MedicalResearch.com Interview with:Dr James J DiNicolantonio PharmD
Ithaca, New York
MedicalResearch.com: What are the main findings of the study?Dr. DiNicolantonio: The increase in the prevalence of diabetes and obesity in the United States occurred with an increase in the consumption of carbohydrate not saturated fat. There is no conclusive proof that a low-fat diet has any positive effects on health (good or bad). The public fear that saturated fat raises cholesterol is completely unfounded as the low-density lipoprotein (LDL) particle size distribution is worsened when fat is replaced with carbohydrate. A public health campaign is drastically needed to educate on the harms of a diet high in carbohydrate/sugar.
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MedicalResearch.com Interview with:Mr. Aneel Bhangu
West Midlands Research Collaborative,
Academic Department of Surgery
Queen Elizabeth Hospital
Birmingham UK
MedicalResearch.com: What are the main findings of the study? Mr. Bhangu: Out study was based on a novel collaborative approach, spanning 95 centres in the UK. It was led by surgical trainees, who form a natural network and work in a rotational pattern. These networks will mature to allow a future of clinical research to be embedded into routine NHS care.
Our study found no increase in complications based on weekend operating. It’s possible that patients present differently at weekends, or that surgeons select less complex patients to operate upon. A key secondary finding is that patients operated on at weekends were less likely to undergo laparoscopy. This means that they are exposed to different processes of care, which may introduce risk. This may be a surrogate marker for other differences in weekend care that require exploration.
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MedicalResearch.com Interview with: Karen Yeung
Professor of Law
Centre for Technology, Ethics Law & Society
King's College London
London WC2R 2LS
MedicalResearch.com: What are the main findings of the study?Professor Yeung: This study found a gap in existing legal regulation of healthcare quality in the UK. While patients receiving treatment under mental health legislation are protected by the criminal law against wilful neglect or ill treatment, other patients are not subject to the same level of protection, although many such patients are just as vulnerable as those who are mentally incapacitated. Hence we argue that a new criminal offence of 'wilful neglect or ill treatment' of patients in the healthcare sector is needed.
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MedicalResearch.com Interview with:Brendan Keating D.Phil
Assistant Professor, Dept of Pediatrics and Surgery, University of Pennsylvania
Lead Clinical Data Analyst, Center for Applied Genomics
Children's Hospital of Philadelphia
Michael V. Holmes, MD, PhD, MSc, BSc, MRCP
Transplant SurgeryDepartment of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
MedicalResearch.com: What are the main findings of the study?Answer:We found that individuals with a genetically-elevated BMI had higher
blood pressure, inflammatory markers, metabolic markers and a higher
risk of type 2 diabetes, although there was little correlation with
coronary heart disease in this study population of over 34,500
European-descent individuals of whom over 6,000 had coronary heart
disease.
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MedicalResearch.com Interview with:Dr Linda Englund-Ögge
Department of Obstetrics and Gynaecology, Institute of Clinical Sciences
Sahlgrenska Academy, Sahlgrenska University Hospital
Gothenburg, Sweden
MedicalResearch.com: What are the main findings of the study?
Answer: Women adhering to a prudent* or a traditional** dietary pattern during pregnancy had a significantly reduced risk of preterm delivery, even after adjusting for a range of confounders. The prudent pattern was also significantly associated to lower risk in the nulliparous, in spontaneous and in late preterm delivery.
*, characterized by high intake of e.g. vegetables, fruit, whole grains and water to drink.
**, characterized by high intake of e.g. boiled potatoes, fish and cooked vegetables.
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MedicalResearch.com Interview with:Holly G. Prigerson, Ph.D.
Irving Sherwood Wright Professor in Geriatrics
Professor of Sociology in Medicine
Co-Director, Center for End-of-Life Research
Weill Cornell Medical College
New York Presbyterian Hospital
New York City, New York 10065
MedicalResearch.com: What are the main findings of the study? Dr. Prigerson: The main outcome of the research was end-of-life treatment and location of death with secondary outcomes being length of survival, late hospice referrals and attainment of preferred place of death. We found that 56 percent of patients receiving palliative chemotherapy in their final months. Patients treated with palliative chemotherapy were five to 10 times more likely to receive intensive medical care and to die in an intensive care unit (ICU). Fewer than half died at home as compared with two-thirds of patients with metastatic cancer not treated with palliative chemotherapy.
