MedicalResearch.com Interview with: Tracie A. Caller, MD , MPH
Neurophysiology Fellow
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr., Lebanon NH 03756, USA
MedicalResearch: What are the main findings of the study?Dr. Caller: We identified factors that appeared to increase the risk for a 30 day readmissions in the epilepsy population, which included refractory seizures but also coexistence of nonepileptic seizures and psychiatric comorbidities.
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MedicalResearch.com: Interview with Kay Wang
Academic Clinical Lecturer
Nuffield Department of Primary Care Health Sciences
University of Oxford, Oxford, UK
MedicalResearch: What are the main findings of the study?Dr. Wang: We have found evidence of recent whooping cough infection in 1 in 5 school age children who see their doctor with a persistent cough and in 1 in 6 children who have been fully vaccinated against whooping cough. We have also shown that whooping cough can still cause clinically significant cough in fully vaccinated children.
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MedicalResearch.com Interview with Chenjie Xu PhD
Assistant Professor of Bioengineering
Nanyang Technological University
Singapore 637457
MedicalResearch: What are the main findings of the study?Answer: Keloid is a long-term dermatological scarring disease characterized by disfiguring lesions resulting from overgrowth of dense fibrous tissue. It is also unsightly and can even lead to disfigurement and psychological problems of affected patients. This study investigated the use of microneedle technology in the self-management of keloid lesions. Briefly, we have developed a “wearable” microneedle device for transdermal delivery of an anti-metabolite drug (5-FU) to inhibit the proliferation activity of keloid fibroblast. This study has provided evidence for effective inhibition of keloid fibroblasts in vitro and successful translation of this platform can significantly reduce the cost of keloid treatment and improve the patient compliance.
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MedicalResearch.com Interview with: Dr. Heli Halava:
Departments of Public Health and Pharmacology,
Turku, Finland
MedicalResearch: What are the main findings of the study?Dr. Halava: The associations between lifestyle factors and nonadherence to statin therapy varied by cardiovascular comorbidity status. Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent.
People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence.
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MedicalResearch.com Interview WithDorothy N. Pierce, DNP, MSN, RN, NP-C, CRN, OCN, CBCN
Advanced Practice Nurse
Rutgers Cancer Institute of New Jersey
Rutgers, The State University of New Jersey
New Brunswick, NJ 08901
MedicalResearch: What are the main findings of the study?Answer: The main findings from the study were:
Nineteen patients out of 24 (79%) reported lymphedema (LE) symptoms. Majority reporting symptoms received chemotherapy and were 50 years of age and older.
The most commonly reported symptoms were limb tenderness (n=10), swelling (n=9), firmness/tightness (n=8), numbness (n=6), heaviness (n=5), impaired movement of the shoulder (n=5), and finger (n=4).
Overall, the participants had low to moderate lymphedema knowledge. The mean knowledge score was 11.9 with a range from zero to 20.
Patients beginning radiation therapy for breast cancer often had not received any lymphedema information from health care providers prior to therapy; Lymphedema knowledge is moderate to weak.
MedicalResearch.com Interview with: Wuwei (Wayne) Feng MD MS FANA
Assistant Professor, Department of Neuroscience
Department of Health Science & Research
Medical University of South Carolina Stroke Center
The Center of Rehabilitation Research in Neurological Conditions
MedicalResearch: What are the main findings of the study?Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years).
By way of background:
84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites.
Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001).
This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes.
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MedicalResearch.com Interview with: David Strauss, M.D., Ph.D., Senior Author
Medical Officer
Center for Devices and Radiological Health
U.S. Food and Drug Administration, Silver Spring, Md
MedicalResearch: What are the main findings of the study?Dr. Strauss:The underrepresentation of women in clinical trials for cardiac resynchronization therapy (CRT) devices, as with other devices, has made it difficult to assess differences in the safety and effectiveness of these devices for women vs. men. The FDA is exploring the potential of pooling and analyzing data from multiple trials to bridge the knowledge gap for certain subpopulations (such as women) often underrepresented in medical device clinical trials. By conducting one such meta-analysis, the FDA found that women benefit from cardiac resynchronization therapy (CRT) significantly more than men do.
