Author Interviews
18 Mar Preclinical Engineered Troponin Keeps Heart Beating Longer
MedicalResearch.com Interview with: [caption id="attachment_22748" align="alignleft" width="137"]
Dr. Jonathan Davis[/caption]
Jonathan P. Davis , Ph.D.
Associate ProfessorThe Ohio State University Medical Center
Department of Physiology & Cell Biology.
Columbus, OH 43210
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Davis: Myocardial infarction (MI) is a leading cause of heart failure and death in the US. Since the infarcted heart does not contract as well, therapeutics have been designed (i.e. positive inotropes) to help the heart contract better. While current positive inotropes help the patients in the short-term, they have detrimental long-term effects (“feel better but die sooner”). There is a dire need to be able to increase cardiac contraction without the deleterious side effects. We have achieved this goal by engineering the Ca2+-dependent switch in the heart, troponin C, to be able to better bind Ca2+. Combining gene therapy with our smartly formulated TnC, we demonstrated that our novel strategy not only protected the mouse from the negative consequences of an MI, but was also therapeutic when given after the MI.
18 Mar High School Girls Using Long-Acting Reversible Contraception Less Likely To Use Condoms
MedicalResearch.com Interview with: [caption id="attachment_22743" align="alignleft" width="200"] Riley Steiner[/caption] Riley Steiner MPH Epidemiologist in the Division of Adolescent and School Health Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Using data from the 2013 national Youth Risk Behavior Survey (YRBS), our analysis looks at...
18 Mar Multiple Chronic Conditions Accumulating Over Time Lead To Frailty
MedicalResearch.com Interview with: [caption id="attachment_22739" align="alignleft" width="125"]
Dr. Alanna Chamberlain[/caption]
Alanna Chamberlain, PhD
Assistant Professor of Epidemiology
Mayo Clinic College of Medicine
MedicalResearch.com: What is the background for this study?
Dr. Chamberlain: The number of elderly individuals in the US will double by the year 2050 and these individuals will become increasingly frail as they get older. Frailty has been recognized by doctors and researchers as an important contributor to poor health and declines in quality of life among older adults. However, it is difficult to measure frailty because it’s not due to a single condition. Instead, multiple health problems tend to accumulate over time until a person becomes increasingly frail. It is important to understand how frailty develops as patients age and how changes in frailty are related to outcomes. To address these questions, we followed individuals over 8 years to identify changes in frailty over time, to describe how people cluster (follow similar trajectories of frailty over time), and to examine how these changes relate to emergency department visits, hospitalizations, and death in a large population from Olmsted County, MN.
18 Mar Xenon Lessens Hypoxic Brain Damage After Cardiac Arrest
MedicalResearch.com Interview with: Ruut Laitio, MD, PhD Department of Anaesthesiology and Intensive Care Division of Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, Turku, Finland MedicalResearch.com: What is the background for this study? Dr. Laitio: Numerous animal studies with different types of brain injury (hypoxic, toxic,stroke, traumatic brain injury) have established the neuroprotective effect of xenon during the last 15 years. We designed a proof-of-concept study to find out whether xenon has neuroprotective effect in humans. An important finding from animal studies was that xenon has at least additive or even synergistic neuroprotective interaction with hypothermia and the results were based on histopathological and functional outcomes. These putative neuroprotective properties had not been reported in humans until now.18 Mar Older Adults with Chronically High Depressive Symptoms May Be At Higher Risk of Dementia
MedicalResearch.com Interview with: Allison R. Kaup, PhD Assistant Adjunct Professor, UCSF Department of Psychiatry Clinical Research Psychologist / Clinical Neuropsychologist and Kristine Yaffe MD Professor of Psychiatry, Neurology and Epidemiology Chief of Geriatric Psychiatry and Director of the Memory Evaluation Clinic San Francisco VA Medical Center MedicalResearch.com: What is the background for this study? Response: Previous research has shown that older adults with depression are more likely to develop dementia. But, most studies have only examined an older adult’s depressive symptoms at one point in time. This is an important limitation because we know that depressive symptoms change over time and that older adults show different patterns of depressive symptoms over time. For the present study, older adults were followed for several years. We assessed what patterns of depressive symptoms they tended to have during the early years of the study, and then investigated whether these different patterns were associated with who developed dementia during the later years of the study. MedicalResearch.com: What are the main findings? Response: Older adults in this study tended to show one of 3 different patterns of depressive symptoms. Most tended to have few, if any, symptoms over time. Some tended to have a moderate level of depressive symptoms at the beginning of the study, which increased over time. And others tended to have a high level of depressive symptoms at the beginning of the study, which increased over time. We found that older adults with the high-and-increasing depressive symptoms pattern were almost twice as likely to develop dementia than those with minimal symptoms, even when accounting for other important factors. While older adults with the moderate-and-increasing depressive symptom pattern were also somewhat more likely to develop dementia, this association was not as strong and did not hold up in our statistical models when we accounted for what individuals’ cognitive functioning was like during the early years of the study.18 Mar Familial Hypercholesterolemia Likely Underrecognized
MedicalResearch.com Interview with: [caption id="attachment_22561" align="alignleft" width="140"]
Dr. Sarah de Ferranti[/caption]
Dr. Sarah de Ferranti MD MPH
Boston Children’s Hospital
Director, Preventive Cardiology Program
Assistant Professor of Pediatrics
Harvard Medical School
MedicalResearch.com: What are the main findings?
