Antibiotic Resistance, Author Interviews, Infections / 08.10.2018

MedicalResearch.com Interview with: David G. Thanassi, Ph.D. Professor and Interim Chair Department of Molecular Genetics & Microbiology Center for Infectious Diseases Stony Brook University Stony Brook, NY 11794-5222 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pathogenic bacteria such as Escherichia coli use hair-like surface appendages termed pili to colonize tissues within the host and initiate infection.  Together with our collaborators - the group of Huilin Li at the Van Andel Research Institute - we used an advanced imaging technique termed cryo-electron microscopy to determine snapshots of bacterial pili as they are being assembled.  The pili we studied are critical for uropathogenic strains of E. coli to colonize the urinary tract and cause urinary tract infections.  Our work revealed a new stage in the pilus assembly process and new details about how these structures are built on the bacterial surface.   (more…)
Abbott, Author Interviews, Flu - Influenza / 08.10.2018

MedicalResearch.com Interview with: Dr. Norman Moore PhD Abbott’s Director of Scientific Affairs for Infectious Diseases  MedicalResearch.com: What is the background for this test? How does ID NOW differ from other tests for influenza? Response: This test was developed to give providers – and their patients – lab-accurate results more quickly than ever, right at the point of care. It was designed for ease of use, as well as to be portable and small enough that it can be used in a broad range of healthcare settings, including walk-in clinics, urgent care centers, doctors’ offices and emergency rooms. Prior to ID NOW, traditional molecular tests offered great performance, but took too long to impact treatment decisions. ID NOW is able to deliver the performance and accuracy of lab-based tests in a timeframe that offers the best chance of improving treatment decisions.  (more…)
Author Interviews, Cost of Health Care, Geriatrics, Osteoporosis / 08.10.2018

MedicalResearch.com Interview with: Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period. As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries. Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture. Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings. (more…)
Author Interviews / 08.10.2018

MedicalResearch.com Interview with: Rowan Chlebowski, MD, PhD Research Professor Department of Medical Oncology & Therapeutics Research City of Hope National Medical Center Duarte, California MedicalResearch.com: What is the background for this study? Response: Regarding study background while obesity has been for several decades been well established respect cancer incidence, it has been difficult to provide evidence that weight loss in postmenopausal women would reduce their breast cancer risk. We address this question by examining short-term, three year weight loss of 5% or more in most menopausal women participating in the Women's Health Initiative observational study. Women who lost this moderate amount of weight regardless of their baseline weight experience as statistically significant lower breast cancer incidence. (more…)
Author Interviews, JAMA, Kidney Disease / 07.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0 Elani Streja MPH PhD Division of Nephrology and Hypertension University of California, Irvine | UCI · Elvira O. Gosmanova, MD, FASN Medicine/Nephrology Albany Stratton VA Medical Center Csaba P Kovesdy MD Fred Hatch Professor of Medicine Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Director, Clinical Outcomes and Clinical Trials Program Memphis TN, 38163  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity in patients with chronic kidney disease (CKD). Statins are lipid-lowering drugs that have a proven track record in reducing risk of CVD in patients with advanced CKD who did not yet reach its terminal stage or end-stage renal disease (ESRD). Paradoxically, new prescription of statins after ESRD onset failed to reduce CVD related outcomes in three large clinical trials. However, benefits of statin continuation at transition from advanced CKD to ESRD was never formally tested. Therefore, we identified a cohort of 14,298 US Veterans who used statins for at least half of the year during 1 year before ESRD transition and evaluated mortality outcomes based on whether statins were continued or stopped after ESRD onset. We found that ESRD patients who continue statins for at least 6 months after transition had 28% and 18% lower risk of death from any cause or cardiovascular causes, respectively, during 12-months of follow up, as compared with statin discontinuers. (more…)
Author Interviews, C. difficile, Critical Care - Intensive Care - ICUs, Infections / 07.10.2018