More specifically, we found that palliative chemotherapy was associated with:
Increased use of CPR and mechanical ventilation: 14% versus 2%
Late hospice referral: 54% versus 37%
Death in an ICU: 11% versus 2%
Death away from home: 47% versus 66%
Death away from their preferred place: 65% versus 80%
Survival did not differ significantly between patients who received palliative chemotherapy and those who did not (hazard ratio 1.11, 95% CI 0.90-1.38). Additionally, patients receiving palliative chemotherapy were less likely to acknowledge their illness as terminal (35% versus 49%, P=0.04), to have discussed end-of-life wishes with a physician (37% versus 48%, P=0.03), and to have completed a do-not-resuscitate order (36% versus 49%, P<0.05).
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MedicalResearch.com Interview with:Dr Julia Brotherton
Victorian Cytology Service, Melbourne, Victoria, Australia
Dr Elizabeth Crowe
The University of Queensland, School of Population Health, Brisbane, Australia
NHS Borders, Department of Public Health, Melrose, Scotland, UKProf. David Whiteman
Group Leader / Department Coordinator
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital, QLD 4029
MedicalResearch.com: What are the main findings of the study?
1. We conducted a case-control study in which we retrieved the HPV vaccination histories of young Australian women who were notified to the Pap smear registry with high-grade cervical lesions or with other types of cervical lesions, and compared them with the vaccination histories of women whose Pap smears showed only normal cytology.
2. We found that women with high grade cervical lesions were significantly less likely than women with normal cytology to have received 3 doses of the quadrivalent HPV vaccine, equivalent to a vaccine effectiveness of 46%.
3. The vaccine effectiveness among 15-19 year old women was even higher at 57%. We believe this reflects the fact that HPV16 causes an even higher proportion of high grade disease in young women due to its higher oncogenicity and shorter latent period.
4. The HPV vaccine had 34% effectiveness against other cervical lesions (i.e. those not proven to be high grade lesions on histology).
5. We also observed that 2 doses of the vaccine were 21% effective in preventing both high grade lesions and other grade lesions.
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MedicalResearch.com Interview with: Juan Jesus CarreroPhD (Pharm and Med)
Associate Professor in Renal Medicine
Karolinska Institutet, Sweden.
MedicalResearch.com: Why did you choose to study this particular question?Answer: We chose this question because there is currently an important knowledge gap regarding safety and effectiveness of common drugs in individuals with chronic kidney disease. Because kidney dysfunction interferes with drug metabolism and drug elimination, patients with kidney dysfunction have traditionally been excluded from randomized controlled trials. Yet, practice guidelines are afterwards extrapolated to those in the absence of formal evaluation.
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MedicalResearch.com Interview with: Scott D. Holmberg, MD, MPH
Chief, Epidemiology and Surveillance Branch
Division of Viral Hepatitis.
MedicalResearch.com: What are the main findings of the study?Dr. Holmberg:Based on interview and testing of over 30, 000 National Health and Nutrition and Examination Survey (NHANES) participants from 2003 to 2010, 273 US residents or about 1%, are chronically (actively) infected with hepatitis C virus (HCV). This translates to about 2.7 million chronic HCV-infected persons in the non-institutionalized population.
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MedicalResearch.com Interview with: Mary-Ann Fitzcharles, MB, ChB, MRCP(UK), FRCP(C)
McGill University Health Centre
Division of Rheumatology and Alan Edwards Pain Management Unit
MedicalResearch.com: What are the highlights of your review?Dr. Fitzcharles: Thank you for your interest in the review article which will shortly be published in Arthritis Care & Research. This was not a research study but rather a review focused towards the use of herbal cannabis for patients with rheumatic diseases.
