Aubry, M.D. Professor of Laboratory Medicine and Pathology Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with: Marie-Christine Aubry, M.D. Professor of Laboratory Medicine and Pathology Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Minn.   Medical Research: What is the background for this study? What are the main findings? Dr. Aubry: Up to 20% of patients will present with multifocal lung cancer or will develop a second lung cancer.  The main clinical issue is distinguishing between independent primaries from true intrapulmonary metastases since this distinction will drive the therapy of the patient.  Currently no ancillary studies allows for this distinction and the distinction is provider specific based on a combination of clinical, radiologic and pathologic assumptions. Based on our prior research using a method called mate pair sequencing , we observed that the probability of detecting identical chromosomal breakpoints in two unrelated tumors, from 2 different patients was basically zero. Similarly, when assessing different components within a single tumor, we always found identical chromosomal breakpoints between these components.  We thus hypothesized that if two tumors within a patient were related, i.e. true metastasis, we should always find a number of identical chromosomal breakpoints between the tumors. And in contrast, if 2 tumors were truly independent primaries, we should not observe any chromosomal breakpoints in common. We first studied a control group of patients that had 1- a primary lung cancer with a known distant metastasis (usually brain metastasis), 2- two lung cancers of different histologic subtype, adenocarcinoma and squamous cell carcinoma which are accepted as true independent primaries and 3- 1 tumor with different portions of the tumor being analyzed individually and compared as true relatedness. There were thus a total of 11 pairs of tumors with predetermined status of independent primaries versus relatedness (ie metastasis or same tumor).  The mate pair generated data showed a perfect concordance with this status.  We then studied 11 pairs of lung tumors of similar histology (2 adenocarcinomas or 2 squamous cell carcinomas).  The current gold standard for the distinction between independent primaries and intrapulmonary metastasis relies on a pathologist’s comparative morphologic assessment. In order to strengthen this gold standard, 2 pulmonary pathologists independently made this assessment. Interestingly, the pathologists agreed on the status of independent primaries and intrapulmonary metastasis in 9 (of 11) cases demonstrating the shortcomings of this gold standard.  Furthermore, there were discordance between the pathologists’ prediction and the clinicians’ assessment in 3 of the 11 patients and the clinician could not come to a final assessment in 1 patient.  The MP data was concordant with the pathology assessment in 8 of these 9 cases, and supported the pathologists’ prediction in 2 (of the 3) discordance with the clinical assumptions. (more…)
Breast Cancer, Exercise - Fitness / 20.11.2014

MedicalResearch.com: Interview Invitation Dr. Wenji Guo University of Oxford Medical Research: What is the background for this study? Response: Previous studies report increased risk for breast cancer in postmenopausal women who have a higher Body Mass Index (BMI) – a measure of body fat based on height and weight. However, BMI is unable to distinguish between excess weight due to fat rather than muscle. More direct measures of fatness, such as body fat percentage, may be better indicators of disease risk. And although probable evidence for the relationship between physical activity and breast cancer now exists, questions still remain over the role of vigorous compared to lower intensity physical activity. (more…)