MedicalResearch.com Interview with: Richard Hengel, MD, FRCPC, FACP Atlanta ID Group Richard Hengel, MD, FRCPC, FACP Atlanta ID Group MedicalResearch.com: What is the background for this study? How does Bezlotoxumab differ from other medications for recurrent C. difficile infections? Response: Clostridium difficile infection (CDI) is now the most common hospital acquired infection in the United States, accounting for significant morbidity and mortality, not only in the US, but around the world. Despite standard antibiotic therapy targeting the Clostridium difficile bacterium directly, recurrent infection is common, occurring in a quarter to a third of patients, often frail individuals with other concurrent medical problems. These patients can have multiple recurrences leading to their progressive deterioration over time. Until recently, the only treatment for CDI included antibiotics. More recently, fecal microbiota transplant is a promising, but as yet, FDA unapproved therapy. Bezlotoximab is a new FDA approved treatment for recurrent Clostridium difficile infection (rCDI) that compliments standard antibiotics. Bezlotoxumab is a monoclonal antibody targeting toxin B produced by Clostridium difficile during CDI. In two large treatment trials, bezotoxumab, in addition to standard-of-care antibiotics, reduced the frequency of CDI recurrences from about 28% to about 18%. In this study, we set out to see if this new drug performed as well in actual clinical practice as it did in the published clinical trials. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Acquired, Infections, Kidney Disease, Merck / 06.10.2018

MedicalResearch.com Interview with: Michelle Hoffman Brown Associate Principal Scientist Merck MedicalResearch.com: What is the background for this study? What are the kidney risks of using colistin to treat carbapenem-resistant bacterial infections? Response: Gram-negative pathogens are responsible for half of all healthcare-associated infections and their ability to resist traditional antibiotics makes them more dangerous for seriously ill patients in a healthcare setting. The need for new approaches to treat these pathogens is essential and this trial aimed to evaluate the efficacy and safety of imipenem/relebactam (IMI/REL) for the treatment of these challenging infections. Nephrotoxicity is a common complication of colistin-based therapy and is the potential adverse experience of greatest concern to prescribing clinicians, limiting its use to treat carbapenem-resistant bacterial infections. Relebactam is a novel β-lactamase inhibitor that restores imipenem activity against many imipenem-non-susceptible strains of Gram-negative pathogens. In the Phase 3 RESTORE-IMI 1 study (NCT02452047), IMI/REL was shown to be as effective as, but better tolerated than, colistin plus imipenem, including as demonstrated by a lower incidence of treatment-emergent nephrotoxicity (prespecified secondary endpoint). This analysis looked at additional renal safety data from the RESTORE-IMI 1 trial.  (more…)
Author Interviews / 06.10.2018

