Author Interviews, Hip Fractures, Orthopedics, Surgical Research / 27.10.2016

MedicalResearch.com Interview with: Tom Withers Research Student, School of Health Sciences University East Anglia Norwich, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a lot of subjective evidence to suggest that physical activity does not improve following hip replacement we wanted to therefore synthesise the current evidence to come to a more objective conclusion. The main finding from this study is that physical activity does not significantly change pre-operatively compared to up to one year post-operatively. (more…)
Author Interviews, Dental Research, Infections / 27.10.2016

MedicalResearch.com Interview with: Michelle E. Doll, M.D., M.P.H. Assistant Professor Associate Hospital Epidemiologist Department of Internal Medicine Division of Infectious Diseases North Hospital Richmond, VA 23298-0019 MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are many studies that show that poor oral health is associated with systemic conditions including bacterial pneumonias Fort Wayne Dentist might have to employ different strategies. Many find this link surprising, but considering that the airways are a direct conduit between the oral cavity and the lungs, saliva containing oral bacteria is able to track down into the lungs via aspiration. Previous studies have found that good oral health seems to prevent pneumonias in people susceptible to lung infections, possibly because the types and quantities of bacteria residing in the mouth are different in people with healthy versus unhealthy teeth. In my infectious disease clinical practice, I am often frustrated by my inability to assist patients with dental problems. Many of my patients are immunosuppressed, and when they have tooth decay for which they are unable to get timely dental care, I worry about consequences of untreated dental disease; lack of access to dental care is common in the United States. For these reasons, we decided to use data from the Medical Expenditure Panel Survey (MEPS) to determine whether dental care is preventive for bacterial pneumonia. The MEPS database is a large, nationwide survey administered by the Agency for Healthcare Research and Quality (AHRQ), with comprehensive insurance data including dental insurance and access. We found that those who never see the dentist were 86% more likely to get pneumonia in a year, compared to those who visit the dentist for routine check-ups twice a year or more. Furthermore, even those who visit the dentist less than once yearly were at smaller but still significantly increased risk of pneumonia compared to those who see the dentist more frequently. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Thromboembolism / 27.10.2016

MedicalResearch.com Interview with: Truven Health AnalyticsJay Margolis, PharmD Sr. Research Scientist Truven Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vitamin K antagonists (VKAs), most commonly warfarin, had been the only orally available anticoagulants available for the last 60 or so years. While highly effective, use of these agents was often problematic due to their narrow therapeutic index, need for routine coagulation monitoring, and interactions with food and other drugs. Recently introduced new oral anticoagulants (NOACs), particularly rivaroxaban, had been shown in clinical trials to provide comparable efficacy to the VKAs without the need for routine coagulation monitoring. There have been few studies outside of clinical trials showing benefits that translate to real-world populations. In our study using real-world data from a large sample of geographically and demographically diverse US hospitals, patients hospitalized for incident venous thromboembolisms (VTE) initiating oral anticoagulant treatment with rivaroxaban had significantly shorter hospital stays and lower hospitalization costs compared with warfarin-treated patients. (more…)
Author Interviews, Compliance, Dermatology, JAMA / 27.10.2016

MedicalResearch.com Interview with: Adewole S. Adamson, MD, MPP Department of Dermatology The University of North Carolina at Chapel Hill Chapel Hill, NC MedicalResearch.com: What is the background for this study? Response: As the United States has moved to increasing levels of electronic medical record keeping, electronic prescribing has become an important part of improving the quality of care and patient experience. E-prescribing increases co-ordination between pharmacist and physician and decreases prescription errors. However, it is less certain whether e-prescribing affects patient primary adherence to medications, meaning whether or not a patient will fill and pick up their medication at the pharmacy. Although it may seem intuitive that primary adherence would increase by removing the patient from the prescription-to-pharmacy routing process, there have been few studies directly comparing primary adherence of patients given traditional paper prescriptions versus e-prescriptions. (more…)
Alcohol, Author Interviews, Cannabis, Schizophrenia / 27.10.2016