Dr. de Ferranti: Familial hypercholesterolemia, or FH, is a genetic condition that causes severely elevated cholesterol levels from birth and is a leading cause of early heart attack. It is generally slowly progressive without symptoms until there is serious heart disease in the 3rd and 4th decade of life, making it important to look for it at a young age. Prior to this analysis it was thought that FH affected about 1 in 500 adults. The current study used data from 36,949 adults who took part in the 1999-2012 National Health and Nutrition Examination Survey (NHANES) and extrapolated to the 210 million U.S. adults aged 20 years and older. We identified cases of probably or definite Familial hypercholesterolemia in our analysis by using a combination of high levels of low-density-lipoprotein cholesterol (considered “bad” because it contributes to plaque buildup in arteries) and early heart disease in a person or close relative.
18 Mar Better Cardiovascular Health Associated With Better Cognitive Functioning
MedicalResearch.com Interview with: Hannah Gardener, ScD Department of Neurology, Miller School of Medicine University of Miami Miami, FL MedicalResearch.com: What is the background for this study? Response: At the beginning of the study, 1,033 participants in the Northern Manhattan Study (average age 72; 65 percent Hispanic, 19 percent black and 16 percent white), were categorized using the American Heart Association’s “Life’s Simple Seven®” definition of cardiovascular health, which includes tobacco avoidance, ideal levels of weight, physical activity, healthy diet, blood pressure, cholesterol and glucose. The participants were tested for memory, thinking and brain processing speed. Brain processing speed measures how quickly a person is able to perform tasks that require focused attention. Approximately six years later, 722 participants repeated the cognitive testing, which allowed us to measure performance over time. The cardiovascular health factors, which have been shown to predict risk of stroke and myocardial infarction, were then examined in relation to cognitive performance and impairment over time.18 Mar Maternal Weight, Blood Glucose and Blood Pressure Affect Baby’s Birth Weight
Posted at 00:47h
in Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA, Weight Research
MedicalResearch.com Interview with:
Debbie Lawlor PhD
School of Social and Community Medicine
University of Bristol, Oakfield House, Oakfield Grove
Medical Research Council Integrative Epidemiology Unit
University of Bristol, UK and
Rachel Freathy PhD,
University of Exeter, Institute of Biomedical and Clinical Science,
Royal Devon and Exeter Hospital, Exeter UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A healthy birth weight is important for babies’ health and wellbeing in the first year of their life. It reflects how well the baby has grown and developed in the womb. The experience of fetuses in the womb and how well they grow and develop might also determine their future health, even into adulthood. Both being too light or too heavy at birth is not good for the baby. Lots of studies have shown that mothers who are fatter at the start of their pregnancy have babies who are more likely to be heavier. But is it not clear whether the mother being fatter causes their baby to be bigger at birth. If mothers’ fatness does cause their baby to be heavier at birth, why this happens is not clear.
We used genes to find out whether being fatter in pregnancy causes babies to be born heavier. We also tested whether risk factors in the mother that are affected by her fatness, such as her blood pressure, and the level of glucose (sugar) and lipids (fats) in her blood stream affect how heavy her baby is.
Our results showed that being fatter during pregnancy did cause a mothers’ baby to be born heavier. We also showed that having higher blood levels of glucose in pregnancy also caused a mothers’ baby to be heavier. But we did not find any effect of mothers’ blood levels of lipids in pregnancy on their baby’s weight. Whilst mothers who are heavier in pregnancy will tend to have higher blood pressure in pregnancy we found that higher blood pressure caused the women’s babies to be lighter.
18 Mar Very Low Dose CT Scans Successfully Detect Bone Fractures
MedicalResearch.com Interview with: [caption id="attachment_22716" align="alignleft" width="133"]
Dr. Sanjit Konda[/caption]
Sanjit Konda, MD
Assistant professor of Orthopaedic surgery
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Konda: We serendipitously found that we could identify periarticular fractures associated with deep knee wounds with the use of a CT-scan. We published a study in the Journal of Orthopaedic Trauma showing that a CT scan could identify a traumatic arthrotomy of a joint better than a saline load test, which at the time was considered the diagnostic gold standard. When we presented that work, we received criticism that we were subjecting patients to a high dose of radiation for a diagnostic test; however, our rationale at the time was that the saline load test was a painful, invasive procedure using a needle, and that we would trade a bit of radiation for lack of invasive procedure.