The essence of our message after a thorough review of the literature is that there is not a single study published regarding efficacy or side effects of herbal cannabis in the rheumatic diseases. It is notable that almost 2 thirds of persons using herbal cannabis for therapeutic reasons report use for musculoskeletal complaints. In the 21st century, we cannot rely upon heresay or anecdote to justify use of a treatment intervention. It is unacceptable to recommend use of a substance without knowledge of concentration of molecules in the product, any knowledge of blood concentrations that might have a positive or negative effect, and formal study in defined patient populations with acceptable endpoint criteria and evidence for short and long term risks.
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MedicalResearch.com Interview with:Sameer Saini MD
Veterans Affairs Center for Clinical Management Research,
VA Ann Arbor Healthcare System
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
MedicalResearch.com: What are the main findings of the study?Dr. Saini: The way that quality measures are defined can have important implications for how care is actually delivered. Current colorectal cancer screening quality measures use age to identify screen-eligible patients, encouraging screening in patients between 50 and 75 years of age. But they do not explicitly incorporate health status. In this context, our study had two main findings.
First, by focusing on age alone, we are not screening everyone who is likely to benefit. Specifically, many healthy people over 75 years of age (who are outside the target age range of the quality measure) may benefit from screening, but the current measure does not encourage screening in this population, leading to low screening use.
Second, some people who are NOT likely to benefit are being screened unnecessarily, like those with serious health problems. For example, people between ages 70-75 with serious health problems (who have limited life expectancy) are unlikely to benefit from screening, and may even be harmed by it. But the current quality measure encourages screening in such individuals due to their age, yielding relatively high screening rates. If the system focused on age and health status (rather than age alone), screening use would be more aligned with screening benefit, and we would have better health outcomes.
MedicalResearch.com Interview with: Dr. Laurie K. Twells, PhD
School of Pharmacy, Memorial University, St. John’s
Faculty of Medicine, Memorial University
St. John’s Newfoundland and Labrador
MedicalResearch.com: What are the main findings of the study?Dr. Twells: Obesity rates in Canada tripled between 1985 and 2011. Although class I obesity (BMI ≥ 30) appears to have increased at a slower rate, obese classes II (BMI ≥ 35) and III (BMI ≥40) continued to increase disproportionately. Over the last decade, every province in Canada experienced increases in obesity rates. Overall obesity rates were lower in the west and higher in the eastern provinces and people over age 40 years were more likely to be overweight/obese than younger people. By 2019 it is projected that twenty-one per cent of Canadians will be obese but this will vary by province from 15.7% in British Columbia to 34.6% in Newfoundland and Labrador.
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MedicalResearch.com Interview with:Professor Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology
Director of the Center for Health Outcomes and Policy Research
Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
MedicalResearch.com:Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. Against that backdrop, can you start by letting us know the background of the study?
Prof. Aiken: European Surgical Outcomes Study in 28 countries showed higher than necessary deaths after surgery.
A comparable study in the US showed that despite the nation spending hundreds of millions of dollars on improving patient safety, there were no improvements in adverse outcomes after surgery in US hospitals between 2000 and 2009. Clearly it is time to consider new solutions to improving hospital care for surgical patients, who make up a large proportion of all hospital admissions. Our study was designed to determine whether there are risks for patients of reducing hospital nurse staffing, and what, if any, are the benefits to patients of moving to a more educated nurse workforce. (more…)
MedicalResearch.com Interview with:Dr. Vincent Yi-Fong Su
Department of Chest Medicine
Taipei Veterans General Hospital
Taipei, Taiwan
MedicalResearch.com: What are the main findings of the study?Answer: We found interestingly that patients with sleep apnea experienced a 1.20-fold (95% CI, 1.10-1.31; p <0.001) increase in incident pneumonia compared to patients without sleep apnea. We also demonstrated an “exposure-response relationship,” in that the patients with more severe sleep apnea might have a higher risk for pneumonia than did those of milder severity.