MedicalResearch.com Interview with: Dr Stine Mai Nielsen Copenhagen University Hospital Mental Health Center Copenhagen Gentofte, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have tested whether use of substances can cause schizophrenia. However due to methodological limitations in the existing literature, uncertainties still remains. We aimed to investigate the association between several types of substance abuses and the risk of developing schizophrenia later in life. We did a nationwide, prospective cohort study using the detailed Danish registers, which enabled us to address some of the limitations from prior findings. Our cohort consisted of more than 3.13 mio. individuals, that we were able to follow up for more than 104 mio. years at risk. We found that dealing with a substance abuse increased the overall risk of developing schizophrenia by 6 times, with abuse of cannabis and alcohol presenting the highest associations (5 and 3 times increased risk). The risk was found to be significant even 10-15 years prior to a diagnosis of substance abuse. (more…)
Author Interviews, BMJ, CT Scanning, Heart Disease / 27.10.2016

MedicalResearch.com Interview with: Professor Marc Dewey Heisenberg professor of radiology Vice Chairman of the Department of Radiology at Charité (Campus Mitte) Berlin Germany  MedicalResearch.com: What is the background for this study? Response: Over 3.5 million cardiac catheterisations are performed in Europe each year. This study, jointly conducted by radiologists and cardiologists at Charité – Universitätsmedizin Berlin and published in today’s issue of The BMJ, compares computed tomography (CT) with cardiac catheterisation in patients with atypical chest pain and suspected coronary artery disease (CAD). MedicalResearch.com: What are the main findings? Response: CT reduced the need for cardiac catheterisation from 100% to 14% in the group of patients who received CT first instead of catheterisation. If catheterisation was needed in the CT group, the proportion of catheterisations showing obstructive CAD was 5 times higher than in the catheterisation group. Over a period of 3.3 years, the patients in the CT group neither had more cardiac catheterisations nor an increase in cardiovascular events. Moreover, CT shortened the length of stay by 23 hours and 79% of patients said they would prefer CT for future examinations of the heart. Overall, the results of the BMJ study show that CT is a gentle test for reliably ruling out CAD in patients with atypical chest pain who are currently being referred for cardiac catheterisation in routine clinical practice. (more…)
Author Interviews, Gastrointestinal Disease, Inflammation / 27.10.2016

MedicalResearch.com Interview with: Cheryl de Valliere, PhD University Hospital Zurich Division of Gastroenterology and Hepatology Zurich Switzerland and co-authors Gerhard Rogler, Jesus Cosin Roger, Pedro A. Ruiz MedicalResearch.com: What is the background for this study? Response: Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn’s disease, gives rise to chronic relapsing inflammation of the gastrointestinal (GI) tract, resulting in a disruption of the epithelial barrier function and exacerbated innate and adaptive immune responses. One of the most important features under these inflammatory conditions is the presence of hypoxic areas where oxygen levels are lower than in normal tissue. It has been widely reported that the main transcription factor regulating cellular responses to hypoxia, hypoxia inducible factor (HIF)-1, is significantly induced in patients with IBD compared with healthy subjects. Furthermore, hypoxia is not only linked to inflammation, but also influences the local tissue pH, leading to an reduction of the pH in the inflamed mucosa compared with the non-inflamed one. A family of pH-sensing G-protein coupled receptors (GPCRs), including the receptor T-cell death-associated gene 8 (TDAG8) and the ovarian cancer G-protein coupled receptor 1 (OGR1 or GPR68), play an important role in physiological pH homeostasis. At low extracellular pH, second messenger signaling pathways are activated by protons binding to the histidine residues located on the extracellular region of the receptor. Recent studies have reported a link between IBD and this family of pH-sensing receptors. Indeed, TDAG8 has been identified as an IBD risk gene and we have previously reported an increased expression of OGR1 in patients with IBD compared with healthy subjects. To better understand the basic mucosal inflammatory mechanisms, and foster the development of new treatment options (e.g. pH receptor blockers and OGR1 antagonists) for chronic mucosal inflammatory diseases, we investigated the effects of hypoxia on pH-sensing OGR1 in the intestinal mucosa and associated cells. (more…)
Anemia, Author Interviews, Genetic Research, Hematology / 27.10.2016