This got us thinking of ways we could decrease the amount of radiation in the CT yet maintain the same diagnostic accuracy of identifying penetrating joint injuries. Collaborating with Dr. Soterios Gyftopoulos, an assistant professor in the Department of Radiology at NYU Langone, we were able to successfully reduce the amount of radiation in these CT scans and still get good bony images. We then thought, if we can get a CT scan that shows us good bony detail and is safer, then why shouldn’t we be doing it on every joint fracture, not just these arthrotomy cases? We then applied this to our current research protocol, REDUCTION(Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury) in which we reduced the average amount of radiation from 0.43 msV to 0.03 msV, or down to the average dose given in a routine chest X-ray. After running a comparison study with our ultra-low dose radiation protocol compared to conventional CT scans, we found we were able to obtain nearly the exact same types of images for various joint fractures and locations without sacrificing any diagnostic accuracy in most cases. We gave sets of these CT scans to orthopaedic surgeons to analyze, and found we achieved 98 percent sensitivity and 89 percent specificity with the ultra-low dose CT scans when occult fractures, or those that could not be seen on an X-ray, were removed from our analysis.
17 Mar Active Commuting Can Lead To Healthier Weight in Mid-Life
MedicalResearch.com Interview with: [caption id="attachment_22686" align="alignleft" width="107"]
Dr. Ellen Flint[/caption]
Dr Ellen Flint
Lecturer in Population Health
MRC Strategic Skills Fellow
Department of Social & Environmental Health Research
London School of Hygiene & Tropical Medicine
London
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Flint: Globally, physical inactivity is a major cause of obesity, chronic disease and premature mortality. Improving population levels of physical activity is therefore a key public health policy aim, in high and middle income countries. In the past, functional active travel was a key source of physical activity for many people. However, since the mass adoption of private motorised travel in the 20th century, the vast majority (63%) of working adults in the UK commute to by car. Using UK Biobank data from more than 150,000 middle-aged adults, we found that those who commuted to work via cycling or walking had significantly lower body fat percentage and lower body mass index (BMI) compared to adults who commuted by car. The strongest associations were seen for adults who commuted via bicycle. For the average man in the sample (age 53 years; height 176.7cm; weight 85.9kg), cycling to work rather than driving was associated with a weight difference of 5kg or 11lbs (1.71 BMI points). For the average woman in the sample (age 52 years; height 163.6cm; weight 70.6kg), the weight difference was 4.4kg or 9.7lbs (1.65 BMI points). Even people who commuted via public transport also showed significant reductions in BMI and percentage body fat compared with those who commuted only by car. This suggests that even the incidental physical activity involved in public transport journeys may be important. The link between active commuting and obesity reduction was independent of other factors such as income, area deprivation, urban or rural residence, education, alcohol intake, smoking, general physical activity, dietary energy intake and overall health and disability. If you're often using public transport, particularly around the New York Area, check out this babylon schedule.
16 Mar Refugees Granted Asylum More Likely to Have Schizophrenia and Psychotic Disorders
Posted at 14:00h
in Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Schizophrenia
MedicalResearch.com Interview with:
[caption id="attachment_22721" align="alignleft" width="159"]
Dr. Anna Clara Hollander[/caption]
Anna-Clara Hollander PhD
Division of Social Medicine, Department of Public Health Sciences
Karolinska Institutet, Stockholm, Sweden.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The humanitarian crises in Europe, the Middle East, north Africa, and central Asia have led to more displaced people, asylum seekers, and refugees worldwide than at any time since the second world war. Refugees are known to be at an increased risk of mental health problems, such as post-traumatic stress disorder and other common mental disorders, compared to non-refugee migrants, but little is known about their risk of psychosis.
The aim of the study was to determine the risk of schizophrenia and other non-affective psychotic disorders among refugees, compared to non-refugee migrants, and the general Swedish population. We used a linked national register data to examine more than 1.3 million people in Sweden, and tracked diagnoses of non-affective psychotic disorders among the population. The cohort included people born to two Swedish-born parents, refugees, and non-refugee migrants from the four major refugee generating regions: the Middle East and north Africa, sub-Saharan Africa, Asia, Eastern Europe and Russia.
Results showed 3,704 cases of non-affective psychotic disorders during the 8.9 million person years of follow up. Refugees granted asylum were on average 66% more likely to develop schizophrenia or another non-affective psychotic disorder than non-refugee migrants. In addition, they were up to 3.6 times more likely to do so than the Swedish-born population. Incidence rates for non-affective psychosis were 385 per million in those born in Sweden, 804 per million in non-refugee migrants, and 1264 per million in refugees.
