Author Interviews, Global Health, HIV, NEJM, OBGYNE / 22.02.2016

MedicalResearch.com Interview with: Jared Baeten, MD PhD Vice Chair, Department of Global Health Professor, Departments of Global Health, Medicine, and Epidemiology Co-Director, International Clinical Research Center University of Washington MedicalResearch.com: What is the background for this studies? Dr. Baeten: Women account for nearly 60 percent of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While several studies have shown that antiretroviral medications (ARVs) are highly effective in preventing HIV, other studies – such as VOICE and FACTS 001 – suggest that for young, at-risk women in Africa, ARVs delivered as a vaginal gel or as a tablet may not be acceptable. Products must be used to be effective, and that was not the case for most of the participants in previous studies. Medical Research: What was the aim of ASPIRE and The Ring Study? Dr. Baeten: As Phase III clinical trials, ASPIRE and The Ring Study were designed to determine whether a vaginal ring containing an antiretroviral (ARV) drug called dapivirine is safe and effective in protecting women against HIV when used for a month at a time. These trials also sought to determine whether women find the vaginal ring practical and easy to use. As sister studies, ASPIRE and The Ring Study were designed as the centerpiece of a broader licensure program to provide the strength of evidence to support potential licensure of the dapivirine vaginal ring for preventing HIV in women. Because at least two Phase III efficacy trials are usually needed for a product to be considered for regulatory approval, ASPIRE and The Ring Study were conducted in parallel to accelerate the timeline to the ring’s potential approval. (more…)
Anesthesiology, Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease / 22.02.2016

MedicalResearch.com Interview with: John G. Laffey MD Chief, Department of Anesthesia; Co-Director, Critical illness and Injury Research Centre; Scientist, Keenan Research Centre for Biomedical Science ‑ St. Michael's Hospital Professor, Anesthesia, Critical Care, and Physiology ‑ University of Toronto Medical Research: What is the background for this study? Dr. Laffey: Acute respiratory distress syndrome is the commonest cause of severe acute respiratory failure in the critically ill. ARDS is a major cause of death and disability in the critically ill worldwide. Second, there is no treatment for ARDS, and our present management approaches are limited to supporting organ function while treating the underlying causes We performed the LUNG SAFE study to address several clinically important questions regarding ARDS. First, the current incidence in a large international cohort was not known. Large regional differences had been suggested: for example, the incidence of ARDS in the US was reported to be ten times greater of that in Europe_ENREF_4. Second, we wanted to understand how we manage patients with  Acute respiratory distress syndrome in the ‘real world’ situation. Specifically, it was not clear to what extent newer approaches to artificial ventilation, such as reducing the size of the breaths (lower tidal volumes) and keeping the lung pressure positive at all times to minimize collapse (PEEP) were used. The impact of studies showing promise for other measures to improve gas exchange such as turning patients prone during mechanical ventilation, or using neuromuscular blockade, on routine clinical practice in the broader international context was not known. Third, there were some concerns over the extent of clinician recognition of ARDS. This was an important issue because implementation of the effective therapies may be limited by lack of recognition of ARDS by clinicians. A better understanding the factors associated with ARDS recognition and how this recognition influenced patient management could lead to effective interventions to improve care. Lastly we wanted to determine the outcome from  Acute respiratory distress syndrome in a global cohort of patients. Medical Research: What are the main findings? Dr. Laffey: We found that ARDS continues to represent an important public health problem globally, with 10% of ICU patients meeting clinical criteria for ARDS. While there appeared to be some geographic variation, this did not seem as great as previously thought. An important finding was the under-recognition of  Acute respiratory distress syndrome by clinicians, with 40% of all cases not being recognized. In addition, over one third of patients did not receive protective lung ventilation strategies. The use of other measures to aid gas exchange during artificial ventilation, such as turning the patient into the prone position, or the use of neuromuscular blockade was also quite low. Of most concern, ARDS continues to have a very high mortality of approximately 40% of patients dying in hospital. (more…)
Anemia, Author Interviews, Kidney Disease, Pharmacology / 22.02.2016

MedicalResearch.com Interview with: Dr. Navdeep Tangri Attending physician and Assistant Professor in the Division of Nephrology Department of Medicine and the Department of Community Health Sciences University of Manitoba and Dr. David Collister  Seven Oaks General Hospital Renal Program Winnipeg, Manitoba Canada.  Medical Research: What is the background for this study? What are the main findings? Response: Anemia is common in chronic kidney disease (CKD) including dialysis and its treatment with erythopoetin stimulating agents (ESAs) reduces the need for blood transfusions and has varying effects on morbidity and mortality. The optimal hemoglobin (HGB) targets for treating anemia in CKD are controversial with safety concerns around the normalization of hemoglobin levels due to an increase in cardiovascular (CV) events. The effects of ESAs on health related quality of life (HRQOL) are unclear with individualization o fhemoglobin targets being controversial as clinicians and patients attempt to balance perceived HRQOL benefits with cardiovascular risk. We performed an updated meta-analysis of randomized controlled trials (RCTs) that evaluated the treatment of anemia in CKD with ESAs that targeted higher versus lower hemoglobin targets using validated HRQOL metrics including SF-36 and KDQ. We included 17 studies and found that higher hemoglobin targets compared to lower HGB targets did result in a statistically significant difference in HRQOL and thus did not improve HRQOL beyond a clinically meaningful threshold. Any change in HRQOL was further attenuated in dialysis subgroups. (more…)
Author Interviews, Gender Differences, Health Care Systems, Women's Heart Health / 22.02.2016