MedicalResearch.com Interview with: Peter M. Glazer, MD, PhD Robert E. Hunter Professor of Therapeutic Radiology and Professor of Genetics; Chair, Department of Therapeutic Radiology Yale University MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is generally recognized that gene editing in blood stem cells could provide a strategy for treatment of inherited disorders such as sickle cell disease and thalassaemia. Recent excitement has focused on CRISPR/Cas9 technology because of it is so easy to use. However, the CRISPR approach introduces an active DNA cutting enzyme into cells, which can lead to off-target cuts in the genome. As an alternative, we have pursued triplex-forming peptide nucleic acids (PNAs) designed to bind site-specifically to genomic DNA via strand invasion and formation of PNA/DNA/PNA triplexes. PNAs consist of a charge-neutral peptide-like backbone and nucleobases enabling hybridization with DNA with high affinity. PNA/DNA/PNA triplexes recruit the cell’s own DNA repair machinery to initiate site-specific editing of the genome when single-stranded ‘donor DNAs’ are co-delivered as templates containing the desired sequence modification. We found that triplex-forming PNAs substituted at the gamma position yielded high levels of gene editing in blood stem cells in a mouse model of human β-thalassaemia. Injection of thalassemic mice with nanoparticles containing gamma PNAs and donor DNAs ameliorated the disease phenotype, with sustained elevation of blood hemoglobin levels into the normal range and up to 7% β-globin gene correction in stem cells, with extremely low off-target effects. We conclude that the combination of nanoparticle delivery and next generation PNAs may offer a minimally invasive treatment for genetic disorders of the blood that can be achieved safely and simply by intravenous administration. (more…)
Addiction, Author Interviews, Opiods / 27.10.2016

MedicalResearch.com Interview with: Brett Wolfson-Stofko, PhD Post-Doctoral Fellow Behavioral Science Training Program Center for Drug Use and HIV/HCV Research Rory Meyers College of Nursing New York University New York, NY 10003 Research Associate Institute for Special Populations National Development & Research Institutes, Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drug overdose mortality rates per year continue to rise in the US. Previous research suggests that public bathrooms are among the most popular public injection locations for people who inject drugs (PWID) in New York City. Though syringe exchange programs provide sterile injection equipment they are not authorized to offer a safe and sanitary space for injection which leads many, particularly those that are unstably housed, to inject in public spaces. This study interviewed 86 business managers throughout NYC and 58% (n = 50) of these managers had encountered drug use in their business bathroom within the past 6 months. Over one-third found improperly disposed syringes and 14% encountered unresponsive individuals. Only 10% of managers reported some form of overdose recognition and naloxone training while 64% of managers thought overdose recognition and naloxone training would be useful for them and their staff. (more…)
Author Interviews, Endocrinology, Menopause, Osteoporosis / 27.10.2016

MedicalResearch.com Interview with: Pauline Camacho, MD, FACE Professor, Endocrinology Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center MedicalResearch.com: What is the background for this report? What is the prevalence and significance of osteoporosis in US women? Response: Osteoporosis is widely prevalent and is increasing in prevalence not only in the US but also around the world. 10.2 million Americans have osteoporosis and that an additional 43.4 million have low bone mass. More than 2 million osteoporosis-related fractures occur annually in the US, more than 70% of these occur in women ( from National Osteoporosis Foundation (NOF) estimates). (more…)
Author Interviews, Gender Differences, Pediatrics / 26.10.2016

MedicalResearch.com Interview with: Rachel H. Farr, Ph.D. Assistant Professor Department of Psychology University of Kentucky MedicalResearch.com: What is the background for this study? Response: Controversy continues to surround parenting by lesbian and gay (LG) adults and outcomes for their children. As sexual minority parents increasingly adopt children, longitudinal research about child development, parenting, and family relationships is crucial for informing such debates. This longitudinal study compared outcomes for children, parents, couples, and the overall family system among nearly 100 (N = 96) adoptive families with lesbian, gay, and heterosexual parents at two time points: when children were preschool-age, and approximately 5 years later, when children were in middle childhood. Child outcomes were assessed via parent- and teacher-reported behavior problems, while parent outcomes were assessed via self-reports of parenting stress levels. Couple and family outcomes were evaluated by parent reports of couple adjustment and overall family functioning. (more…)
Author Interviews, Lancet, Primary Care, Weight Research / 26.10.2016