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MedicalResearch.com Interview with: Dr. Jill A Poole MD
Pulmonary, Critical Care, Sleep, and Allergy Division, Department of Medicine
College of Medicine, University of Nebraska Medical Center
The Nebraska Medical Center, Omaha, Nebraska
MedicalResearch.com: What are the main findings of the study?Dr. Poole: Our study found that adding vitamin D 4000 IU daily to a cocktail of anti-allergy medications resulted in a further 40% reduction in hive symptom scores at 3 months. There was no further reduction in hive symptoms when 600 IU of vitamin D was added to the anti-allergy medications. The anti-allergy regimen utilized was triple drug therapy with cetirizine (twice daily), ranitidine (twice daily), and montelukast (once daily). No adverse reactions occurred.
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MedicalResearch.com Interview with:Dr. Kendra J. Grim
Department of Anesthesiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch.com: What are the main findings of the study? Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent. Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “
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MedicalResearch.com Interview with:Dr. Susan N. Hocevar MD
Centers for Disease Control and Prevention
Atlanta, GA 30333;
MedicalResearch.com: What are the main findings of the study?
Dr. Hocevar: This public health investigation uncovered microsporidiosis transmitted to 3 organ recipients who received organs from a common donor. This illness cluster was the first recognized occurrence of donor-derived microsporidiosis.
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MedicalResearch.com Interview with :Professor Didier Pittet, MD, MS
Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Switzerland
MedicalResearch.com: What are the main findings of the study?Prof. Pittet: The density of bacterial contamination of the stethoscope’s membrane is closely correlated with the density of bacterial counts on the doctor’s fingertips.
This is true for both common skin comensals and multi-resistant nosocomial pathogens such as MRSA.
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MedicalResearch.com Interview with:Dr. Jerome A. Leis, MD, MSc
Sunnybrook Health Sciences Centre
Toronto, ON, M4N 3M5, Canada
MedicalResearch.com: What are the main findings of the study?Dr. Leis: We know that positive urine cultures from patients who lack signs and symptoms of urinary tract infection are a trigger FOR unnecessary antibiotic prescriptions in hospitals. This problem has not improved despite many educational initiatives. We identified a subset of patients in our hospital where only 2% of all urine specimens sent to the laboratory were associated with symptomatic infection and decided to no longer routinely report positive results from these specimens on the electronic medical record, unless a special telephone request was made. We found that with this simple change, unnecessary antibiotic prescriptions declined markedly and this did not require any education of care providers. Most importantly, based on our safety audits, patients who had a urinary tract infection all received appropriate treatment.
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MedicalResearch.com Interview with: Valérie D'Acremont, MD, PhD
Group leader
Swiss Tropical and Public Health Institute | Basel | Switzerland
Médecin-adjointe, PD-MER
Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland
MedicalResearch.com: What are the main findings of the study?Dr. D'Acremont: We discovered that, in a rural and an urban area of Tanzania, half of the children with fever (temperature >38°C) had an acute respiratory infection, mainly of the upper tract (5% only had radiological pneumonia). These infections were mostly of viral origin, in particular influenza. The other children had systemic viral infections such as HHV6, parvovirus B19, EBV or CMV. Overall viral diseases represented 71% of the cases. Only a minority (22%) had a bacterial infection such as typhoid fever, urinary tract infection or sepsis due to bacteremia. Malaria was found in only 10% of the children, even in the rural setting.
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MedicalResearch.com Interview with: Dr. Ido Weinberg MD MSc MHA
Massachusetts General Hospital, Vascular Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Weinberg: The study examined the relationship between blood pressure difference between arms and clinically meaningful outcomes such as death and new-onset (incident) cardiovascular disease including myocardial infarction and stroke. The main finding of the study was that an elevated inter-arm blood pressure difference correlated with these negative outcomes. We have also shown that the correlation was strong enough to be independent from the classic Framingham risk score. Adding an elevated inter-arm blood pressure to the risk score made it a more accurate.