MedicalResearch.com Interview with: Professor Robyn Norton Principal Director of The George Institute for Global Health Board Member, The George Institute for Global Health Professor of Public Health at the University of Sydney Professor of Global Health at the University of OxfordProfessor Robyn Norton Principal Director of The George Institute for Global Health Board Member, The George Institute for Global Health Professor of Public Health at the University of Sydney Professor of Global Health at the University of Oxford Medical Research: What is the background for this study? What are the main findings? Prof. Norton: The impetus to focus on women’s health, stems from the knowledge that, while noncommunicable diseases (NCDs) are the leading cause of death and disability for women worldwide, this is not sufficiently recognized nor sufficiently resourced. Equally, while there is increasing evidence that we can learn so much more about how to address the burden of disease for women, by collecting and analyzing data on women, separately to that for men, this is not happening. We are calling for a refocus of the women’s health agenda on NCDs – given that globally and in many countries the focus of women’s health almost exclusively is still on women’s sexual and reproductive health. The fact is that in all but the poorest countries, the greatest health burden, for women, is  noncommunicable diseases and so that if we are to make significant gains in improving women’s health then we must focus on addressing NCDs. The current global burden of disease for women reflects both the significant gains that have been made as a result of addressing maternal mortality and changes that have affected both women and men equally – namely, that populations are living longer, as a consequence of reductions in both infant mortality and communicable diseases, as well as the fact that populations are becoming wealthier and, as a result, are engaging in behaviors that increase the risk of noncommunicable diseases. (more…)
Author Interviews, Cost of Health Care, Pediatrics / 22.02.2016

MedicalResearch.com Interview with: Joanna Thomson MD MPH Assistant Professor Division of Hospital Medicine Cincinnati Children’s Hospital Medical Center Medical Research: What is the background for this study? What are the main findings? Response: Children with medical complexity have lifelong and complex illnesses. These children account for a disproportionate amount of pediatric health care use.  The lives of families are affected – both financially and socially.  We sought to characterize the challenges these families face through examination of financial and social hardships. In a cohort of families with children who receive care at Cincinnati Children’s Complex Care Center, four out of five families reported experiencing at least one hardship. The striking frequencies observed, despite relatively high measures of household socioeconomic status, suggest that these families face great challenges.  For example, families frequently experienced the need to borrow money and expected little to no help from family or friends. In order to benchmark the hardships experienced by families of children with medical complexity, we compared the hardships they experienced to those faced by the families of children with asthma in the Greater Cincinnati Asthma Risks Study. After accounting for key demographic and socio-economic differences between the two groups, families of children with medical complexity experienced similar to higher levels of financial and social hardship.  For instance, families of children with medical complexity were over two times as likely to report the inability to pay their rent or mortgage than families of children with asthma. (more…)
Author Interviews, Heart Disease, Stroke / 22.02.2016

MedicalResearch.com Interview with: Dr. Rolf Wachter Head Senior physician University of Goettingen Göttingen, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Wachter: Atrial Fibrillation is a known risk factor for stroke, and in stroke patients, it is a strong predictor of adverse outcome, if it is not adequately treated (e.g. by anticoagulation). However, in its paroxysmal form, Atrial Fibrillation (AF) may escape routine diagnostics. We aimed to show that we can increase the number of patients with detected AF if we do more monitoring for atrial fibrillation. As a unique feature of our study, we did not focus on a certain stroke subtype (i.e. cryptogenic stroke), but we aimed to consider all patients >= 60 years in whom the detection of  Atrial Fibrillation has a clinical relevance. The main finding of our study was that enhanced and prolonged Holter ECG monitoring (3x10 days of monitoring, analysed in a dedicated core lab) tripled the number of detected AF cases (from 4.5 to 13.5 %). 11 patients had to undergo enhanced and prolonged monitoring to find one additional case of Atrial Fibrillation. (more…)
Author Interviews, Diabetes, OBGYNE, Pediatrics / 22.02.2016

