Author Interviews, Columbia, Compliance, HIV, JAMA, Pediatrics / 04.11.2015

MedicalResearch.com Interview with: Dr. Louise Kuhn PhD Professor, Epidemiology Sergievsky Center Columbia University  Medical Research: What is the background for this study? What are the main findings? Dr. Kuhn: Ritonavir-boosted lopinavir-based antiretroviral therapy is recommended as first-line treatment for HIV-infected infants and young children while efavirenz is recommended for adults and older children. There are several advantages of transitioning HIV-infected children to efavirenz-based treatment as they get older.  These advantages include the possibility of once-daily dosing, simplification of co-treatment for tuberculosis, avoidance of some metabolic toxicities, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. However, there have been concerns about possible reduced viral efficacy of efavirenz-based treatment in children exposed to nevirapine for prevention of mother-to-child transmission.  This is because efavirenz and nevirapine are in the same drug class and the majority of children who become infected despite exposure to nevirapine used for prevention have mutations in their virus that usually predict resistance to this drug class. In this study, we randomized HIV-infected children to two different treatment strategies: In the control strategy they remained on their initial ritonavir-boosted lopinavir regimen; in the alternative strategy they transitioned to an efavirenz-based regimen.  All children had been exposed to nevirapine used (unsuccessfully) to prevent mother to child HIV transmission and were virologically-suppressed (HIV in blood < 50 copies/ml) at the time of enrollment into the study.  We observed excellent virological control in both groups with fewer than 3% of children having levels of HIV in their blood greater than 1000 copies/ml.  Sustained suppression of virus in blood below 50 copies/ml throughout follow-up was achieved in 82% of the children transitioned to efavirenz-based treatment compared to 72% of children remaining on the control treatment. (more…)
Antibiotic Resistance, Author Interviews, CDC, Infections / 04.11.2015

Dr. Bob Kirkcaldy MD, MPH Epidemiologist, Division of STD Prevention CDCMedicalResearch.com Interview with: Dr. Bob Kirkcaldy MD, MPH Epidemiologist, Division of STD Prevention CDC Medical Research: What is the background for this study? What are the main findings? Dr. Kirkcaldy: Gonorrhea is a common sexually transmitted disease that, if untreated, can cause severe reproductive health complications. While gonorrhea is very common, it is often symptomless and many may not realize they have it. 333,004 cases were diagnosed in 2013, but more than 820,000 are estimated to occur annually. Because antibiotic resistance has jeopardized treatment for gonorrhea, CDC’s Gonoccocal Isolate Surveillance Project (GISP) monitors antimicrobial susceptibility and tracks patterns of resistance among antibiotics currently used to treat gonorrhea. From 2006-2009, susceptibility to the oral cephalosporin antibiotic cefixime declined in GISP, threatening the effectiveness of this drug. Continued use of cefixime in the face of declining susceptibility could theoretically foster broad resistance to the cephalosporin class (including ceftriaxone, the last treatment option). So in 2012,  CDC changed its treatment recommendations to recommend only dual gonorrhea treatment with injectable ceftriaxone plus oral azithromycin. The most recent data from GISP analyzed urethral gonorrhea samples of men from STD clinics in 34 cities from 2006-2014 and found resistance to cefixime increased in 2014 after two years of dramatic decreases. While CDC’s STD Treatment Guidelines suggest cefixime should only be considered as an alternative treatment for gonorrhea when ceftriaxone is not available, trends of cefixime susceptibility have historically been a precursor to trends in ceftriaxone so it’s important to continue monitoring cefixime to be able to anticipate what might happen with other drugs in the future. GISP data also found that resistance remained stable for ceftriaxone and resistance levels remain highest among men who have sex with men (MSM). We’re concerned about the increase in resistance for cefixime; however, more years of data are needed to know if the 2014 increase is the beginning of a new trend. (more…)
Anesthesiology, Author Interviews, Pain Research / 03.11.2015

MedicalResearch.com Interview with: Dr Emmanuel Boselli, MD, PhD Anesthesiology and Intensive Care University Claude Bernard Lyon I University of Lyon Lyon, France Medical Research: What is the background for this study? What are the main findings? Dr. Boselli: We hypothesized that the use of conversational hypnosis in patients undergoing regional anesthesia procedures for ambulatory upper limb surgery might provide better comfort than the use of oral premedication during the regional anesthesia procedure. We assessed the subjective effect of conversational hypnosis on a patient self-reported comfort scale ranging from 0 (no comfort) to 10 (maximal comfort), and the objective effect was assessed using the Analgesia/Nociception Index (ANI), a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. In our study of 100 patients undergoing hand surgery in two different centers, 50 had conversational hypnosis while being given regional anesthesia (Saint-Grégoire hospital), and 50 were given of oral hydroxyzine 30 minutes to an hour before the regional anesthesia procedure (Lyon hospital). Patients having hypnosis measured an average ANI of 51 before and 78 after hypnosis, whereas those who had premedication averaged 63 before and 70 after. The average comfort scale of those who had received hypnosis was 6.7 before and 9.3 after, while patients who had medication averaged 7.8 before and 8.3 after. The main finding of this study is that conversational hypnosis induced greater increase in comfort scales and ANI values than oral premedication. Medical Research: What is conversational hypnosis? What does it consist of? Dr. Boselli: Conversational hypnosis consists of matching the patient's behavioral communication patterns, reflective listening, avoiding any negative suggestion (e.g. "Keep calm and quiet" instead of "Please don't move!") and focalizing the patient's attention on something else than the regional anesthesia procedure, such as the ultrasound machine screen. (more…)
Author Interviews, Nutrition, Social Issues / 03.11.2015