The increased rate in refugees was significant for all areas of origin except sub-Saharan Africa, for whom rates in both groups were similarly high relative to the Swedish-born population. One possible explanation is that a larger proportion of sub-Saharan Africa immigrants will have been exposed to deleterious psychosocial adversities before emigration, irrespective of refugee status. Alternatively post-migratory factors, such as discrimination, racism, and social exclusion may explain these high rates.
Overall, our findings are consistent with the hypothesis that increased risk of non-affective psychotic disorders among immigrants is due to a higher frequency of exposure to social adversity before migration, including the effects of war, violence, or persecution.
16 Mar Hospital Stays Provide Opportunity to Vaccinate High Risk Patients
Posted at 13:48h
in Annals Internal Medicine, Author Interviews, Flu - Influenza, Kaiser Permanente, Surgical Research, Vaccine Studies
MedicalResearch.com Interview with:
[caption id="attachment_22564" align="alignleft" width="142"]
Dr. Sarah Tartoff[/caption]
Sara Y. Tartof, PhD, MPH
Kaiser Permanente Southern California Department of Research & Evaluation
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Tartof: The flu is a highly contagious respiratory infection that can cause serious complications, hospitalizations and, in some cases, even death. Some people, such as older adults, young children and people with certain health conditions, are at high risk for serious complications. In addition to recommending annual flu vaccination for people 6 months of age and older, the Centers for Disease Control and Prevention recommends that hospitalized patients who are eligible receive the flu vaccine before discharge.
Historically, inpatient rates of vaccination have been low. There has been concern among surgeons that vaccinating patients while they are in the hospital can contribute to increased risk of vaccine-related fever or muscle pain, which might be incorrectly attributed to surgical complications. However, there have been no data to support that concern. The objective of this study was to provide clinical evidence that would either substantiate or refute concerns about the safety of perioperative vaccination.
16 Mar Cochrane Study Reviews Workplace Interventions For Reducing Sitting at Work
MedicalResearch.com Interview with: [caption id="attachment_22719" align="alignleft" width="199"]
Dr. Nipun Shrestha[/caption]
Dr Nipun Shrestha MBBS, MPH
Health Research and Social Development Forum
Thapathali, Kathmandu, Nepal
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: These days our work in the offices isn't the same as it used to be. Almost everybody is working with a computer nowadays and that makes you sit still all day. We do not need to move from our chair to do most of the things. This is not just the case in developed countries but for developing countries as well.
One would argue though we are sitting in the office hours but we are regularly doing lots of exercises. However researchers have found that sedentary behavior is an independent risk factor for many chronic diseases like diabetes, cardiovascular diseases and cancer. So breaking up time that we spend sitting is important.
There are many commercial innovations available in the market which are being advertised heavily by the manufacturers. The evidence on effectiveness of such innovation is however not available.
We found that there is limited evidence on effectiveness of interventions that aim to reduce sitting at work. There is some evidence that sit-stand desk may reduce sitting at work between 30 minutes to 2 hours without any adverse effects.
16 Mar Dogs Strong Sense of Smell Can Detect Urinary Tract Infections
MedicalResearch.com Interview with: Maureen Maurer, MS American Institute for Research Makawao, HI MedicalResearch.com: What is the background for this study? Response: Complications from UTIs are a serious medical problem for many people with neurological impairment such as spinal cord injuries. Detection is often difficult in these patients, resulting in delayed diagnosis and more serious infections such as pyelonephritis and sepsis. UTIs are also the most common hospital acquired infection for all patients. Given the prevalence of UTIs, their complications, and increasing drug therapy resistance, improved early detection methods are needed. The olfactory acuity of dogs is over 100,000 times stronger than humans. Dogs’ superior olfactory capabilities have been employed to assist humans by detecting bombs, drugs, and more recently, cancer. Trained dogs may present a novel method for early UTI detection. Our objective was to determine whether canines could be trained to discriminate culture-positive from culture-negative urine samples.16 Mar Electronic Records Overwhelm Primary Care Physicians With Messages
MedicalResearch.com Interview with: [caption id="attachment_22586" align="alignleft" width="132"]
Dr. Daniel Murphy[/caption]
Daniel R. Murphy MD MBA
Assistant Professor - Interim Director of GIM at Baylor Clinic
Department of Medicine
Health Svc Research & General Internal Medicine
Baylor College of Medicine
Houston, TX, US
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Murphy: Electronic health records (EHRs) have enabled a large number of messages to be transmitted to physicians each day, including new types of messages that were not present in the pre-EHR era. Lack of support and policies to assist physicians with this workload creates opportunities for important information, such as abnormal tests results, to be missed among the vast amount of other information. We found that primary care physicians (PCPs) at three clinics using commercial EHRs received an average of 77 messages per day, of which only about 20% were test results. Specialists received an average of 29 total messages per day. Extrapolating time needed to process these messages from prior work suggests that PCPs would require an average of 67 minutes per day to process these messages.