MedicalResearch.com Interview with: Laurie A. Nommsen-Rivers, PhD, RD, IBCLC Assistant Professor, UC Department of Pediatrics Cincinnati Children's Hospital Medical Center  Medical Research: What is the background for this study? Dr. Nommsen-Rivers: Breastfeeding provides important benefits for mother and infant. Exclusive breastfeeding—that is, without any other food or fluids provided to the infant—is recommended for the first six months of life by multiple public health organizations. Some mothers, despite their best efforts, have difficulty establishing and sustaining sufficient milk production to support exclusive breastfeeding. Our previous research suggested that mothers with less optimal glucose tolerance are at risk for prolonged delays in time between birth and the establishment of copious milk production. We wanted to extend this finding by probing if mothers who had diabetes in pregnancy, as a sign of less optimal glucose tolerance, are at greater risk of sustained low milk production. “Glucose tolerance” refers to the body’s ability to metabolize glucose and maintain a healthy blood sugar level, which is orchestrated by the hormone insulin. For a long time, we did not consider insulin to play a role in milk production, but we are now learning that insulin plays an essential role in milk production. (more…)
Author Interviews, Epilepsy / 21.02.2016

MedicalResearch.com Interview with: Dr. Samba Reddy, PhD, RPh, FAAPS Professor Neuroscience and Experimental Therapeutics College of Medicine Texas A&M University Health Science Center Bryan, TX Medical Research: What is the background for this study? What are the main findings? Dr. Reddy: Neurosteroids are a group of neuroactive compounds present in the brain. They are known to modulate ionotropic post-synaptic GABA-A receptors, which are the primary mediators of fast inhibitory neurotransmission in the brain. Hence, the neurosteroid—GABA-A receptor system is a critical axis for controlling neuronal excitability in certain brain disorders, such as anxiety and epilepsy. There is new evidence that such neurosteroids can strongly activate extrasynaptic GABA-A receptors, which are located outside of the synapses mainly on soma, dendrites and axons. However, the neurosteroid structure requirement for functional activation of extrasynaptic receptors remains largely unexplored.  In this study, we identified a consensus neurosteroid pharmacophore model at extrasynaptic GABA-A receptors for activation of tonic current and seizure protection. (more…)
Author Interviews, Clots - Coagulation, Stroke / 21.02.2016

MedicalResearch.com Interview with: Thorsten Steiner, MD, PhD Klinikum Frankfurt Hoechst and Heidelberg University Hospital Germany Medical Research: What is the background for this study? What are the main findings? Dr. Steiner: Background of the study is intracranial hemorrhage (ICH) related to vitamin-K antagonists. The mortality rate is about 60%. Main reason for the high mortality rate is hematoma expansion which occurs in about 50% during the acute phase right after the start of symptoms. We performed an investigator initiated randomized controlled trial (RCT) and found that a 4-factor prothrombin complex (PCC) is superior to fresh frozen plasma (FFP) in normalizing the international normalized ratio (INR) and prevents hematoma expansion. This let to more deaths within 48 hours in the FFP-group but had no clinical impact at 3 months - but our study was powered to detect INR normalization and not a clinical endpoint. (more…)
Author Interviews, CDC, HIV / 21.02.2016

MedicalResearch.com Interview with: Martin Hoenigl, MD Postdoctoral Fellow AntiViral Research Center, Department of Medicine University of California, San Diego Medical Research: What is the background for this study? Response: The detection of acute HIV infection (AHI) is critical to HIV prevention and treatment strategies. Many field-based testing programs rely on point-of-care HIV antibody testing, which will reliably identify persons with established infection, but fail to detect persons with AHI. In many of these programs additional tests for AHI are only performed / recommended in persons presenting with signs and symptoms consistent with an acute retroviral syndrome (ARS). These signs and symptoms are unspecific and include fatigue, headache, pharyngitis, skin rash, GI symptoms, night sweats and others. However, the proportion of persons with acute HIV infection presenting symptomatic for their diagnostic test remains unknown. The objective of our study was therefore to determine the proportion of persons with acute HIV infection presenting with signs and symptoms consistent with ARS for HIV screening. Medical Research: What are the main findings? Response: We analyzed signs and symptoms in 90 patients diagnosed with acute HIV infection in a community-based program in San Diego that offered universal HIV-1 nucleic acid amplification testing, independent of signs and symptoms. Forty-seven (52%) patients reported ongoing signs or symptoms consistent with ARS on the day of NAT screening. Another 25 (28%) reported signs or symptoms that had occurred during the 14 days before testing, but had resolved by the testing date. Another 12 (13%) reported signs and symptoms that started after the diagnostic test. Only 6/90 (7%) reported no signs and symptoms consistent with ARS. As a secondary finding, viral loads were significantly higher (p=0.001) in the 72 individuals reporting signs and symptoms consistent with ARS before or at the time of NAT screening compared to the 18 participants who did not report signs and symptoms at their diagnostic test. Most frequently reported ARS signs and symptoms included fever, myalgia, fatigue and headache. (more…)
Author Interviews, Genetic Research, JNCI, Melanoma / 21.02.2016