MedicalResearch.com Interview with: Meg Bruening, PhD, MPH, RD Assistant Professor Arizona State University School of Nutrition and Health Promotion College of Health Solutions Phoenix, AZ 85004 Medical Research: What is the background for this study? What are the main findings? Dr. Bruening: Food insecurity is understudied in college populations, particularly college freshmen. We saw that over 1/3 of our population of freshmen living in dorms reported inconsistent access to healthy foods. Students who were food insecure reported higher odds of anxiety and depression (by almost 3-fold), and were less likely to eat breakfast and eat home cooked meals. (more…)
Author Interviews, Biomarkers, Brigham & Women's - Harvard, Cancer Research / 03.11.2015

MedicalResearch.com Interview with: Bakhos A. Tannous, Ph.D Associate Professor of Neurology Harvard Medical School Director, Experimental Therapeutics and Molecular Imaging Lab Director, Interdepartmental Neuroscience Center Director, MGH Viral Vector Development Facility Massachusetts General Hospital Charlestown, MA 02129 Medical Research: What is the background for this study? What are the main findings? Dr. Tannous: In recent years, it has become apparent that, in addition to their role in promoting blood clotting, platelets take up protein and RNA molecules from tumors, possibly playing a role in tumor growth and metastasis. Working with our collaborators Dr. Thomas Wurdinger and Pieter Wesseling at the VU Medical Center, Amsterdam, the Netherlands, we found that the RNA profiles of tumor-educated platelets – those that have taken up molecules shed by tumors – can (1) distinguish healthy individuals and patients with six different types of cancer, (2) determine the location of the primary tumor and (3) identify tumors carrying mutations that can guide therapeutic decision making and personalized medicine. (more…)
Author Interviews, OBGYNE, Social Issues / 03.11.2015

MedicalResearch.com Interview with: Susan Cha, PhD Division of Epidemiology Department of Family Medicine and Population Health School of Medicine Virginia Commonwealth University Richmond, VA  Medical Research: What is the background for this study? What are the main findings? Dr. Cha: We used data from the 2006-2010 National Survey of Family Growth to evaluate the association between couple pregnancy intentions and rapid repeat pregnancy (RRP) in women. Results indicated that the odds of RRP was primarily influenced by paternal rather than maternal desire for pregnancy. For instance, couples where the father intended the pregnancy but not the mother were 2.5 times as likely to have rapid repeat pregnancy than couples who both intended their pregnancy. Furthermore, more than 85% of women in the study reported no contraceptive use between pregnancies. (more…)
Author Interviews, Endocrinology, Exercise - Fitness, Heart Disease, Vitamin D / 03.11.2015

Dr Emad Al-Dujaili Reader in Biochemistry and Nutrition, Queen Margaret University Department of Health Science Queen Margaret UniversityMedicalResearch.com Interview with: Dr Emad Al-Dujaili Reader in Biochemistry and Nutrition, Queen Margaret University Department of Health Science Queen Margaret University Medical Research: What is the background for this study? What are the main findings? Dr. Al-Dujaili: Recent studies have implicated vitamin D deficiency as a risk factor for Cardiovascular disease and its deficiency is a potential biological predictor of increased rates of CVD. We have done 2 earlier studies investigating the effects of Vitamin D intake on Blood pressure and the stress hormone level cortisol and found that people taking the supplement of Vitamin D had reduced systolic and diastolic blood pressure compared to those who took the placebo. Vitamin D deficiency has also been associated with hypertension, obesity, diabetes mellitus and oxidative stress and reduced exercise performance. For instance, the Framingham offspring study proved that low levels of vitamin D are independently related to Cardiovascular disease incidence. In this placebo-controlled study, We have observed that people given 50ug of Vitamin D daily for 2 weeks showed a significantly reduced systolic and diastolic blood pressure, reduced urinary free cortisol (the hormone that produces stress and high blood pressure if its levels are high. Moreover, the distance cycled in 20 minutes significantly increased by 30% with slightly less efforts compared with that before Vitamin D supplement. (more…)
Author Interviews, NYU, Weight Research / 03.11.2015