MedicalResearch.com Interview with: Paul Aveyard PhD MRCP FRCGP FFPH Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences University of Oxford Radcliffe Primary Care Building Radcliffe Observatory Quarter Oxford MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that opportunistic brief interventions by physicians can be effective, but there is no evidence that they are so for obesity. Physicians worry that broaching this topic will be offensive, time-consuming, and ineffective. We needed a randomised trial to assess whether physicians’ fears were justified, or in fact brief interventions could be as effective for patients who are overweight as they are for smoking or problem drinking and that’s what we did. (more…)
Author Interviews, Cost of Health Care, Orthopedics / 26.10.2016

MedicalResearch.com Interview with: Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training. • Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut. • 61 percent of patients say a surgeon’s salary should not be tied to outcomes. • 79 percent of patients say reimbursement to drug and device companies should be reduced. (more…)
Author Interviews, Autism, Education, Lancet, Pediatrics / 26.10.2016

MedicalResearch.com Interview with: Prof. Tony Charman Chair in Clinical Child Psychology King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) Department of Psychology PO77, Henry Wellcome Building De Crespigny Park Denmark Hill London MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study is a follow-up of a treatment trial on which we have previous reported. In the original Preschool Autism Communication Trial (PACT), 152 children aged 2-4 with autism were randomised to receive the 12 month early intervention or treatment as usual. The type of early intervention used in this study focuses specifically on working with parents. Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents are able to enhance their awareness and response to their child’s unusual patterns of communication; they become better able to understand their child and communicate back appropriately in a focused way. Parents take part in 12 therapy sessions over 6 months, followed by monthly support sessions for the next 6 months. In addition, parents agree to do 20-30 minutes per day of planned communication and play activities with the child. The study published today is the follow-up analysis of the same children approximately 6 years after the end of treatment. The main findings are that children who had received the PACT intervention aged 2-4 had less severe overall symptoms six years later, compared to children who only received ’treatment as usual’ (TAU) with improved social communication and reduced repetitive behaviours, although no changes were seen in other areas such as language or anxiety. These findings on an international recognised and blind rated observational measure of autism symptoms were accompanied by improvements in children’s communication with their parents for the intervention group, but no differences in the language scores of children. Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours. However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours (eg, conduct/oppositional disorder) or depression. (more…)
Allergies, Author Interviews, NIH / 26.10.2016

MedicalResearch.com Interview with: Geoffrey Mueller, Ph.D. Staff Scientist Genome Integrity and Structural Biology Laboratory National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, NC 27709 MedicalResearch.com: What is the background for this study? What are the main findings? Response: While allergic disease is a wide spread problem, it is actually a select few proteins, called allergens, that initiate allergy symptoms. This study was focused on looking for fundamental biochemical differences between allergens and non-allergens derived from the house dust mite. We found that the mite allergens, as a group, are distinctly different from the non-allergens in that they are more highly produced, and more stable. Previous anecdotal evidence suggested that these properties would lead to more allergens surviving the journey from the source (either mites or pollens) to a person. In addition, the greater stability of allergens may influence the decision making of the immune system to target these proteins as dangerous instead of harmless. (more…)
Author Interviews, OBGYNE, Pediatrics, Primary Care, Yale / 26.10.2016