16 Mar Study Examines Adverse Childhood Health After Planned Repeat C-Section
MedicalResearch.com Interview with: [caption id="attachment_22696" align="alignleft" width="150"]
Dr. Mairead Black[/caption]
Dr Mairead Black MBChB, MRCOG, MSc
Clinical Lecturer, Obstetrics and Gynaecology
School of Medicine and Dentistry, Division of Applied Health Sciences
University of Aberdeen
Aberdeen Maternity Hospital, Cornhill Road
Aberdeen
MedicalResearch.com: What is the background for this study?
Dr. Black: The commonest reason for performing a planned Cesarean Section (CS) in high-income countries is a history of a previous CS. However, there is very little information available on childhood health outcomes of birth after a previous .
MedicalResearch.com: Why might vaginal birth be beneficial?
Dr. Black: If a baby is born naturally, it is exposed to various processes of labour and birth which may help their immunity and ability to avoid or fight future illness.
15 Mar Population Based Program Improved Cardiovascular Health Across Community
MedicalResearch.com Interview with: [caption id="attachment_18607" align="alignleft" width="150"]
Dr. Michael Miedema[/caption]
Michael D. Miedema, MD, MPH
Minneapolis Heart Institute Foundation
Abbott Northwestern Hospital
Minneapolis, MN
MedicalResearch.com: What is the background for this study?
Dr. Miedema: Heart disease is the leading cause of death in the United States. With increasing risk factors like obesity and diabetes more population level prevention efforts are needed. Heart of New Um Project (HONU) was created as a demonstration project to test prevention of cardiovascular disease by reducing modifiable risk factors across the entire community. HONU interventions focus on improving health by reaching individuals in health care, worksites, and the community settings but also creating healthier environment and a social movement around being healthy to enable individuals to make healthier choices. Example interventions in health care, worksite, and the broader community include:
- Health care: Comprehensive free heart health screening held every few years to identify risks (results shared with providers and follow up was done in clinics to address medication needs). We also used the electronic health record to apply some algorithms to calculate risk of heart disease and were able to offer health coaching to people who did not yet have heart disease or diabetes but who were at high risk.
- Worksites: we developed and partnered with over 40 worksites in the community to conduct health screenings of employees, to identify ways companies could improve their wellness policies, and offering onsite behavior change programs.
- Community: work with restaurants to improve healthy options, increasing farmers market participation by farmers and by consumers, creating run/walk events, community wide health challenges, and creating a social movement through social marketing and community organizing.
15 Mar About 3% of Rhinoplasty Surgeries Require Revision
MedicalResearch.com Interview with: [caption id="attachment_22682" align="alignleft" width="80"]
Dr. Shaun Desai[/caption]
Shaun C. Desai, MD
Assistant Professor
Facial Plastic and Reconstructive Surgery
Department of Otolaryngology - Head & Neck Surgery
Johns Hopkins University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Desai: Estimates of the rate of revision septorhinoplasty and the risk factors associated with revision are unknown because the current published literature is limited to small, retrospective, single-surgeon studies with limited follow-up time. The purpose of this study is to determine the overall revision rates of patients undergoing a septorhinoplasty procedure (for functional or cosmetic reasons) and to determine risk factors for the revision. We found that the overall revision rate was 3.3% (5,775 patients of a total of 175,842 patients undergoing the procedure) with an average time to revision at 1 year. Risk factors for revision surgery included female gender, younger age, a history of anxiety or autoimmune disease, cosmetic indications, and more complicated initial surgery (i.e. cleft rhinoplasty).
15 Mar Using Small Carriers Increases Number of Cardiac Stem Cells Remaining in Heart
MedicalResearch.com Interview with: [caption id="attachment_22678" align="alignleft" width="90"]
Dr. Joost Sluijter[/caption]
Joost P.G. Sluijter, PhD, FESC
Associate Professor
Department of Cardiology
Experimental Cardiology Laboratory
UMC Utrecht
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sluijter: Cell transplantation therapy for ischemic heart disease has entered the arena of clinical trials more than a decade ago. Multiple cell types have been used since these first endeavors, and there is accumulating evidence that different cell types positively influence the damaged heart through paracrine and/or regenerative mechanisms. One of the most promising cell types to be used are the cardiac-located stem cells. Cardiac stem cells (CSCs) have been found to reside in the adult heart and can differentiate towards all cell types that are needed in the normal functional heart. These cells have shown great potential as a regenerative therapeutic upon myocardial infarction (MI) in animal models and are currently being tested in some clinical studies. However, although promising, no systematic overview and subsequent meta-analysis of preclinical data exists to date for this cell type and if they are consistently effective. Our systematic approach, yielded 80 studies and included over 1900 animals, confirms the consistent effect of CSCs and provides us with a first comprehensive overview of pre-clinical MI studies in an unbiased and systematic manner. Nowadays we are aware of a failure in therapeutic effect size for the translation axis, where we try to bridge fundamental findings from the lab to the bedside. This means that effects we observe in our initial studies on cardiac performance are slowly getting less successful when we are getting closer to a real clinical scenario.