MedicalResearch.com Interview with: MedicalResearch.com Interview with: Gili Regev-Yochay, MD, Lead author Director of the Infection Prevention & Control Unit Sheba Medical Center Tel HaShomer, Israel.  MedicalResearch.com: What is the background for this study? Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens).  Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak. MedicalResearch.com: What are the main findings?  Response: The outbreak source were the sink-traps in nearly all the patient rooms, which were contaminated with this same bacteria. Once we understood that this was the source we took two measures: 1) Sink decontamination efforts, including intensive chlorine washes of the drainage and water system, replacement of all sink-traps, acetic acid treatment and more, all these efforts were only partially and only temporarily successful. So that even today, after a year of such efforts and a period in which we didn't have any patients with this infection, the drainage system is still contaminated with these bugs and they grow in the sink-traps and can be found in the sink outlets. 2) The second measure we took was an educational intervention, where we engaged the ICU team through workshops to the issue of the contaminated sinks and together enforced strict "sink-use guidelines" (sinks are to be used ONLY for hand washing, prohibiting placement of any materials near the sinks, etc.). Using these two measure the outbreak was fully contained. To date, nearly 1.5 years since the last outbreak case, we did not have any further infections in our ICU patients with this bug. MedicalResearch.com: What should readers take away from your report? Response: Sink-traps and drainage systems can be a major source of CPE transmission. While traditionally CPE outbreaks were attributed to patient-to patient transmission, the environment and particularly water and drainage system appears to play a major role. MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: There is urgent need to find a technological solution for drainage system contaminations. While some have suggested to get rid of sinks in ICU this is probably not realistic in the era of emerging Clostridium infections (where washing hands, and not only alcohol rubs are needed).  Citation: Gili Regev-Yochay, Gill Smollan, Ilana Tal, Nani Pinas Zade, Yael Haviv, Valery Nudelman, Ohad Gal-Mor, Hanaa Jaber, Eyal Zimlichman, Nati Keller, Galia Rahav. Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit. Infection Control & Hospital Epidemiology, 2018; 1 DOI: 1017/ice.2018.235 [wysija_form id="3"] [last-modified]     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.  Gili Regev-Yochay, MD, Lead author Director of the Infection Prevention & Control Unit Sheba Medical Center Tel HaShomer, Israel.  MedicalResearch.com: What is the background for this study? Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens).  Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak. (more…)
Author Interviews / 06.10.2018

MedicalResearch.com Interview with: Claudia Syueping Crowell, MD Lead author of the study Assistant professor of pediatrics University of Washington and Seattle Children's Hospital MedicalResearch.com: What is the background for this study? What are the main findings?
  • This research was conducted as part of the SMARTT (Surveillance Monitoring for ART Toxicities) study, which is an observational cohort study of HIV exposed uninfected children with the overall aim of studying the long-term safety of fetal and infant exposure to prophylactic antiretroviral (ARV) therapy.
  • This particular analysis was conducted in response to prior studies that showed an increased risk of seizures and other neurologic conditions in children who were exposed to ARVs in utero.
  • The aim of our study was to determine if in utero exposure to any particular ARV is associated with the diagnosis of neurologic conditions later in infancy and childhood.
  • In our cohort of 3747 HIV-exposed uninfected children we found 237 children who had neurologic conditions, 16 of whom were exposed to efavirenz in utero and 4 of whom were exposed to dolutegravir in utero.
  • The most common neurologic diagnoses were microcephaly, febrile seizures, non-febrile seizures and eye related disorders.
  • When comparing various antiretroviral medications, we found that children of women whose ART regimen included efavirenz were more likely to be diagnosed with a neurologic condition than children of women whose ART regimen did not include efavirenz (9.6% vs. 6.2%). This translated to a 60% higher risk of being diagnosed with a neurologic condition in the efavirenz exposed group after controlling for other risk factors.
  • We also found a suggestion of an association between in utero dolutegravir exposure and later diagnosis of a neurologic condition but the number of children exposed to dolutegravir was small (number of exposed children = 94). 
(more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Cancer Research, Red Meat / 05.10.2018

MedicalResearch.com Interview with: "bacon&eggs" by ilaria is licensed under CC BY 2.0 Maryam Farvid, Ph.D., Research Scientist   Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior prospective studies on red and processed meat consumption with risk of breast cancer have produced inconsistent results. Current meta-analysis of 15 prospective studies shows that women who eat a high amount of processed meat each day may have a higher risk of breast cancer than those who don't eat or have a low intake in their diet.  (more…)
Addiction, Author Interviews, Opiods / 05.10.2018