MedicalResearch.com Interview with: Ann Kurth, Ph.D., C.N.M., R.N. USPSTF Task Force member Dean of the Yale School of Nursing MedicalResearch.com: What is the background for this study? What are the main findings? Response: Breastfeeding is beneficial for both mothers and their babies, with the evidence showing that babies who are breastfed are less likely to get infections such as ear infections, or to develop chronic conditions such as asthma, obesity, and diabetes. For mothers, breastfeeding is associated with a lower risk for breast and ovarian cancer and type 2 diabetes. While breastfeeding rates have been rising in recent decades—with 80 percent of women starting to breastfeed and just over half still doing so at six months—they are still lower than the Healthy People 2020 targets and the Task Force wanted to review the latest evidence around how clinicians can best support breastfeeding.” After balancing the potential benefits and harms, the Task Force found sufficient evidence to continue to recommend interventions during pregnancy and after birth to support breastfeeding. This recommendation includes the same types of interventions the Task Force recommended in 2008, such as education about the benefits of breastfeeding, guidance and encouragement, and practical help for how to breastfeed. (more…)
Author Interviews, Weight Research / 26.10.2016

MedicalResearch.com Interview with: Dr. Susan L. McElroy, M.D. Professor of Psychiatry and Behavioral Neuroscience Chief Research Officer Lindner Center of HOPE University of Cincinnati College of Medicine. MedicalResearch.com: What is the background for this study? What are the main findings? Response: SPD489-346, designed as a multi-center, double-blind, placebo-controlled, dose-optimized, randomized-withdrawal study, is the first-ever longer-term pharmacologic study (38 weeks) to evaluate the maintenance of efficacy between Vyvanse and placebo in adults with moderate to severe binge eating disorder (B.E.D.). Study SPD489-346 evaluated the longer-term maintenance of efficacy (38 weeks) between Vyvanse and placebo based on the primary endpoint of time to relapse during the randomized-withdrawal phase in adults aged 18 to 55 (N=267) with moderate to severe B.E.D. based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision (DSM-IV-TR®) criteria. In the study, relapse was defined as having two or more binge days per week for two consecutive weeks prior to any visit and an increase in Clinical Global Impressions-Severity (CGI-S) score of two or more points relative to the randomized-withdrawal baseline visit Results from SPD489-346 indicated that Vyvanse (n=136) demonstrated significant maintenance of efficacy compared to placebo (n=131) based upon the primary endpoint of time to relapse. At the conclusion of the study, maintenance of efficacy for patients who had an initial response during the open-label phase, and then continued on Vyvanse during the randomized-withdrawal phase, was demonstrated with Vyvanse being superior over placebo as measured by time to relapse. Safety and tolerability evaluations of Vyvanse included treatment-emergent adverse events (TEAEs) and vital signs. The safety profile for Vyvanse in this study was generally consistent with the known profile reported in previous studies in adult patients with moderate to severe B.E.D. Vyvanse is indicated for the treatment of moderate to severe B.E.D. in adults. Vyvanse is not for weight loss. It is not known if Vyvanse is safe and effective for the treatment of obesity. Vyvanse is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep in a safe place to prevent misuse and abuse. Selling or sharing Vyvanse may harm others and is illegal. (more…)
Author Interviews / 26.10.2016

MedicalResearch.com Interview with: CuVerroAnthony M. Kulik Director CuVerro® Business   MedicalResearch.com: What is the background for this announcement? What are the benefits of CuVerro copper alloys? Response: The NCAA Basketball Champion Villanova Wildcats have installed Black Iron Strength dumbbells and attachments made with CuVerro bactericidal copper in their training facilities as a way to promote greater hygiene and help kill bacteria that cause infections. The gripping surfaces of Black Iron Strength dumbbells and attachments are made of EPA-registered CuVerro bactericidal copper.  CuVerro copper surfaces begin killing bacteria on contact, and continuously kill greater than 99% of bacteria within two hours of exposure.  It works 24/7 and won’t wash out or wear away.  Copper surfaces like those used by Black Iron Strength are gaining attention among owners and operators of athletic facilities and health and fitness clubs around the country for their hygienic properties.  CuVerro bactericidal copper is also increasingly being used in healthcare and other industries to fight infection-causing bacteria, as cited in recent articles published in the New York Times, Washington Post, and Wall Street Journal. (more…)
ALS, Antioxidants, Author Interviews, Columbia, Inflammation, JAMA, Nutrition / 26.10.2016