MedicalResearch.com Interview with: Nancy E. Thomas, MD PhD Department of Dermatology, University of North Carolina Chapel Hill, NC 27599 Medical Research: What is the background for this study? Dr. Thomas: Melanoma had been thought for some time to arise from at least two causal pathways, a ‘chronic sun exposure pathway’ and a ‘nevus pathway’. However, the role of inherited genetic variation in development of melanoma along these pathways had not previously been studied. Thus, we chose to examine the association of SNPs in putative low-penetrance melanoma susceptibility loci with histologic markers of divergent pathways. Medical Research: What are the main findings? Dr. Thomas: Within the large Genes, Environment and Melanoma Study, we investigated the relationship of germline variants in newly identified low-penetrance melanoma risk loci to histologic markers of divergent causal pathways in melanoma. We present strong evidence that the IRF4 rs12203592*T genotype is positively associated with chronic sun exposure-related melanoma and inversely associated with nevus-related melanoma. We also found that the IRF4 rs12203592 genotype is linked to the bi-model age distribution known to occur in melanoma and which is related to the divergent pathways. IRF4 rs12203592 is a functional variant known to affect IRF4 expression in human skin and melanoma cell lines. We conclude that IRF4rs12203592 is likely, at least in part, to determine pathway-specific risk for melanoma development. (more…)
Author Interviews, Gender Differences, Race/Ethnic Diversity, Stroke, Wake Forest / 20.02.2016

MedicalResearch.com Interview with: Cheryl Bushnell, MD, MHS Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist Health Medical Center Boulevard Winston Salem, NC  27157  Medical Research: What is the background for this study? What are the main findings? Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status.  But, we pre-specified gender and race because we knew these could be important predictors of outcome.  As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome. Medical Research: What should clinicians and patients take away from your report? Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored.  Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important.  We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke.  Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities. (more…)
Author Interviews, Epilepsy, Neurological Disorders, Stroke / 20.02.2016

MedicalResearch.com Interview with: Alexander Merkler, MD Fellow in neuro critical care Weill Cornell Medical College and New York-Presbyterian Hospital, New York Medical Research: What is the background for this study? What are the main findings? Dr. Merkler:  Patients with stroke often ask about what type of problems they may expect in the future. As neurologists, we often warm our patients about the risk for recurrent stroke, infections, clots, eating difficulty, and depression. Although seizures are a well-known complication of stroke, there was little data regarding the long-term rate of seizures in patients who have a stroke. Therefore, we sought to evaluate the long-term risk of seizures following stroke in order to better advise physicians and patients on the likelihood of developing seizures after suffering a stroke. We identified over 600,000 patients with stroke and found that the rate of seizures after stroke is high – 15.3% of all patients with stroke will develop seizures. Patients who have hemorrhagic stroke face an even higher rate of seizures – 24% of patients with hemorrhagic type stroke will develop seizures. The rate of seizures after ischemic stroke was significantly higher than previous literature - 13.5% of patients with an ischemic stroke had a seizure in our study. (more…)
Author Interviews, Cancer Research, Cost of Health Care, End of Life Care / 19.02.2016

MedicalResearch.com Interview with: Melissa Garrido, PhD Assistant Professor / Research Health Science Specialist GRECC, James J Peters VA Medical Center, Bronx, NY Brookdale Department of Geriatrics & Palliative Medicine Icahn School of Medicine at Mount Sinai, New York, NY Medical Research: What is the background for this study? What are the main findings? Response: Medical costs for people with serious illnesses are rapidly rising in the United States. Concerns about medical debt and bankruptcy are especially relevant when deciding whether to begin or maintain a treatment that may have limited benefit to a patient’s survival or quality of life. Among patients with advanced cancer, one such decision is the choice of whether to use additional chemotherapy when the disease has not responded to an initial line or lines of chemotherapy. In this study, we used data from a prospective study of patients with advanced cancer and their caregivers to examine the relationship between chemotherapy use at study entry (median of four months before death) and estimated costs of healthcare other than chemotherapy in the last week of life. Medical Research: What is the background for this study? What are the main findings? Dr. Garrido: Among patients with end-stage cancer, those who received chemotherapy in the months before death had higher estimated costs of care in the last week of life.  We did not find evidence that this relationship was explained by patients’ preferences for care, do-not-resuscitate orders, or discussions of care preferences. (more…)
Aging, Author Interviews, Gender Differences / 19.02.2016