MedicalResearch.com Interview with: "150826-fentanyl-factory-underground-illicit.jpg" by r. nial bradshaw is licensed under CC BY 2.0 Jon Zibbell, PhD, Senior public health scientist Behavioral Health Research Division RTI International Research Triangle Park, NC,  MedicalResearch.com: What is the background for this study? What are the main findings? Response: For the first time in 2016, U.S. overdose deaths involving illicitly-manufactured fentanyl surpassed deaths from heroin and prescription deaths. Fentanyl is an extremely potent synthetic opioid, and an illicitly-manufactured form of the drug is regularly being mixed with heroin and often sold to unwitting consumers. Fentanyl is 50 times more potent than heroin and its illicitly-manufactured version is extremely difficult to discern when mixed with heroin. Harm reduction organizations have started to distribute FTS and people consuming street-purchased opioids are using them to test drugs for fentanyl. Our objective was to assess whether this point-of-use form of drug checking was influencing people’s drug use behavior. The study was self-funded by the research institute RTI International. Our findings show that consumers who tested street opioids with fentanyl test strips were five times more likely to engage in safer drug use behavior when the test comes back positive. The study was conducted among a group of 125 people who inject drugs in Greensboro, North Carolina. (more…)
Author Interviews, MRSA / 05.10.2018

MedicalResearch.com Interview with: Kathryn Dalton, VMD MPH AKC CHF Fellow PhD Student, Davis Lab Environmental Health and Engineering Johns Hopkins Bloomberg School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Animal-assisted interventions (or AAI for short) have become increasing popular in hospitals for the emotional and physical benefits they bring to patients. But there is a risk that these therapy dogs could potential spread infectious germs, including MRSA (methicillin-resistantStaphylococcus aureus), to patients. Our study found that therapy dogs can spread MRSA to patients, and children who had more contact with the therapy dog were at higher risk of getting MRSA. But, we used a new cleaning protocol on the dog with an anti-septic shampoo before the visit and anti-septic wipes during the visit. Patients who had more contact with the dog did not have a higher risk of MRSA when the dog was giving this new cleaning protocol, which made the AAI therapy visits safer for the patients. In addition, the patients’ emotional and physical benefits we observed were not changed by using this dog cleaning protocol.       (more…)
Author Interviews, Endocrinology, Fertility, OBGYNE / 05.10.2018

MedicalResearch.com Interview with: Dr. Ernest Loumaye, MD, PhD Co-Founder and CEO ObsEva SA   MedicalResearch.com: What is the background for this announcement? How does Nolasiban work to decrease contractions and improve uterine blood flow? Response: The WHO has recognized infertility as a global health issue, and many couples undergo IVF treatment: there are more than 700,000 annual IVF treatment cycles in Europe and more than 200,000 in the U.S. However, more than 50% of IVF procedures do not result in pregnancy, and failure has tremendous emotional and financial costs to patients.  ObsEva is dedicated to improving fertility outcomes in IVF while also supporting the use of single embryo transfer to minimize multiple births that are associated with significant health risks to mother and baby, as well as significant health costs from premature delivery. Nolasiban works by blocking the hormone oxytocin, which is known to induce uterine contractions.  Nolasiban reduces uterine contractions and could improve uterine blood flow, both effects being favourable for the embryo to properly implant. (more…)
Accidents & Violence, Author Interviews, Geriatrics, JAMA, Ophthalmology, University of Pittsburgh / 05.10.2018

MedicalResearch.com Interview with: Syed Mahmood Ali Shah, M.D. Associate Professor of Ophthalmology University of Pittsburgh School of MedicineSyed Mahmood Ali Shah, M.D. Associate Professor of Ophthalmology University of Pittsburgh School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Eye trauma is a significant cause of morbidity throughout the world. In the United States, the incidence of individuals hospitalized with eye trauma from 2001 through 2014 increased. Most of these individuals were above the age of 65 and suffered a fall. This is a worrisome trend in light of an increased awareness and continued and concentrated effort to reduce falls. This is a critical point: We need to improve our existing strategies to reduce falls. The second at-risk group is children and adolescents. Previous studies have shown that effective widespread implementation of injury prevention efforts can lower trauma rates. While we did observe a small decrease in eye trauma as a primary admitting diagnosis, the fact that it was more common in children and adolescents (for whom eye trauma carries devastating consequences and can significantly reduce quality of life) highlights the significance of continued efforts to prevent eye trauma.  (more…)
Author Interviews, Cleveland Clinic, Diabetes, JAMA, Ophthalmology / 05.10.2018