MedicalResearch.com Interview with: Dr. Jeri Nieves PhD Director of bone density testing New York's Helen Hayes Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Amyotrophic lateral sclerosis (ALS) is a devastating severe neurodegenerative disorder that causes progressive muscle atrophy, paralyses, and eventual respiratory failure. Our objective was to evaluate the associations between nutrition and severity of ALS around the time of diagnosis. This was a cross-sectional analysis of data from a multicenter cohort of 302 patients with ALS. We assessed nutrient intake using a modified Block Food Frequency Questionnaire. The outcomes were respiratory function (measured using percentage forced vital capacity; FVC%) and functional performance measured by ALS Functional Rating Scale–Revised (ALSFRS-R), both considered important indicators of the severity of ALS. Results of the regression analysis were that higher intakes of antioxidants and carotenes from vegetable intake were associated with higher ALSFRS-R scores or better %FVC. We used a novel analysis to evaluate the diet as a whole and found that higher intakes of antioxidants, fiber from grains, vegetables, fruit, eggs, fish, and poultry were all associated with higher function in patients with ALS. However, milk and lunch meats were associated with lower measures of function. These consistent results from two different statistical analyses indicate that diet may help minimize the severity of ALS. Perhaps these findings point to the role of oxidative stress in ALS severity. In summary, increased consumption of antioxidant nutrients, foods high in carotenoids and fiber, vegetables and fruits, poultry and fish are associated with better function around the time of ALS diagnosis. (more…)
Author Interviews, Dermatology, JAMA / 26.10.2016

MedicalResearch.com Interview with: Aaron S. Farberg, MD Department of Dermatology Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Regular sunscreen use is a critical component of sun protection and has been shown to reduce skin cancer risk. However, there have often been conflicting sunscreen messages (sometimes without scientific support) that have led to confusion by the public. Controversy has also emerged surrounding the safety and possibility of adverse effects from various sunscreen ingredients. The purpose of this study was to determine US dermatologists’ actual sunscreen perceptions, potential safety concerns as well as their recommendations and personal usage. Some people are so affected by the sun that they require a brand of Custom Sunscreens to help protect them from the sun. Our study found that dermatologists have an overall positive view of sunscreen. 97% of dermatologists agree that regular sunscreen use helps lower skin cancer risk, 100% agree that it reduces subsequent photoaging, and 99% recommend their family/friends use sunscreen. Nearly all (96%) consider FDA approved sunscreens currently available in the US to be safe and (99%) believe their patients generally under-apply sunscreen. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Pediatrics / 26.10.2016

MedicalResearch.com Interview with: Yunru Huang Ph.D. Candidate in epidemiology Department of Pediatrics University of California Davis, Sacramento, CA MedicalResearch.com: What is the background for this study? Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses. We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED. (more…)
Author Interviews, BMJ, Orthopedics, Technology / 26.10.2016

MedicalResearch.com Interview with: Jason Busse PhD Associate Professor, Department of Anesthesia McMaster University Hamilton, ON MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our group previously reviewed the evidence regarding the effectiveness of low-intensity pulsed ultrasound (LIPUS) for fracture healing. We found moderate to very low quality evidence for LIPUS in accelerating functional recovery among patients with fracture, and that most trials only explored effects on surrogate outcomes (e.g. radiographic healing); only five of 13 trials directly assessed functional end points - of these, one was positive. We concluded that large trials of high methodological quality, focusing on patient important outcomes such as quality of life and return to function, were needed to establish the role of LIPUS in fracture healing. We have now completed such a study. Our large, international trial of LIPUS for surgically managed tibial fractures found the addition of LIPUS does not improve functional recovery or accelerate radiographic healing. (more…)
Author Interviews, BMJ, Lipids, Nutrition, Omega-3 Fatty Acids, Weight Research / 26.10.2016