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MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
MedicalResearch: What are the main findings of the study?Dr. Sui: In the present study, cancer survivors who reported performing resistance exercise (RE) at least 1 day of the week had a 33% lower risk of all-cause mortality compared with individuals who did not report participation in resistance exercise. Further, there was an inverse relationship between resistance exercise and all-cause mortality in those who were physically active, but not in those who were physically inactive. Although leisure-time physical activity was not associated with a lower risk of all-cause mortality, the present results support the benefits of resistance exercise and physical activity was during cancer survival.
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MedicalResearch.com Interview with:Professor Lixin Jiang MD, PhD, F.A.C.C.
National Clinical Research Center of Cardiovascular Diseases
State Key Laboratory of Cardiovascular Disease
Fuwai Hospital, National Center for Cardiovascular Diseases
Beijing , China
MedicalResearch: What are the main findings of the study?Professor Jiang: In this first representative nationwide assessment of quality of care in China, we studied 13,815 hospital admissions for STEMI in 162 hospitals across China over the past decade. We found that the incidence of hospital admission for STEMI quadrupled from 3.7 per 100,000 in 2001 to 15.8 per 100,000 in 2011.
There were substantial changes in testing and treatment patterns. Over the study period, the rate of testing for troponin increased from 21.4% in 2001 to 66.5% in 2011. Additionally, based at the ideal patients’ analysis, the use of several highly effective treatments for STEMI, including aspirin, clopidogrel and statins, improved over the study period. However, other therapies known to reduce mortality in STEMI patients – such as β-blockers and ACE inhibitors – were underused with only 57.7% of patients receiving beta-blockers and 66.1% ACE inhibitors respectively in 2011.
While the proportion of patients receiving reperfusion therapy remained constant, there was a notable shift away from fibrinolysis, which was the primary means of reperfusion in 2001, towards primary PCI. However, in 2011, only 27.6% of patients admitted to Chinese hospitals for STEMI received primary PCI, the gold standard of treatment, while 27.4% received fibrinolytic therapy in the ideal patients.
Despite increasing overall intensity of treatment, procedure use, and testing, no significant change in the rate of in-hospital death from STEMI was seen over the study period. (more…)
MedicalResearch.com Interview with: Benjamin S. Brooke, M.D., Ph.D.
Assistant Professor of Surgery
Division of Vascular Surgery
University of Utah School of Medicine
MedicalResearch: What are the main findings of the study?Dr. Brooke:This study was designed to evaluate whether high-risk surgical patients who visit a primary care provider (PCP) during the early period following hospital discharge are less likely to be readmitted within 30-days. We examined this question by performing a retrospective cohort analysis of Medicare beneficiaries (2003-2010) who underwent a high risk surgery (open thoracic aortic aneurysm repair) as well as a control group of patients who underwent a lower risk surgical procedure (open ventral hernia repair), and then determining whether there was evidence of early PCP follow-up.
In risk-adjusted analyses, we found that early primary care provider-follow-up was associated with a significant lower likelihood of 30-day readmission for high-risk patients undergoing open thoracic aortic aneurysm repair, particularly if a post-operative complication had occurred. In comparison, early primary care provider follow-up did not have a significant effect on lowering readmissions in uncomplicated patients and those undergoing lower-risk operations such as ventral hernia repair.
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MedicalResearch.com Interview with: Prashanthi Vemur, Ph.D.
Mayo Clinic
Rochester, Minnesota
MedicalResearch: What are the main findings of the study?Dr. Vemuri: Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic. We studied two non-overlapping components of lifetime intellectual enrichment: education/occupation-score and mid/late-life cognitive activity measure based on self-report questionnaires. Both were helpful in delaying the onset of cognitive impairment but the contribution of higher education/occupation was larger.
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MedicalResearch.com Interview with: Kay W. Chang, MD
Associate Professor of Otolaryngology and Pediatrics
Stanford University
Department of Otolaryngology
Lucile Packard Children's Hospital at Stanford
Division of Pediatric Otolaryngology
MedicalResearch: What are the main findings of the study?Dr. Chang:At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight.
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MedicalResearch.com Interview with: Regina Shih PhD
Senior Behavioral Scientist at the RAND Corporation.