MedicalResearch.com Interview with: Amy Babiuch, M.D. Medical Retina Specialist  |  Cole Eye Institute Assistant Professor Ophthalmology Case Western Reserve University WPSA Regional Focus Committee Chair Cleveland Clinic MedicalResearch.com: What is the background for this study? Response: In previous studies, the disorganization of retinal inner layers (DRIL) has demonstrated its ability to help determine visual acuity (VA) prognosis in diabetic macular edema that requires treatment. Given this association, the research group at Cole Eye Institute studied how DRIL may affect VA outcomes in patients with retinal vein occlusion (RVO) undergoing treatment for secondary macular edema. DRIL is defined as the extent to which there is a failure in the recognition of any of the demarcations between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer on optical coherence tomography (OCT). (more…)
Author Interviews, CDC, JAMA, Pediatrics, Smoking / 04.10.2018

MedicalResearch.com Interview with: "Electronic Cigarette/E-Cigs/E-Cigarettes" by Chris F is licensed under CC BY 2.0Brian King, PhD Lead author and Deputy Director for Research Translation Office on Smoking and Health. CDC MedicalResearch.com: What is the background for this study? Response: Since first entering the U.S. marketplace in 2007, e-cigarettes have been a rapidly evolving product class. Typically, national surveys provide annual, self-reported estimates of e-cigarette use among adults and youth. However, given the dynamic nature of the e-cigarettes landscape, data collected at a sub-annual level can be useful for identifying rapid changes and patterns. For example, retail sales data, which is available at more frequent intervals, such as weekly, can complement annual surveys and help keep a pulse on emerging trends. This study assessed e-cigarette retail sales data in the United States from 2013 through 2017. (more…)
Author Interviews, Heart Disease, Technology / 04.10.2018

MedicalResearch.com Interview with: Waqaas Al-Siddiq Founder and CEO of Biotricity Inc MedicalResearch.com: In light of Apple's announcement that it will incorporate an EKG monitoring device into Apple watches in the near future, would you discuss your vision of the growing medical wearables market?  Response: First of all, the public is still largely confused as to what constitutes a medical wearable device. Apple’s new watch, with its EKG monitoring service, is not a medical wearable because it will not produce clinical-grade data needed for diagnosis or treatment. This is not to say that Apple’s watch isn’t helpful. Many people are not even aware that they have a heart problem, but if their Apple watch consistently tells them that they have an irregular heart rhythm, or arrhythmia, they could take that as a sign to go to a physician and get a professional diagnosis. A physician will then prescribe a medical wearable device, such as our Bioflux, to monitor the patient’s heart rhythm. Medical-grade wearable devices produce clinical-grade data that is accurate to within 90-95 percent or higher and are prescribed by physicians to make diagnoses and treatment plans. That being said, I envision that the medical wearables market will expand considerably with the advent of consumer-based wearables that facilitate health tracking. One of the biggest problems we have today is a lack of awareness. Anywhere between 2.7 and 6.1 million people in the U.S. suffer from atrial fibrillation - a condition that makes the heart beat irregularly - and many aren’t aware that they have the condition. Consumer-based health trackers like the Fitbit and the Apple Watch can help raise awareness and alert consumers to possible health issues, which will encourage them to see a physician for a thorough and professional examination and diagnosis. This, in turn, gives the medical wearable market a boost as more people will be diagnosed with the aid of a medical wearable. Another factor that is playing into this adoption trend is that next-generation medical wearables are increasingly becoming smaller and easier to use for both patients and physicians. So, I think that the future of medical wearables will see them firmly entrenched in mainstream practice and eventually become tools within the home for individuals with chronic issues.  (more…)
Author Interviews, JAMA, Neurology, Outcomes & Safety, Parkinson's, Pharmacology, University of Pennsylvania / 04.10.2018