MedicalResearch.com Interview with: John Tower, PhD Professor, Molecular and Computational Biology Program Department of Biological Sciences USC Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California Los Angeles, CA 90089-2910 Medical Research: What is the background for this study? What are the main findings? Dr. Tower: Possible interventions in aging that are currently being studied include alterations to the diet and also drugs that target the p53 and TOR pathways.  Our results show that these manipulations sometimes have opposite effects on survival in males versus females. In addition, our results show that the same “low-vitality” individuals in the population are susceptible to death caused by disease and to death caused by aging.  This is called the “Strehler-Mildvan” relationship, and these “low-vitality” individuals could be related to human frailty. (more…)
Author Interviews, Depression, Opiods, Pain Research / 19.02.2016

MedicalResearch.com Interview with: Dr-Jeffrey-ScherrerJeffrey F. Scherrer, PhD Associate Professor Research Director Department of Family and Community Medicine Saint Louis University School of Medicine St. Louis, MO 63104  Medical Research: What is the background for this study? What are the main findings? Dr. Scherrer: We initiated a series of studies on chronic opioid use and risk of depression about 3 years ago and obtained an NIH R21 to study prescription opioid use and risk of new onset depression, depression recurrence and transition to treatment resistant depression.  The rationale comes partly from clinical observations of the research team (I am not a clinician, just a epidemiologist).  We also observed the large field demonstrating patients with depression are more likely to get opioids for pain, take them longer and develop abuse.  We wanted to switch the direction of effect to determine if the reverse exists.  After publishing two papers demonstrating longer use of opioid was associated with increasing risk of depression, our next step was to look at recurrence among patients with a recent history of depression. Medical Research: What should clinicians and patients take away from your report? Dr. Scherrer: Our main recommendation is clinicians should repeatedly screen patients for depression.  While screening at time of starting opioids is common, repeated screening is worth consideration.  Patients with depression who may experience temporary euphoria should not expect opioids to cure depression and they may increase risk for worsening mood and or recurrence after long term use. (more…)
Author Interviews, Mayo Clinic, Stroke / 19.02.2016

MedicalResearch.com Interview with: Thomas G. Brott, M.D. Professor of neurology and director for research and The Eugene and Marcia Applebaum Professor of Neurosciences and James C. and Sarah K. Kennedy Dean for Research. Mayo Clinic in Jacksonville, Fla Medical Research: What is the background for this study? What are the main findings? Dr. Brott: Revascularization for carotid artery stenosis is the accepted treatment for symptomatic patients with >50% stenosis and for asymptomatic patients with >70% stenosis.  The original CREST report in 2010 showed both surgery and stenting were the safe methods to treat severe carotid stenosis.  But the follow-up averaged 2.5 years and Medicare-age patients live for an average of 18-20 years.  These patients and their families needed to know if surgery and stenting are durable in preventing stroke. CREST was designed to answer the questions of clinical and anatomic durability for the long-run. (more…)
Author Interviews, CDC, Ebola, NEJM / 19.02.2016

MedicalResearch.com Interview with: Tim Uyeki MD, MPH, MPP Influenza Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention and Associate Clinical Professor of Pediatrics Department of Pediatrics San Francisco General Hospital Medical Research: What is the background for this study? Dr. Uyeki: During 2014-2015, 27 patients with Ebola virus disease (EVD) were hospitalized in the United States and Europe. Frequent international teleconferences were convened among U.S. and European clinicians caring for EVD patients, often on a weekly basis, to share detailed information and suggestions on clinical management of these patients. We collected clinical, epidemiologic, laboratory, and virologic data on all of these patients and performed descriptive data analyses. We summarized our findings in this article. Medical Research: What are the main findings? Dr. Uyeki: Of the 27 patients with Ebola virus disease cared for in 15 hospitals in nine countries, the median age was 36 years; 19 (70%) were male; 9 of 26 (35%) had underlying medical conditions; and 22 (81%) were healthcare personnel, including 17 of 22 (77%) who had worked in an Ebola treatment unit in West Africa. Of the 27 patients, 20 (74%) were medically evacuated from West Africa, 4 (15%) were imported cases, and 3 (11%) were healthcare personnel who acquired Ebola virus infection while caring for EVD patients in the U.S. or Europe. At illness onset, the signs and symptoms of EVD were non-specific; the most common symptom reported was fatigue. At admission to a hospital in the U.S. or Europe, most patients had fever, weakness, and gastrointestinal symptoms. The median time from illness onset to hospitalization was four days. During hospitalization, all patients had diarrhea, often profuse watery diarrhea; and most experienced electrolyte abnormalities such as hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia, as well as hypoalbuminemia. One third of patients experienced renal abnormalities such as oliguria or anuria, nearly 60% were clinically diagnosed with systemic inflammatory response syndrome, and one third were clinically diagnosed with encephalopathy or encephalitis. Although minor bleeding abnormalities were reported in some patients, only two patients had any gross hemorrhage. Leukopenia was observed during the first week of illness, with increases in white blood cell count during the second week. Thrombocytopenia was common, and aminotransferase levels peaked in the second week of illness. Creatine kinase and lactate levels were elevated in most of the patients who were tested. Ebola virus levels in blood peaked on the seventh day of illness, and critical illness occurred at the end of the first week and during the second week after illness onset. All patients received intravenous fluids; most were treated empirically with antibiotics; and 85% received an investigational therapy, including 70% who received at least two experimental therapies. Eleven (41%) patients were critically ill, including seven who required invasive mechanical ventilation and five who received continuous renal replacement therapy. Five (18.5%) patients died (81.5% survival). (more…)
Author Interviews, Emergency Care, Surgical Research, Weight Research / 19.02.2016