MedicalResearch: What are the main findings of the study?Dr. Shih: RAND identified 25 high-impact policy options to improve the delivery, workforce, and financing of long term care, with a specific eye toward those with dementia and their caregivers. Undertaking these 25 policy options would achieve five goals: increasing public awareness of dementia and its signs and symptoms; improving access to long-term care; promoting high-quality, person-centered care like that offered at Lakeside Manor; providing better support for family caregivers; and reducing the burden of dementia costs on individuals and their families.
Of these 25 policy options, we identified four unique options that have never been identified in any national plan on dementia or long-term care. This is likely because we focused on the intersection between dementia and long-term care, rather than just one or the other. And, rather than only focusing on actions that federal agencies can take, we identified policy options by interviewing 30 different stakeholders in the public and private sectors at the local, state, and national levels. These unique, high-impact policy options have to do with
Linking private health insurance with private long-term care insurance;
Including home and community-based services in state Medicaid plans;
Establishing cross-setting teams focused on returning the person with dementia to the community;
Expanding financial compensation to family caregivers.
MedicalResearch.com Interview with:Dr. Ali Abbara
Imperial College London, United Kingdom
Dr. Abbara: What are the main findings of the study?
MedicalResearch: We found that a novel blood test for kisspeptin was able to identify asymptomatic pregnant women who were at increased risk of subsequent miscarriage. Blood kisspeptin performed better than the more commonly measured pregnancy hormone BHCG in identifying women at increased risk of miscarriage. (more…)
MedicalResearch.com Interview with: Grégoire Rey
Directeur du CépiDc
CépiDc-Inserm
Hopitâl Bicêtre France
MedicalResearch: What are the main findings of the study?Dr. Rey: We found that, between 2000 and 2010, unemployment and suicide rates were globally associatedin eight Western European countries (Austria, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK). However, this ecological association was weak (0.3% increase in suicide rate for a 10% increase in unemployment rate). Across countries, it was inconsistently confounded by the effect of other concomitant features of the economic crisis.
MedicalResearch: Were any of the findings unexpected?(more…)
MedicalResearch.com Interview with: Krim K. Lacey, PhD
Research Fellow, Research Center for Group Dynamics
Program for Research on Black Americans (PRBA)
Institute for Social Research
University of Michigan Ann Arbor, MI
MedicalResearch: What are the main findings of the study?Dr. Lacey: The main findings from this nationally representative study were that U.S. Black women abused by a domestic partner, on a whole were vulnerable to various negative physical and mental health problems.
While the findings of the study support the few previous studies conducted on women within this population, this study was the first population-based, predominantly black sample that used structured clinical assessments. Importantly, the study substantiates other arguments that the Black population is not culturally monolithic, that African American and Caribbean Black women are affected differently by severe intimate partner violence.
Another key finding was the association identified between eating disorders and intimate partner violence, which in general, has been largely underexplored.
Finally, the study provided national information on the health outcomes of Caribbean Black women; one of the fastest growing subgroups within the Black population.
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MedicalResearch.com Interview with: Dr. Michele Callisaya
Faculty of Medicine, Nursing & Health Sciences
Monash University, ClaytonMedicalResearch: What are the main findings of the study?
Dr. Callisaya: Falls are common in older people and can lead to hip fracture and loss of mobility. Blood pressure reducing medications are commonly taken by older people to protect against heart attacks and stroke, but may have some unwanted side effects such as light-headedness and loss of balance. We found that older people who were on large doses of such medications were at increased risk of falling.(more…)
MedicalResearch.com Interview with:Colin R. Cooke, MD, MSc, MS;
Assistant Professor of Medicine,
Division of Pulmonary & Critical Care Medicine
Faculty, Center for Healthcare Outcomes & Policy
University of Michigan
MedicalResearch: What are the main findings of the study?Dr. Cooke: There were three primary findings from our study.
First,we determined that between 1992 and 2005 there was almost a 40% increase in the number of admissions to an intensive care unit (ICU) among patients with lung cancer who were hospitalized for reasons other than surgical removal of their cancer.
Second, most of this increase was because doctors were admitting these patients to intermediate intensive care units. These are units that provide greater monitoring and nurse staffing than typically available in general hospital wards, but usually also have less ability to provide life support measures than full service ICUs.