Through our meta-analysis, we observed a consistent therapeutic effect of Cardiac stem cells therapy on cardiac function after MI, where 12% of functional improvements is observed in rodents, and only an 8% improvement was still present in large animal models. From previous observations, we know that this leaves a 3-4% of effect in a patient population. In addition to the difference in effect size between small and large animal models, also a difference in study quality and attrition bias was observed. Interestingly, although additional support to the idea that Cardiac stem cells are efficacious in preclinical studies were observed, we did not find any influence of immunosuppression, cell source, comorbidity of CSC donors, culture methods, or model of ischemia on the outcomes.
15 Mar Quitting Smoking Cold Turkey Leads To More Success
MedicalResearch.com Interview with: [caption id="attachment_22551" align="alignleft" width="200"]
Dr. Lindson-Hawley[/caption]
Dr Nicola Lindson-Hawley PhD
Cochrane Tobacco Addiction Group (TAG) Managing Editor
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Lindson-Hawley: For many people, the obvious way to quit smoking is to cut down gradually until they stop. After all, that’s how we accomplish most other goals that are hard. With addictions other than smoking, we aim to get people to cut down gradually rather than stop abruptly. But with smoking, the norm is to advise people to stop all at once. Around the world, physicians and others who support smoking cessation help people to quit abruptly and not to cut down first. However, if physicians are not providing support to people who want to quit by reduction, then they will have less chance of success as we know that people who receive support to quit are more likely to succeed. On the other hand, if cutting down is a bad way to quit, then we need to persuade people to abandon their common sense idea and quit abruptly instead. Therefore, this study investigated this by comparing a group of smokers advised to quit gradually by cutting down with a group who quit all at once. What we found was that cutting down first, was a less successful way to quit than smoking as normal and then stopping. Smokers who quit abruptly were 25% more likely to have quit after 4 weeks than those who quit gradually.
15 Mar Doctors Make More Mistakes When Patients Are Difficult or Disruptive
MedicalResearch.com Interview with: [caption id="attachment_22661" align="alignleft" width="100"]
Dr. Silvia Mamede[/caption]
Sílvia Mamede, MD, PhD
Associate professor
Institute of Medical Education Research Rotterdam
Erasmus MC
Rotterdam, The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Mamede: Doctors are often engaged in clinical encounters that are emotionally charged. Patients who feel anxious about their problems often respond emotionally in their interaction with their doctors. Most of these encounters fall within the limits of what is to be expected in clinical practice, but some patients behave in ways that make the doctor-patient interaction particularly distressing. Aggressive or disrespectful patients, frequent demanders, patients who don’t trust their doctors’ competence or ever-helpless patients are known, in the medical literature, as “difficult patients”. Doctors have reported to encounter these so-called “difficult patients” in around 15% of the outpatient consultations. As it might be expected, these patients’ behaviors provoke emotional reactions in doctors. The potential negative effect of these reactions on the doctor’s diagnostic accuracy has long been discussed in the medical literature. However, there was no empirical evidence that this happened. We conducted two studies to fill this gap.
In the two studies, doctors diagnosed clinical cases that were exactly the same except for the patient’s behaviors. In the first study, we used complex and simple cases. Even though the cases were the same, doctors made 42% more mistakes in disruptive than in non-disruptive patients when the cases were complex, and 6% more mistakes when the cases were simple. In the second study, we used cases deemed to be at an intermediate level of complexity. Doctors made 20% more mistakes in difficult compared to neutral patients. These findings show that disruptive behaviors displayed by patients seem to affect doctors’ reasoning and induce them to make diagnostic errors. The findings of our second study suggest that disruptive behaviors “capture” the doctor’s attention at the expense of attention for the clinically relevant information. We came to this conclusion because when asked to recall the information from a case afterwards, doctors who were confronted with a difficult patient remember more information about the patient’s behaviors and less information of the clinically relevant symptoms than doctors confronted with the natural version of the same patient. Recall of information is considered a measure of the amount of attention given to such information.