MedicalResearch.com Interview with: Allison W. Willis, MD, MS Assistant Professor of Neurology Assistant Professor of Biostatistics and Epidemiology Senior Fellow, Leonard Davis Institute Senior Scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was motivated by my own experiences as a neurologist-neuroscientist. I care for Parkinson disease patients, and over the year, have had numerous instances in which a person was taking a medication that could interact with their Parkinson disease medications, or could worsen their PD symptoms. (more…)
Author Interviews, NEJM, Osteoporosis / 04.10.2018

MedicalResearch.com Interview with: Prof Ian Reid Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bisphosphonates prevent fractures in patients with osteoporosis, but their efficacy in women with less marked bone loss (referred to as osteopenia) is unknown. Most fractures in postmenopausal women occur in osteopenic patients, so therapies with efficacy in osteopenia are needed. (more…)
Author Interviews, Clots - Coagulation, Critical Care - Intensive Care - ICUs, NEJM / 04.10.2018

MedicalResearch.com Interview with: Alex C Spyropoulos, MD, FACP, FCCP, FRCPC Professor of Medicine – The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Professor - The Center for Health Innovations and Outcomes Research - The Feinstein Institute for Medical Research System Director – Anticoagulation and Clinical Thrombosis Services Northwell Health at Lenox Hill Hospital New York, NY 10075 MedicalResearch.com: What is the background for this study? Response: Hospitalised medically ill patients have a significant risk of developing venous thromboembolism (VTE) within 6 weeks after discharge. The role of extended thromboprophylaxis in this population with either low molecular weight heparin or the direct oral anticoagulants remains uncertain, as it has shown either excess bleeding or beneficial effects mainly from reducing asymptomatic deep vein thrombosis (DVT). The MARINER trial was designed to compare rivaroxaban with placebo for the prevention of the composite outcome of symptomatic VTE and VTE-related death in medically ill patients at increased risk of VTE post-hospital discharge. The principal safety objective was major bleeding. The trial was a randomized, double-blind, placebo-controlled, event-driven study that included a total of 12,024 patients aged ≥40 years who had been hospitalised with an acute medical illness for 3-10 consecutive days and had additional VTE risk factors as defined by the modified IMPROVE VTE risk score of ≥4 or a score of 2 or 3 plus a plasma D-dimer level more than twice the upper limit of normal). The rivaroxaban regimen consisted of 10 mg once daily in patients with a creatinine clearance (CrCl) of >=50ml/min or 7.5 mg for patients with a CrCl of 30 to <50 ml/min. The first dose was given on the day of discharge and the last dose at Day 45. Patients were followed up for an additional 30 days. Baseline characteristics were well matched between groups and typical of a medically ill population. (more…)
Author Interviews, Rheumatology / 03.10.2018

MedicalResearch.com Interview with: Virginia Ladd, CEO   American Autoimmune Related Disease Association (AARDA) MedicalResearch.com: Would you briefly explain what is meant by autoimmune disorders? Response: Autoimmune disease is a broad category of related diseases which share both genetic and mechanistic properties.  They occur when the person’s immune system attacks the body’s own cell, and tissue. The immune system goes awry and mistakenly attacks the tissues and organs it was designed to protect. Normally the immune system protects the It does this by body by responding to invading microorganisms, such as bacteria, and viruses. Producing antibodies which are special proteins that recognize and destroy the invaders. Autoimmune diseases occur when autoantibodies attack the body’s own cells, tissue and organs. (more…)
Author Interviews, Health Care Systems, Psychological Science / 03.10.2018