MedicalResearch.com Interview with: Junaid A. Bhatti, MBBS, MSc, PhD Sunnybrook Health Sciences Centre Research Institute Toronto, Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Bhatti: Weight loss surgeries are consistently increasing in the US. While the positive impact of surgery on patient’s health are undebatable, limited information is available about long-term healthcare utilization, especially, emergency care utilization in bariatric surgery patients. This study compared emergency care utilization in bariatric patients three years following surgery to that of three years prior to surgery. Overall, we found that emergency care utilization increased by about 17% following surgery compared to the before surgery period. While complaints related to cardiovascular, ear, respiratory, and dermatology decreased, the complaints related to gastrointestinal, genitourinary, mental health, and substance misuse increased following surgery.  (more…)
Author Interviews, Emergency Care, Mental Health Research / 19.02.2016

MedicalResearch.com Interview with: Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary, AB Canada Medical Research: What is the background for this study? Response: Numerous studies have shown that high users of the emergency department (ED) are often patients with complex medical needs and limited personal and social resources. It is also recognized that high users are a heterogeneous group driven by variability in the operational definition used to define this patient population. “High use” of ED services is often defined by the number of visits per year (namely ≥3 or ≥4 visits to the ED in a 1-year period) with little exploration of the distribution/pattern of these visits over time. The purpose of our study was to examine patient and encounter-level factors and costs related to periods of short-term resource intensity (clustered ED visits) among high users of the ED within a tertiary-care teaching facility. This is important as it may inform interventions that can focus on a more defined group with the goal of providing the needed care in a setting outside of the ED. Medical Research: What are the main findings? Response: Our main findings demonstrate that among high  emergency department users (i.e. patients with 3 or more ED visits in a 1-year period), approximately 1 in 7 patients had a period of high-intensity ED use (3 or more visits clustered within a week). These patients with clustered visits were more likely to be homeless, require psychiatric emergency services, and revisit the  emergency department for the same presenting complaints. The high-intensity users were also less likely to be admitted, more likely to leave without being seen and had lower costs per encounter, although their total ED cost across all visits was higher. (more…)
Author Interviews, Biomarkers, Heart Disease, Lipids / 19.02.2016

MedicalResearch.com Interview with: Lorenz Räber, MD, PhD Director Division CAD and MI INSELSPITAL, Bern University Hospital Bern, Switzerland Medical Research: What is the background for this study? Response: Inflammation is a key player in the pathobiology of atheorsclerosis. Inflammatory markers and specifically C-reactive protein (CRP) associate with statin-mediated clinical event reduction and plaque burden reduction in patients with stable CAD. Whether CRP correlates with changes in plaque composition, ie. an important presumed substrate of plaque vulnerability, remains unknown. We thought to assess compositional atheroma changes by means of virtual histology IVUS in relation to levels of hs-CRP in STEMI patients. For this purpose, we performed intracoronary imaging using virtual histology IVUS in the proximal part of the two non-infarct related coronary arteries of STEMI patients at baseline and 13 months follow-up (IBIS-4 study). A total of 44 patients with 80 vessels had serial imaging and hsCRP measurements available. Medical Research: What are the main findings? Response: This is the first study to show that serial changes and on-treatment levels of hs-CRP correlate with virtual histology IVUS-defined necrotic core content in patients with STEMI receiving high-intensity statin therapy. Patients with a low inflammatory activity are more likely to achieve a reduction in necrotic core, which represents a presumed substrate of plaque vulnerability. These findings may provide the basis for assessing inflammation at follow-up to monitor disease activity in STEMI patients. (more…)
Author Interviews, Cancer Research, Columbia, Genetic Research / 19.02.2016

MedicalResearch.com Interview with: Jeanine D'Armiento, M.D., Ph.D. Associate Professor of Medicine in Anesthesiology Director of the Center for Molecular Pulmonary Disease in Anesthesiology and Physiology and Cellular Biophysics Director, Center for LAM and Rare Lung Disease New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. D'Armiento: I am the Director of the Center for Lymphangiomyomatosis (LAM) and Rare Lung Disease at Columbia University; the Center focuses on this proliferative lung disease, which arises spontaneously or as the pulmonary manifestation of the Tuberous Sclerosis Complex (TSC). We have one of the largest cohorts of these patients in the country. Through an understanding of the pathogenesis of LAM our research aims to identify novel therapeutic targets of the disease to improve the care of these patients. Building on our previous research we demonstrated that the HMGA2 gene and its signaling pathway (the route of information which begins an action within cells), are required to produce tumors in the lung and kidneys in individuals with Tuberous Sclerosis Complex. (more…)
Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 19.02.2016