15 Mar Retirees Report Significant Improvement in Lifestyle
MedicalResearch.com Interview with: [caption id="attachment_22664" align="alignleft" width="180"]
Dr. Melody Ding[/caption]
Ding Ding (Melody), Ph.D., MPH
NHMRC Early Career Senior Research Fellow/Sydney University Postdoctoral Research Fellow
Prevention Research Collaboration
Sydney School of Public Health
The University of Sydney
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Ding: This study used data from the Sax Institute’s 45 and Up Study, a large Australia based cohort of adults aged 45 or older. We followed around 25,000 participants who were working at baseline (2006-2008) for an average of 3 years (follow-up in 2010). During the follow-up period, around 3,000 participants retired from the workforce. Participants were asked to report their health-related lifestyle behaviors, such as physical activity, smoking, and sleep time at both baseline and follow-up. We found that those who retired overall had significant improvement in their lifestyle as compared with those who did not, including more physical activity, less sitting time, and more sleep. Female smokers who retired were also more likely to have quit smoking.
15 Mar CPAP Benefits Sleep and Blood Pressure in Diabetics, But Not Glucose Control
MedicalResearch.com Interview with: [caption id="attachment_22702" align="alignleft" width="142"]
Dr. Jonathan Shaw[/caption]
Jonathan Shaw MD, FRACP, FRCP (UK), FAAHMS
Associate Professor
Domain Head, Population Health Research
Baker IDI Heart and Diabetes Institute
Melbourne VIC 3004
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Shaw: Over the last decade or so, there has been a lot of research connecting obstructive sleep apnoea with type 2 diabetes. They co-exist very frequently in the same individual, they are both much more common in overweight and obese people than in people of healthy weights, both improve with weight loss, and both are associated with other conditions such as hypertension and heart disease. In addition, there has been evidence that some of the key abnormalities occurring in sleep apnoea (in particular, fragmented sleep and intermittent low oxygen levels) may have a direct effect on glucose metabolism, and increase blood sugar levels. This led many people to suspect that untreated sleep apnoea might be one reason that type 2 diabetes is hard to control, and that treating sleep apnoea in people with type 2 diabetes would improve their blood sugar control.
We, therefore, undertook a large trial among people with type 2 diabetes, and previously unrecognised sleep apnoea, in which participants were randomised to either a group receiving specific treatment for sleep apnoea (continuous positive airways pressure, or CPAP, therapy at night) or to a control group.
Over the six months of the trial, we saw no benefit of CPAP therapy in regard to blood sugar control (as measured by HbA1c). Even when we looked at sub-groups with worse blood sugar control at the start or worse sleep apnoea or who did the best in terms of using CPAP every night, there was still no sign of benefit on blood sugar control. We did, however, see some other benefits of CPAP therapy, with less daytime sleepiness, improvements in quality of life and lower diastolic blood pressure.
15 Mar Many Seniors Carry Superbugs Home From the Hospital
Posted at 10:40h
in Author Interviews, Hand Washing, Hospital Acquired, JAMA, University of Michigan
MedicalResearch.com Interview with:
Lona Mody, MD, MS
Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center
Division of Geriatric and Palliative Medicine, University of Michigan Medical School,
School of Public Health
University of Michigan, Ann Arbor
MedicalResearch.com: What is the background for this study?
Dr. Mody: Hand hygiene is considered to be the most important strategy to prevent infections and spread of drug resistant organisms. Surprisingly, all strategies and efforts have predominantly involved healthcare workers and that too mainly in acute care hospitals. We are now facing a tsunami of an aging population in our hospitals, post-acute care facilities and long-term care facilities. Hand hygiene falls off when patients are hospitalized compared to when they are at home. So, we were very interested, first, in hand colonization in older patients who have recently been transferred from the acute care hospital to a post-acute care (PAC) facility for rehabilitation or other medical care before fully returning home. We were also interested in evaluating whether these organisms persisted.
MedicalResearch.com: What are the main findings?
Dr. Mody: We recruited and followed 357 patients (54.9 percent female with an average age of 76 years). The dominant hands of patients were swabbed at baseline when they were first enrolled in a post-acute care facility, at day 14 and then monthly for up to 180 days or until discharge.
The study found:
- To our surprise, nearly one-quarter (86 of 357) of patients had at least one multi-drug resistant organism on their hands when they were transferred from the hospital to the post-acute care facility
- During follow-up, 34.2 percent of patients’ hands (122 of 357) were colonized with a resistant organism and 10.1 percent of patients (36 of 357) newly acquired one or more resistant organisms.
- Overall, 67.2 percent of colonized patients (82 of 122) remained colonized at discharge from PAC.
15 Mar Obesity Reporting By Schools Did Not Improve Students’ BMI
MedicalResearch.com Interview with: [caption id="attachment_22656" align="alignleft" width="200"]
Michele Leardo[/caption]
Michele Leardo
Assistant Director
Institute for Education & Social Policy
New York University
New York, NY 10012
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: US school districts increasingly distribute annual fitness and body mass index (BMI) “report cards” to students and parents. Such personalized informational interventions have appeal in economics because they can inform parents about their children's obesity status at relatively low costs. Awareness of the weight status can lead to behavioral responses that can improve health. New York City public schools adopted Fitnessgram in 2007-2008, reporting each student’s BMI alongside categorical BMI designations.