MedicalResearch.com Interview with: Professor Mary Dixon-Woods Director, The Healthcare Improvement Studies Institute (THIS Institute) University of Cambridge  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The challenges around employee voice are well documented. For various reasons, employees in all industries are often reluctant to raise concerns when they witness disruptive or unsafe behaviour from their colleagues. But it’s crucial that they speak up – especially in healthcare. Patient safety may depend on it. Our study focused on a large academic medical centre in the US that wanted to improve employee voice. Despite having reporting mechanisms in place, the organisation still had issues with disruptive behaviour from group of powerful senior individuals that went unchallenged and contributed to a culture of fear. Through confidential interviews with 67 frontline staff and leaders and the organizational actions that followed, we learned it’s important for employees to feel that their concerns will be dealt with authentically. It also helps when healthcare organisations have clear definitions of acceptable and unacceptable behaviour and well-coordinated response mechanisms. Once someone does raise a concern, organizations need good, fair and transparent systems of investigations and be prepared to implement consequences for disruptive behaviour consistently.  (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, NIH, Nutrition, Race/Ethnic Diversity, Salt-Sodium / 03.10.2018

MedicalResearch.com Interview with: Dr. George Howard DPH, for the research team Professor and Chair of Biostatistics University of Alabama at Birmingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: Perhaps the most important distinction to draw for the readers is that this is not a paper about risk factors for hypertension, but rather a paper that looks for contributors to the black-white difference in the presence of hypertension.  This racial difference in hypertension is the single biggest contributor to the immense disparities in cardiovascular diseases (stroke, MI, etc.) that underpin the approximate 4-year difference in black-white life expectancy.  As such, this work is “going back upstream” to understand the causes that lead to blacks having a higher prevalence of hypertension than whites with hopes that changing this difference will lead to reductions in the black-white disparities in cardiovascular diseases and life expectancy.   This difference in the prevalence of hypertension is immense … in our national study of people over age 45, about 50% of whites have hypertension compared to about 70% of blacks … that is HUGE.   We think that changing this difference is (at least one of) the “holy grail” of disparities research. This study demonstrates that there are several “targets” where changes could be made to reduce the black-white difference in hypertension, and thereby the black-white difference in cardiovascular diseases and life expectancy; however, the most “potent” of these appears to be diet changes.   Even though we know what foods promote a heart healthy lifestyle, we still have major differences in terms of how that message is being adopted by various groups of Americans.  We can’t know from our data what about the Southern diet is driving these racial differences in hypertension but we can begin to design community based interventions that could possibly help to reduce these racial disparities through diet.  It is interested that diet more than being overweight was the biggest contributor to the racial disparities in hypertension.  This would suggest we might want to consider interventions to increase health foods in the diet while minimizing fried foods and processed meats. While this is not a clinical trial that “proves” that changes in diet will reduce the disparity in blood pressure, we consider the “message” of the paper to be good news, as the things that we found that contribute to this black-white difference are things that can be changed.   While it is always hard for individual people to change their diet, it can be done.   More importantly, over time we as a society have been changing what we eat … but we need to “double down” and try to change this faster.   Also, policy changes of play a role to gently make changes in these diet, where for example Great Britain has been making policy changes to slowly remove salt from the diet.   These changes are possible … and as such, we may see a day when the black-white differences in hypertension (and thereby CVD and death) may be reduced.  (more…)
Accidents & Violence, Alcohol, Author Interviews / 03.10.2018

MedicalResearch.com Interview with: Pamela Trangenstein, PhD While  a predoctoral fellow at Johns Hopkins Bloomberg School of Public Health's Center on Alcohol Marketing and Youth (CAMY)  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Research repeatedly shows that alcohol outlet density (the number of businesses that sell alcohol in an area) is associated with violent crime, but studies disagree about whether alcohol outlets that are on premise (e.g., bars, restaurants) or off premise (e.g., liquor stores, beer and wine stores) have a stronger association with violent crime. We used advanced methods that consider both the number of alcohol outlets and their locations to better understand how the association between alcohol outlets and violent crime differs by type of outlet. We found that alcohol outlets that allow off-premise sales like liquor stores had a stronger association with homicide, aggravated assault, and robbery than on-premise outlets like bars and restaurants. We also found that disadvantaged neighborhoods had higher access to the types of alcohol outlets associated with the most harms: off-premise outlets.  (more…)
Author Interviews, JAMA, Orthopedics, Surgical Research / 03.10.2018