MedicalResearch.com Interview with: Artemis P. Simopoulos, M.D. FACN President, The Center for Genetics Nutrition and Health Washington, DC 20016 MedicalResearch.com: What is the background for this study? What are the main findings? Response: I have written extensively on the evolutionary aspects of diet, the diet of Crete prior to 1960 in which I pointed to the misinterpretation of the data of the Seven Countries Study by Keys et al. A major characteristic of these diets is a balanced omega-6/omega-3 ratio. The recommendation to substitute saturated fats with omega-6 rich oils (sunflower, corn, soybean) increases inflammation and coronary heart disease. It has been shown in a number of studies that a high omega-6/omega-3 (20/1 instead of a balanced ratio) leads to an increase in white adipose tissue and prevents the formation of brown adipose tissue leading to obesity. The changes in the diet-high in omega-6 oils depletion of omega-3 and high fructose along with highly refined carbohydrates in processed foods and a sedentary lifestyle lead to obesity, diabetes, coronary heart disease and cancer. The scientific evidence from the FAT-1 mouse and recent cohort studies clearly show that the current dietary guidelines as the previous ones are not based on science that takes into consideration genetics, metabolism, the concept that a calorie is not a calorie. It is important to consider that nutrients influence the expression of genes, the omega-6 fatty acids are the most pro-inflammatory nutrients, and inflammation is at the base of all chronic non-communicable diseases. (more…)
Anesthesiology, Author Interviews / 25.10.2016

MedicalResearch.com Interview with: Dr. Richard Dutton, MD Chief quality officer U.S. Anesthesia Partners Dallas MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to document the change in national anesthesia practice over the past 5 years, specifically the increase in non-operating room anesthesia NORA. We found that non-operating room anesthesia now accounts for more than 1/3 of all anesthetics. The proportion continues to rise as minimally invasive procedures are developed in gastroenterology, cardiology, radiology and other non-surgical disciplines. These procedures are often performed in complex patients, and require anesthesia involvement to facilitate. (more…)
Author Interviews, Health Care Systems / 25.10.2016

MedicalResearch.com Interview with: Julie M. Kapp, MPH, PhD, FACE Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The United States lags behind its high-income peer countries on a number of critical health outcomes, including life expectancy, and this gap has been widening for the last several decades. The 2010 Patient Protection and Affordable Care Act (ACA) created a number of provisions to try to address this, including an emphasis on a systems-engineering approach to health care services. In addition to the ACA, there is a growing movement toward collective impact among community-based organizations. However, despite this focus, U.S. health and health care activities are often uncoordinated and fragmented. We applied a systems-thinking approach to U.S. population health. We used the Malcolm Baldrige Framework for Performance Excellence as the unifying conceptual systems-thinking approach. In addition to this proposed framework, we make two critical recommendations: 1) the need to drive a strategic outcomes-oriented, rather than action-oriented, approach by creating an evidence-based national reporting dashboard; and 2) improve the operational effectiveness of the workforce. (more…)
Author Interviews, Cancer Research, JAMA, Smoking / 24.10.2016

MedicalResearch.com Interview with: Joannie Lortet-Tieulent MSc Senior Epidemiologist American Cancer Society, Inc. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? Response: Many tobacco control policies are decided at state level. We have known for some times that some states have pioneered tobacco control, or have implemented strong tobacco control or programs. Meanwhile, in other states, tobacco control and programs can be weaker. Also, some states have large populations with low socioeconomic status, among which smoking prevalence is higher. We were interested in how those state-level differences impact people’s health. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 24.10.2016

MedicalResearch.com Interview with: Anna D. Sinaiko, PhD, MPP Research Scientist Department of Health Policy & Management 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: One strategy for reducing health care spending in the U.S. is to increase transparency in health care pricing for patients. The idea is that patients can learn about and anticipate the prices they would pay for health care before they receive care, and incorporate that information into their choices about whether and where to receive care. When patients incorporate price information into their decisions, it gives providers an incentive to compete on price and quality. There has been a dramatic increase in the availability of health care price information over the last few years for patients who have commercial health insurance, primarily through web-based tools. In this study, we examined the impact of this information on patient choice of health care facility. We find that a small number of enrollees with commercial health insurance through Aetna, 3% overall, accessed price information through their transparency tool. Among users of the tool, patients who viewed price information for imaging services and for sleep studies before they had the service chose facilities with lower prices, and incurred lower spending (of 12%) for imaging services. We found no effect on patient choices for patients who viewed price information for 6 other health care services (carpal tunnel release, cataract/lens procedures, colonoscopy, echocardiogram, mammograms, and upper gastrointestinal endoscopy). (more…)
Author Interviews, Brain Injury, JAMA, Pediatrics / 24.10.2016