We examined how being classified as “overweight” for the previous academic year affected the students’ subsequent BMI and weight. Specifically, we compared female students whose BMI was close to their age-specific cutoff for being considered overweight with those whose BMI narrowly put them in the “healthy” category. We find that being labeled overweight had no beneficial effects on students’ subsequent BMI and weight.
14 Mar Women Are First Authors in About 1/3 Major Medical Journals
MedicalResearch.com Interview with: [caption id="attachment_22647" align="alignleft" width="137"]
Dr. Giovanni Filardo[/caption]
Giovanni Filardo, PhD, MPH
Director of Epidemiology, Office of the CQO, Baylor Scott & White Health Briget da Graca, JD, MSSenior Medical Writer
Center for Clinical Effectiveness
Office of the CQO
Baylor Scott & White Health Dallas, Texas
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Filardo: While there are readily available, up-to-date data on the proportion of medical school applicants, graduates, and member of faculty women constitute, no similar information is routinely collected and shared about women’s participation in and leadership of medical research studies. The previous studies looking at this issue were conducted in 2004, and were limited to investigating the proportion of women among the first authors with MD degrees and with institutional affiliations in the United States or United Kingdom. The time was therefore ripe for an updated, rigorous, and comprehensive examination of first authorship in high impact medical journals.
We examined female first authorship of original research articles published over the past 20 years in the 6 general medical journals with the highest impact factors: Annals of Internal Medicine (Annals), Archives of Internal Medicine (Archives), The BMJ (formerly the British Medical Journal), Journal of the American Medical Association, The Lancet, and New England Journal of Medicine (NEJM). After adjusting for differences over time and between journals related to different prioritisation of studies according to type, topic/specialty, country in which the research was conducted, or number of listed authors, we found that female first authorship increased overall from 27% in 1994 to 37% in 2014, but had plateaued – and in the cases of The BMJ and NEJM – declined in the last 5 years. Our results also revealed significant differences in female first authorship between journals.
14 Mar Health Care Plan ‘Cadillac Tax’ Will Affect Mostly Middle Class Employees
MedicalResearch.com Interview with: Steffie Woolhandler MD, MPH, FACP and David U. Himmelstein MD, FACP CUNY School of Public Health at Hunter College MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Cadillac Tax aims to eventually eliminate tax subsides to employer-sponsored coverage. When an employer provides health benefits to an employee, the employee pays no income or FICA tax on the value of those benefits, although the benefits are obviously part of the employee's compensation. In other words, the taxpayers are currently picking up part of the employee's health insurance costs. Economists and politicians have been justifying the ACA's Cadillac Tax by portraying it as a "Robin Hood" tax that would take from the rich and give to the poor. That view of the Cadillac Tax is untrue. We found that the main beneficiaries of the current tax subsidies to employer sponsored coverage are middle class families (defined by a family income between $39,000 and $100,000 in 2009 dollars) for whom the subsidies boost their effective income by about 5%. These middle class people are the ones who would be most harmed when the Cadillac Tax kicks-in and curtails the current tax subsidies.14 Mar Children Receive a Disproportionate Share of Antibiotic Treatment
MedicalResearch.com Interview with: Ashley Bryce, NIHR PhD student Centre for Academic Primary Care, University of Bristol (first author) Dr Céire Costelloe NIHR Health Protection Research Unit in Healthcare associated infections and AMR, Imperial College London (senior author) MedicalResearch.com: What is the background for this study? Response: Antimicrobial resistance is an internationally recognised threat to health. Previous antibiotic use has been shown to be a risk factor for antimicrobial resistance in adults. The contribution of primary healthcare is particularly important as this is where almost 80% of all antibiotics used within the health service are prescribed. Children receive a lot of primary healthcare services and, as such, receive a disproportionately high number of antibiotics compared with middle aged populations. Despite this, little research has been published describing the prevalence of bacterial resistance in children or the risk factors of importance in this group. MedicalResearch.com: What are the main findings? Response: Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment.14 Mar Impaired Gait Speed Predicts Adverse Events in Heart Failure
MedicalResearch.com Interview with: Giovanni Pulignano, MD, FANMCO Dirigente Cardiologo/ Senior Cardiologist I UO Cardiologia /UTIC/Gruppo Operativo Interdisciplinare Scompenso Cardiaco Heart Failure Unit/ Cardiology Unit/CCU Azienda Ospedaliera San Camillo-Forlanini, Roma S.Camillo-Forlanini Hospital, Rome, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Pulignano: As the population ages, heart failure (HF)is becoming increasingly common,...