MedicalResearch.com Interview with: "Meniscus adalah tisu/rawan berbentuk huruf C yang berfungsi mencegah dua tulang bergesel di antara satu sama lain di bahagian lutut. Tisu meniscus yang koyak berpunca kebiasaannya daripada bersukan yang melibatkan pergerakan lutut yang banyak. Warga emas" by Rawatan Alternatif Shah Alam is licensed under CC BY 2.0 Victor A. van de Graaf, MD OLVG Ziekenhuis Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment. In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy.  (more…)
Author Interviews, Endocrinology, JAMA, Thyroid Disease / 02.10.2018

MedicalResearch.com Interview with: thyroid-gland-wikipediaDr. med. Martin Feller, MSc Epidemiology (LSHTM) FMH Allgemeine Innere Medizin & Prävention und Gesundheitswesen Scientific Research Coordinator INSELSPITAL, Universitätsspital Bern Universitätsklinik und Poliklinik für Allgemeine Innere Medizin (RodondiResearch) MedicalResearch.com: What is the background for this study? What are the main findings? Response: SUBCLINICAL HYPOTHYROIDISM IS VERY COMMON, WITH AN ESTIMATED 13 MILLION AMERICANS AFFECTED. SUBCLINICAL HYPOTHYROIDISM IS OFTEN TREATED WITH LEVOTHYROXINE, PARTICULARLY WHEN IT CO-OCCURS WITH SYMPTOMS POTENTIALLY ATTRIBUTABLE TO HYPOTHYROIDISM SUCH AS TIREDNESS, CONSTIPATION, AND UNEXPLAINED WEIGHT GAIN. THIS PRACTICE MAY CONTRIBUTE TO LEVOTHYROXINE BEING THE MOST PRESCRIBED DRUG FROM 2014 ONWARDS IN THE US. HOWEVER, IN OUR META-ANALYSIS OF 21 RANDOMIZED CLINICAL TRIALS, WE OBSERVED NO BENEFIT OF LEVOTHYROXINE THERAPY (COMPARED TO PLACEBO) REGARDING GENERAL QUALITY OF LIFE, THYROID-RELATED SYMPTOMS, DEPPRESSIVE SYMPTOMS, FATIGUE, COGNITIVE FUNCTION, BLOOD PRESSURE OR BODY-MASS INDEX.  (more…)
Author Interviews, Primary Care, Respiratory, Telemedicine / 02.10.2018

MedicalResearch.com Interview with: Dr. Kathryn A. Martinez PhD MPH CanSORT Cancer Surveillance and Outcomes Research Team Cleveland Clinic MedicalResearch.com: What is the background for this study? What are the main findings? Response: Most upper respiratory infections are viral and therefore should not be treated with antibiotics. Despite this, physicians commonly prescribe them for these conditions. Patients often expect antibiotics for respiratory tract infections.  As a result, physicians may find it easier to give patients what they want rather than explain to them why antibiotics aren’t needed. We hypothesized it also might be more time consuming for physicians to explain to patients why they don’t need antibiotics, which creates a further incentive to prescribe them. To explore this potential phenomenon, we used data from a large direct to consumer telemedicine system to assess differences in medical encounter length by prescription outcome for patients diagnosed with respiratory tract infections. We found that encounters resulting in antibiotics were 0.33 minutes shorter than those that resulted in no prescriptions, supporting our hypothesis that prescribing an antibiotic takes less time than prescribing nothing. (more…)