MedicalResearch.com Interview with: Dr. Adnan Qureshi MD Professor of Neurology, Neurosurgery and Radiology University of Minnesota  Medical Research: What is the background for this study? Dr. Quershi: Women who have the last pregnancy at advanced age (usually defined as pregnancy at age of 40 years or greater) have higher risk of developing hypertension, hypertension related disorders, and diabetes mellitus during pregnancy. There is some evidence that disproportionately higher rates of cardiovascular risk factors continue years after the pregnancy. Perhaps there are unknown medical conditions triggered during pregnancy at advanced age. These changes continue to progress without being clinically evident until years later manifesting as a cardiovascular event. Medical Research: What are the main findings? Dr. Quershi: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period  of 12 years. A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p<0.0001), hemorrhagic stroke (0.5% versus 1.0%, p<0.0001), myocardial infarction (2.5% versus 3.0%, p<0.0001), and cardiovascular death (2.3% versus 3.9%, p<0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke even after adjusting for differences in age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking were adjusted. (more…)
Author Interviews, Cancer Research, Compliance / 19.02.2016

MedicalResearch.com Interview with: Dr. Madhur Garg MD Professor, Clinical director, Department of Radiation Oncology Montefiore Einstein Center for Cancer Care Albert Einstein College of Medicine. Bronx, NY 10467 Medical Research: What is the background for this study? What are the main findings? Dr. Garg: In most curative settings, external beam radiotherapy (RT) for the treatment of solid tumors is delivered five days each week over multiple weeks in an outpatient setting. Unintended treatment prolongation, generally attributed to treatment toxicity or inter-current illness, has been associated with inferior tumor control in a number of disease sites. Montefiore Einstein Center for Cancer Care recently identified radiotherapy (RT) noncompliance as a prevalent issue among patients receiving RT with curative intent. Approximately 20% of patients were deemed to be noncompliant, and statistically significant predictors of noncompliance risk included diagnosis, treatment course length, and socioeconomic status (SES). In this report, we examined if radiotherapy noncompliance is associated with clinical outcomes in our patient population. In this analysis, we have found that treatment noncompliance is associated with inferior clinical outcomes for patients receiving radiotherapy with curative intent. The associations we detected were both statistically significant and clinically meaningful and consistent across disease sites. This is a novel finding that may have significant implications for how cancer care delivery can be improved, particularly in disadvantaged patient populations. Our finding that  radiotherapy noncompliance is strongly associated with inferior outcomes, even after adjusting for confounders such as comorbidity index and SES, suggests to us that noncompliance may serve as a behavioral biomarker for other risk factors that contribute to poor outcomes. These may include noncompliance with other important clinician visits and procedures, lack of social support, and mood disorders. (more…)
Author Interviews, Autism, JAMA, Pediatrics / 18.02.2016

MedicalResearch.com Interview with: Dr. David Grossman MD MPH Vice chair of the U.S. Preventive Services Task Force Professor at the University of Washington Schools of Public Health and Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Grossman: The Task Force cares deeply about the challenges that children affected by autism and their families face in getting the care and support they need. This was the first time that we assessed the evidence around screening young children for autism, and our recommendation was informed by a review of the most up-to-date science, which included randomized trials, observational studies, and research from a number of Federal health agencies. We concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder in children for whom no concerns of autism have been raised by their parents or a clinician. This is an I statement, which is not a recommendation against screening, but a call for more research on screening and treatment in young children who don’t have obvious symptoms. It is important to note that this recommendation will not affect insurance coverage for autism screening, which is currently covered under the Affordable Care Act as a result of the American Academy of Pediatrics’ Bright Futures Guidelines. (more…)
Author Interviews, BMJ, Weight Research / 18.02.2016

MedicalResearch.com Interview with: Dr. Mark A Green PhD Department of Geography & Planning University of Liverpool Liverpool UK Medical Research: What is the background for this study? What are the main findings? Dr. Green: Previous research on trends in body mass index (BMI) have focused on changes in the middle value (average BMI). We extended this investigation by exploring trends both in the middle (using the median – the mid-point of BMI values), the 5th centile (the BMI value at which bottom 5% of the population with the lowest BMIs fall below) and the 95th centile (the BMI value at which the top 5% of the population with the highest BMIs fall above) to examine how trends have changed both in the middle, and at the top and bottom of the distribution. We found that median BMI increased in England in the 1990s, before beginning to slow its rate of change. This is contrary to the 95th centile which has continued to increase at a higher rate throughout the period, with little change in the 5th centile. (more…)
Author Interviews, Lipids, Nutrition, Omega-3 Fatty Acids, Red Meat / 18.02.2016