MedicalResearch.com Interview with: Brian Elbel, PhD MPH Associate professor, Department of Population Health NYU Langone Medical Center and at NYU’s Wagner Graduate School of Public Service  Medical Research: What is the background for this study? What are the main findings? Dr. Elbel: Since New York City implemented in 2008 its mandatory calorie counts in all chain restaurants, including in fast-food eateries, public health officials and the general public have wondered what impact it’s having on curbing the obesity epidemic gripping the nation and the city. An estimated third of adult Americans are obese (with a body mass index of 30 or more), and that number is expected to rise to 42 percent by 2030, among the highest of any country in the developed world. Our study looks at the effects of so-called calorie counts some six years out from when the law took effect. Between 2013 and 2014, a team of NYU Langone researchers analyzed the receipts of some 7,699 diners at fast-food restaurants in NYC and in nearby NJ cities to see if the menu labels reduced the overall number of calories that consumers of fast food order and presumably eat. Our research team compared calories consumed at fast-food eateries with and without calorie labels. Researchers found that the average number of calories bought by patrons at each sitting between 2013 and 2014 was statistically the same as those in a similar survey we conducted in 1,068 fast-food diners in 2008, when New York City initially imposed menu labeling. Diners were surveyed at major fast-food chains: McDonald’s, Burger King, KFC, and Wendy’s. Calorie counts in the 2013-2014 analysis averaged between 804 and 839 per meal at menu-labeled restaurants, and between 802 and 857 per meal at non-labeled eateries; whereas, they averaged 783 per meal for labeled restaurants and 756 per meal for non-labeled restaurants shortly after the policy was introduced. For the surveys, diners entering the fast-food restaurant were asked to return their itemized receipt to research assistants and answer some follow-up questions in person in exchange for two dollars. Our study suggests that menu labeling, in particular at fast-food restaurants, will not on its own lead to any lasting reductions in calories consumed. (more…)
Author Interviews, Cancer Research, Cognitive Issues, Journal Clinical Oncology, Memory / 03.11.2015

MedicalResearch.com Interview with: Dr Janette Vardy  BMed (Hons), PhD, FRACP A.Prof of Cancer Medicine University of Sydney Medical Oncologist ,Concord Cancer Centre Concord Repatriation & General Hospital Concord, Australia  Medical Research: What is the background for this study? Dr. Vardy: Many patients complain that their memory and concentration is not as good after chemotherapy.  Most of the studies have been in younger women with breast cancer, and are often limited by small sample sizes and short term follow up.    This is the largest longitudinal cohort study assessing impacts of cancer and its treatment on cognitive function. We evaluated changes in cognitive function in 289 men and women with localized colorectal cancer (CRC), comparing those who received chemotherapy to those who did not require chemotherapy, 73 with metastatic disease, and a group of 72 healthy controls.?The localized CRC patients were assessed at baseline (soon after diagnosis and prior to any chemotherapy), 6, 12 and 24 months.  The healthy controls and metastatic group were assessed at baseline, 6 and 12 months.  We also examined underlying mechanisms. (more…)
Author Interviews, Colon Cancer, Genetic Research, Journal Clinical Oncology / 03.11.2015

MedicalResearch.com Interview with: Hans F.A. Vasen, MD Department of Gastroenterology Leiden University Medical Center and Netherlands Foundation for the Detection of Hereditary Tumours Leiden, the Netherlands Medical Research: What is the background for this study? Dr. Vasen: People with familial colorectal cancer (CRC) have a 3-6 fold increased risk of colorectal cancer. It has been estimated that about 2% of the population have familial CRC (about 2.7 million people in the US). Previous studies showed that colonoscopic surveillance reduces the CRC-mortality by >80%. In people with hereditary CRC, i.e., Lynch syndrome (10 fold increased risk of CRC), an intensive screening program with colonoscopy 1x/1-2 years, is recommended. In familialcolorectal cancer, the optimal screening program  is unknown. Medical Research: What are the main findings? Dr. Vasen: In this randomized trial with 528 individuals at risk for familial CRC, we compared screening intervals of 3 and 6 years. We found that patients had significant more high-risk adenomas (precursor lesions of CRC) at 6-years-follow-up compared to at 3-years-follow-up. However, because of the relatively low rate of high-risk adenomas at 6 years (7%) and the absence of colorectal cancer in the 6-years group, we consider a 6-year-interval safe. (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 03.11.2015

MedicalResearch.com Interview with: Dr. Tove Fall, PhD Associate Professor in Epidemiology Ingelsson Group Upssala University Medical Research: What is the background for this study? What are the main findings? Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, Cognitive Issues / 03.11.2015