Third, over the same period the reasons for ICU admission have changed. Although the most common reason for admission continues to be for problems related to the patients’ lung cancer, problems such as breathing difficulties requiring a ventilator and severe infections are increasingly common.
These findings suggest that although overall use of the ICU for patients with lung cancer is increasing over time, providers may be shifting some of the intensive care for lung cancer patients toward less aggressive settings such as the intermediate care unit.
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MedicalResearch.com Interview with: Cheryl Bushnell, MD, MHS
Associate Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist School of Medicine
Winston Salem, NC 27157
MedicalResearch: What are the main findings of the study?Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure).
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MedicalResearch.com Interview withBethanie Wilkinson, Ph.D.
Pfizer
445 Eastern Point Rd.
Groton, CT 06340
MedicalResearch: What are the main findings of the study?Dr. Wilkinson: ORAL Start showed that XELJANZ (tofacitinib citrate) 5 and 10 mg twice daily (BID), taken by itself without methotrexate (MX), inhibited the progression of structural damage and reduced the signs and symptoms of rheumatoid arthritis (RA), and was statistically significantly superior to methotrexate on these measures at Month 6 (primary endpoint) and at all measured time points up to 24 months in patients with rheumatoid arthritis who had not previously received methotrexate or therapeutic doses of methotrexate. XELJANZ is not indicated in patients who had not previously received methotrexate.
Both doses of XELJANZ met the study’s co-primary efficacy endpoints of mean change from baseline in van der Heijde modified Total Sharp Score (mtss) [0.18 and 0.04 (both P<0.001) for tofacitinib 5 and 10 mg BID, respectively, versus 0.84 for MTX], and ACR70 response rates [25.5% and 37.7% for tofacitinib 5 and 10 mg BID (both P<0.001) versus 12.0% for MTX], at Month 6.
These results were sustained at all measured time points up to 24 months.
MedicalResearch.com Interview with: Lei Zheng, M.D., Ph.D.
Assistant Professor of Oncology and Surgery
Gastrointestinal Cancer Program
Division of Immunology
The Sidney Kimmel Comprehensive Cancer Center and
Department of Oncology
Johns Hopkins University School of Medicine
The Bunting-Blaustein Cancer Research Building (CRB1)
Baltimore, MD 21231
MedicalResearch: What are the main findings of the study?Dr. Zheng: This study shows for the first time that treatment with a vaccine-based immunotherapy directly re-programs the pancreatic cancer microenvironment, allowing the formation of lymphoid aggregates, which are organized, lymph node-like, functional immune structures and which convert an immunologically quiescent tumor into an immunologically active tumor. (more…)
MedicalResearch.com Interview with: Dr. Hardeep Singh MD, MPH
Chief the Health Policy, Quality & Informatics Program
Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine
MedicalResearch: What are the main findings of the study?Dr. Singh: EHRs use can prompt new patient safety concerns, and many of these problems are complex and difficult to detect. We sought to better understand the nature of these patient safety concerns and reviewed 100 closed investigations involving 344 technology-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA).
We evaluated safety concerns related to technology itself as well as human and operational factors such as user behaviors, clinical workflow demands, and organizational policies and procedures involving technology. Three quarters of the investigations involved unsafe technology while the remainder involved unsafe use of technology. Most (70%) investigations identified a mix of 2 or more technical and/or non-technical underlying factors.
The most common types of safety concerns were related to the display of information in the EHR; software upgrades or modifications; and transmission of data between different components of the EHR system.
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MedicalResearch.com Interview with Daniel Rocke, MD
Duke Medicine
Department Otolaryngology
MedicalResearch: What are the main findings of the study?Dr. Rocke: I think the main point is that, to quote the paper, "end-of-life decision making by patients with cancer and their caregivers is significantly affected by their preference for quality of life or quantity of life, but OHNS physicians’ decision making is not." This is important because physicians counseling patients making end-of-life decisions are coming at these decisions from a different perspective that may not line up with their patients. If physicians recognize this, I think that these end-of-life discussions can be more productive
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MedicalResearch.com: Interview with: Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC
Hamilton General Hospital
237 Barton Street East Canada
MedicalResearch: What are the main findings of the study?Dr. Leong:The main findings of this study are that while low-moderate levels of alcohol use are associated with a reduced risk of myocardial infarction, this protective association was not seen in peoples of all ethnicities.