MedicalResearch.com Interview with: Professor Chris Seal and Professor Carlo Leifert Nafferton Ecological Farming Group (NEFG),School of Agriculture, Food and Rural Development, Newcastle University Nafferton Farm, Stocksfield, Northumberland UK Medical Research: What is the background for this study? Response: In 2009 an FSA-sponsored study by Dangour et al. was published and concluded that there are no composition differences between organic and conventional crops and animal (meat and dairy) products. This contradicted the results of literature reviews, field experiments and retail surveys that many of the scientists involved in the EU-FP7 project QualityLowInputFoods (www.qlif.org/) had carried out or were in the process of completing in 2009. We therefore decided to put together an international team of scientists and carry out a larger, updated systematic literature reviews and meta-analyses to determine whether or not the Dangour et al (2009) study was justified in drawing the conclusions they had.  This took 5 years to complete. We reported on crops in 2014 (http://research.ncl.ac.uk/nefg/QOF/crops/) and the studies published now report the results on meat (http://research.ncl.ac.uk/nefg/QOF/meat/) and milk/dairy products (http://research.ncl.ac.uk/nefg/QOF/dairy/). Medical Research: What are the main findings? Response: 
  • both organic milk and meat contain around 50% more beneficial omega-3 fatty acids than conventionally produced products
  • organic meat had slightly lower concentrations of two saturated fats (myristic and palmitic acid) that are linked to an increased risk of cardiovascular disease
  • organic milk contains 40% more conjugated linoleic acid (CLA)
  • organic milk contains slightly higher concentrations of iron, Vitamin E and some carotenoids
  • conventional milk contained around 70% more of the essential mineral iodine and slightly more selenium
We feel the most important results in terms of nutrition is that both organic milk and meat contain around 50% more beneficial omega-3 fatty acids than conventionally produced products. Omega-3s are linked to reductions in cardiovascular disease, improved neurological development and function, and better immune function. Organic milk had 57% higher concentrations of the nutritionally most desirable, very long chain (VLC) omega-3 fatty acids eicosapentaenic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA). Fatty acid profiles in milk are known to change very little during processing in to high fat dairy products such as butter and cheese. Omega-3s are linked to reductions in cardiovascular disease, improved neurological development and better immune function. The European Food safety Authority (EFSA) estimates that average dietary intakes of VLC omega-3 fatty acids account for less than half of what we need for optium health. The finding of substantially higher concentrations of iodine in conventional milk is also important information, especially for UK consumers, where iodized table salt is not widely available and dairy products are an important source of this nutrient. However, it should be pointed out that the Organic Milk Marketing Co-operative (OmsCo) has recently increased iodine fortification of organic dairy feeds and reports that levels of iodine in organic milk are now similar to those found in conventional milk (www.omsco.co.uk/_clientfiles/pdfs/omsco-iodine-levels.pdf). (more…)
Author Interviews, Lipids, Nutrition / 18.02.2016

MedicalResearch.com Interview with: Sachin A. Shah, Pharm.D. Residency Director & Regional Coordinator - Travis AFB Associate Professor of Pharmacy Practice TJ Long School of Pharmacy and Health Sciences University of the Pacific Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The link between serum cholesterol and cardiovascular mortality has been well established. Dietary sources of cholesterol can play a major role toward a beneficiary or unfavorable lipid profile. Fatty acids in foods typically fall within one of the four categories: saturated fats (SFAs), common in animal sources, trans fats (TFAs), common in processed foods, polyunsaturated fats (PUFAs), and monounsaturated fats (MUFAs), both common in plant-derived sources. Although low-fat diets are generally recommended, studies have indicated that altering the types of fats you consume may further modify the risk of dyslipidemia. We performed a meta-analysis of existing studies to determine the impact of avocados on the lipid profile. Ten unique studies incorporating 229 subjects were included. Avocado consumption significantly reduced TC, LDL-C, and TG by 18.80 mg/dL, 16.50 mg/dL, 27.20 mg/dL respectively. HDL-C decreased non-significantly. (more…)
Author Interviews, Stroke / 18.02.2016

MedicalResearch.com Interview with: Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute Cumming School of Medicine, University of Calgary Calgary, Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Hill: The HERMES collaboration is a pooled analysis of 5 randomized controlled trials of endovascular stroke therapy.  The purpose is of this analysis is to assess the relationship between time from stroke onset and effect size. The main finding is that there is a declining effect size as time elapses from stroke onset.  Shorter onset to reperfusion times are associated with better outcomes.  However, the slope of the decline is shallow compared to past estimates.  We believe this is because imaging selection identifies a group a patients in whom there is slow growth of the core infarct. (more…)