MedicalResearch.com Interview with: Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion University of Ottawa Director, Clinical Research Unit Children’s Hospital of Eastern Ontario Ottawa, ON MedicalResearch.com: What is the background for this study? Response: Concussion remains a major public health concern in children. Approximately 30% of affected children experience persistent post-concussive symptoms (PPCS) for at least one month post-injury. These symptoms may negatively impact their health related quality of life. Examples may include cognition, memory and attention affecting school attendance and performance, mood and social engagement, as well as physical performance. Prior to this study, there was little evidence that examined the relationship between PPCS and quality of life following concussion. This was important to better understand in order to provide appropriate interventions, expectation management and ultimately a better standard of care to affected patients and their families. (more…)
Author Interviews, Columbia, JAMA, OBGYNE, Stroke / 24.10.2016

MedicalResearch.com Interview with: Eliza Miller, M.D. Vascular Neurology Fellow New York-Presbyterian Hospital/Columbia University Medical Center We collaborated with researchers at the Massachusetts General Hospital and with the New York State Department of Health. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research has found that older women of childbearing age are at higher risk of stroke during pregnancy and postpartum than younger women. We hypothesized that their increased stroke risk might not be due to pregnancy-related factors, but just due to the fact that stroke risk increases with age for all people. We used billing data from New York State hospitals to calculate incidence risk ratios for four age groups: 12-24, 25-34, 35-44 and 45-55. In each age group, we compared the incidence of stroke in women who were pregnant or postpartum to the incidence of stroke in women of the same age who were not pregnant. As in prior studies, we found that the incidence of pregnancy-associated stroke was higher in older women compared to younger women (about 47/100,000 deliveries in the oldest group, versus 14/100,000 deliveries in the youngest group). However, the incidence ratios showed that pregnancy increased stroke risk significantly in women under 35, but did not appear to increase stroke risk in women over 35. In the youngest group (age 12-24), pregnancy more than doubled the risk of stroke, and in the 25-34 age group, pregnancy increased stroke risk by 60%. In women aged 35 and older, pregnancy did not increase stroke risk. Women who had pregnancy-related strokes tended to have fewer traditional vascular risk factors like hypertension and diabetes, compared to same-aged women with non-pregnancy related strokes. (more…)
Author Interviews, Neurological Disorders, Pulmonary Disease / 24.10.2016

MedicalResearch.com Interview with: Paolo Prandoni, M.D., Ph.D. and Department of Cardiovascular Sciences Vascular Medicine Unit University of Padua, Padua Sofia Barbar, M.D Department of Internal and Emergency Medicine Civic Hospital of Camposampiero Camposampiero MedicalResearch.com: WhaWhat are the main findings? Response: Syncope is defined as a sudden loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. According to the most recent guidelines, syncope can be classified as neurally-mediated, due to orthostatic hypotension and cardiovascular. Syncope is frequent in general population and represents up to 2% of all attendances in Emergency Department in Europe. The initial approach is unable to identify a plausible cause for syncope in 25-30% of cases and approximately 40% of syncope referred to an Emergency Department is then admitted to the hospital. Pulmonary embolism (PE) is an obstruction in the pulmonary arteries interfering with both blood circulation and gas exchange and therefore representing a potentially life-threatening event. Clinical features of PE are extremely variable. Available guidelines on syncope management consider PE as an infrequent cardiovascular cause of syncope. However, the true prevalence of pulmonary embolism in syncope-patients it is actually unknown. Moreover a workup for PE diagnosis in these patients is not suggested in the current guidelines. (more…)