Secondly, heavy alcohol use (≥6 drinks) within a 24 hour period was associated with a significant increase in the immediate risk of myocardial infarction.
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MedicalResearch.com Interview with:
Dalliah Black, MD F.A.C.S.
Department of Surgical Oncology
The University of Texas
MD Anderson Cancer Center, Houston
MedicalResearch: What are the main findings of the study?Dr. Black: This is a retrospective study from 2002 - 2007 using the SEER/Medicare database of over 31,000 women with node negative breast cancer evaluating the utilization of sentinel node biopsy (SNB) as it transitioned from an optional method for axillary staging to the standard of care instead of complete axillary lymph node dissection (ALND). We found that SNB use increased each year in both white and black breast cancer patients throughout the study period. However, SNB was less often performed in black patients (62.4%)compared to white patients (73.7%) and this disparity persisted through 2007 with a 12% difference. Appropriate black patients more often had an ALND instead of the minimally invasive sentinel node biopsy which resulted in worse patient outcomes with higher lymphedema rates in black patients. However, when black patients received the minimally invasive SNB, their rates of lymphedema were low and comparable to white patients who received SNB.
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MedicalResearch.com Interview with:Athena Philis-Tsimikas, M.D.
Corporate Vice President
Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health
MedicalResearch: What are the main findings of the study?Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions.
Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care. The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed.
Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure.
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MedicalResearch.com: Interview with Mette Andersen Nexø
Psychologist, Ph.D. student at The National Research Center for the Working Environment
Copenhagen Area, Denmark
MedicalResearch: What is the background for this study?Answer: The present study is a systematic assessment of the influence of a spectrum of thyroid diseases on ability to work. By presenting new information on the possible socioeconomic consequences of thyroid diseases, the results can help bring awareness to important needs for rehabilitation of thyroid patients.
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MedicalResearch.com Interview with: John L. VandeBerg PhD
Southwest National Primate Research Center
Texas Biomedical Research Institute
San Antonio, TX 78245-0549
MedicalResearch: What are the main findings of this study?
Dr. VandeBerg:Despite the increasing use of sunscreen in recent decades, the incidence of melanoma continues to rise by 3% annually, leading to concerns that sunscreen may not be effective in preventing melanoma despite its efficacy in preventing sunburn. Our results established in the laboratory opossum, which is the only natural mammalian model of UVB-induced melanoma, that SPF 15 sunscreen applied to infants prior to low dose UVB radiation leads later in life to a 10-fold reduction in pre-melanotic lesions, which are known to progress to malignant melanoma.
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MedicalResearch.com Interview with:Benjamin D. Horne, PhD, MPH, FAHA, FACC
Director, Cardiovascular and Genetic Epidemiology, Intermountain Heart Institute
Adjunct Assistant Professor, Genetic Epidemiology Division, Department of Medicine,
University of Utah
MedicalResearch: What is the background for this study?Dr. Horne: The Fasting II trial was a single-arm interventional trial of 24-hour water-only fasting among pre-diabetics with metabolic syndrome. The participants were adults with fasting blood glucose >100 mg/dL and at least two other components of the metabolic syndrome, including high triglycerides, low HDL cholesterol (the “good” cholesterol), high blood pressure, or high waist circumference. The participants were asked to fast once per week for 6 weeks, with multiple goals in this pilot study. This is the first interventional trial of fasting in people with pre-diabetes or diabetes.
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MedicalResearch.com Interview with: Natasha K Brusco
Manager of Physiotherapy Services, Cabrini Health
PhD Candidate, Physiotherapy Department, Faculty of Health Science,
La Trobe University, Bundoora,
Victoria, Australia
MedicalResearch: What are the main findings of the study?Answer: This economic evaluation reports that providing additional Saturday rehabilitation, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per quality adjusted life year gained and for a minimal clinically important difference in functional independence. This builds on previous literature that reports that additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and may reduce patient length of stay.
(more…)
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