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MedicalResearch.com Interview with: Brian D'Onofrio, PhD
Associate Professor
Department of Psychological and Brain Sciences
Indiana University Bloomington, IN
MedicalResearch.com: What are the main findings of your study?Dr. D'Onofrio: The main finding from our study is that the specific associations between advancing paternal age at childbearing and offspring psychiatric and academic problems were much larger than in previous studies. In fact, we found that advancing paternal age was associated with greater risk for several problems, such as Attention Deficit Hyperactivity Disorder, suicide attempts and substance use problems, whereas traditional research designs suggested advancing paternal age may have diminished the rate at which these problems occur.
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MedicalResearch.com Interview with:Gang Hu, MD, MPH, PhD, FAHA
Assistant professor & Director
Chronic Disease Epidemiology Lab
Adjunct assistant professor, School of Public Health
LSU Health Sciences Center
Pennington Biomedical Research Center,
Baton Rouge, Louisiana
MedicalResearch.com: What are the main findings of the study?Dr. Gang Hu: Our study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years.
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MedicalResearch.com Interview with: Tobias Skillbäck, MD
Clinical Neurochemistry Laboratory
Institute of Neuroscience and Physiology
Department of Neurochemistry, Sahlgrenska Academy
University of Gothenburg Mölndal, Sweden
MedicalResearch.com: What are the main findings of the study?Dr. Skillbäck: There were two main findings in this study.
First; Levels of t-tau and the T-tau/P-tau ratio in CSF of CJD (Creutzfeldt-Jakob Disease) patients are markedly increased, as compared to patients with Alzheimer's disease and other dementias, and they are high enough to distinguish CJD against these important differential diagnoses.
Secondly, levels of these biomarkers tend to increase rapidly with disease progress in Creutzfeldt-Jakob Disease. This trend could not be observed for Alzheimer's disease and other dementias, and could also be used to clinically distinguish CJD and indicates that repeated CSF measurements might be of value if a clinical suspicion of Creutzfeldt-Jakob Diseaseis present.
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MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO
Neurologist, Associate Professor
Department of Neurology
Helsinki University Central Hospital
MedicalResearch.com: What are the main findings of the study? Dr. Strbian: That even if the SEDAN score had the best performance, none of the scores showed better than a moderate performance.
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MedicalResearch.com Interview with: Dr. Ulf Risérus
Associate Professor in Clinical Nutrition
Department of Public Health and Caring Sciences
Clinical Nutrition and Metabolism
Faculty of Medicine, Uppsala university
Sweden
MedicalResearch.com: What are the main findings of the study?Dr. Risérus: It has previously been shown in animal studies that overfeeding polyunsaturated fat causes less fat accumulation than saturated fats, but this study is the first to suggest that this could be true also in humans. Overeating saturated fats caused significantly more accumulation of fat in the liver and intra-abdominally, as compared with overeating polyunsaturated fats from. This study suggests it does matter where the excess calories come from when we gain weight. If a high-caloric diet contains large amounts of saturated fats it seems to switch on some genes that may promote abdominal fat storage and insulin resistance, and thereby result in a more unfavorable fat storage. In contrast, such effects were not seen if the diet was lower in saturated fats but higher in polyunsaturated fats from non-tropical vegetable oils. This study also suggests a novel contributing factor regarding the tendency of some individuals to accumulate fat in the liver and abdomen, i.e. in some people excessive amounts of saturated fat in combination with sugars might induce more fat in their livers and a propensity towards abdominal visceral fat accumulation.
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MedicalResearch.com Interview with: Steven A. Safren, Ph.D., ABPP
Professor of Psychology, Harvard Medical School
Director, Behavioral Medicine, Department of Psychiatry
Massachusetts General Hospital,
Boston, MA 02114
MedicalResearch.com: What are the main findings of the study?Dr. Safren: The main findings of the study are that, in patients with uncontrolled type 2 diabetes and depression, a type of psychological treatment, cognitive behavioral therapy (CBT) that addressed both self-care and depression, resulted in improvements in both depressed mood, self-care, and glucose control. This was a randomized controlled trial, and this cognitive-behavioral treatment worked better than lifestyle adherence and nutrition counseling alone; and the effects were sustained over 8 months.
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