MedicalResearch.com Interview with: Kelly N. H. Nudelman, Ph.D. Department of Radiology and Imaging Sciences Indiana University-Purdue University Indianapolis (IUPUI) Indianapolis, IN 46202 Medical Research: What is the background for this study? Dr. Nudelman: Varying levels of cognitive problems and related changes in brain structure and function have been reported in breast cancer patients treated with chemotherapy. Pain has also been associated with altered brain structure and function. However, the association of chemotherapy-induced peripheral neuropathy (CIPN), a side-effect of chemotherapy treatment characterized by nerve damage primarily in the extremities, has not been specifically investigated for association with cognitive symptoms in breast cancer. We used data from a prospective, longitudinal breast cancer cohort to investigate the relationship of CIPN and neuroimaging measures of cognitive dysfunction.  Medical Research: What are the main findings? Dr. Nudelman: We found that increased chemotherapy-induced peripheral neuropathy symptoms were associated with resting brain blood flow increase in regions known to be involved in pain processing. We also found that decreased frontal lobe gray matter density was correlated with these changes, suggesting a link between chemotherapy-induced peripheral neuropathy and cognitive dysfunction. (more…)
Author Interviews, Emory, Flu - Influenza, Vaccine Studies / 02.11.2015

MedicalResearch.com Interview with: Saad Omer MBBS MPH PhD Associate Professor Emory Vaccine Center Associate Professor Global Health and Epidemiology Rollins School of Public Health Emory University MedicalResearch: Can you give us a little background on this study? Dr. Omer: My background is in global health, epidemiology and pediatrics and I have been fortunate to conduct field and clinical vaccine trials in a number of countries and with multiple infectious diseases including influenza, polio, measles and pneumococcal vaccines. We were familiar with the data on investigating the potential effects of statins on other infections i.e. sepsis and community acquire pneumonia including Dr. Vandermeer’s study in 2012 suggesting that “statin use may be associated with reduced mortality in patients hospitalized with influenza”. Statins have lipid-lowering effects but they also exhibit anti-inflammatory and immunomodulatory properties. For lack of a better image, I think of statins as acting like a ‘big hammer made of Jell-O’: they have a broad, small dampening effect on immune response (as opposed to a narrow or deep effect). (more…)
Author Interviews, OBGYNE / 01.11.2015

Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament (RQRM) Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montreal Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-JustineMedicalResearch.com Interview with: Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament (RQRM) Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montreal Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine Medical Research:  Should we have any reservations about prescribing these macrolides during pregnancy? Dr. Bérard: With penicillin, macrolides are amongst the most used medications in the general population and in pregnancy. However, debate remained on whether it is the infections or in fact the macrolides used to treat them that put women and their unborn child at greater risk of adverse pregnancy outcomes, including birth defects. Our study was performed within the Quebec Pregnancy Cohort, one of the largest pregnancy cohorts in the World, and did not find a statistically significant association between macrolide use (a widely used class of antibiotics) during pregnancy and the risk of malformations. When looking at specific types of macrolides, no association was found between azithromycin, clarithromycin or erythromycin use during the first trimester of pregnancy and the risk of major malformations or cardiac malformations. This is reassuring when treating infections during pregnancy. (more…)
Asthma, Author Interviews, Immunotherapy, Pediatrics / 31.10.2015

MedicalResearch.com Interview with: Stephen J. Teach, MD, MPH Chair, Department of Pediatrics Children's National Health System Washington, DC  Medical Research: What is the background for this study? What are the main findings? Dr. Teach: Inner-city children aged 6 to 17 years with moderate to severe asthma continue to experience exacerbations at high rates during the fall season despite therapy which follows the guidelines of the National Institutes of Health. These exacerbations are most common among children with a history of prior exacerbations and sensitivities to common indoor allergens who develop an upper respiratory infection with the common cold virus (rhinovirus). The PROSE study found that treatment with omalizumab begun 4 to 6 weeks before the children return to school, significantly reduced exacerbations of asthma in the first 90 days of the school year. This effect was most dramatic among those children who had experienced an exacerbation in the months preceding the beginning of the school year. Omalizumab is an antibody which binds and deactivates the IgE antibody. The IgE antibody serves as the basis for allergic sensitivity. (more…)
Author Interviews, Breast Cancer, Technology / 31.10.2015

MedicalResearch.com Interview with: Anuradha Godavarty PhD and Dr. Sarah J Erickson-Bhatt PhD Dept of Biomedical Engineering, Florida International University Miami, FL Medical Research: What is the background for this study? What are the main findings? Response: It is well known that early detection and staging of breast cancer is crucial in order to save lives. While the current gold standard for breast cancer screening is x-ray mammography, this method still misses many cancers especially in younger women with denser tissue. Our group and others have explored diffuse optical tomography using near-infrared light to image breast tumors. We have developed a unique optical imager with a hand-held probe that can contour to breast curvature in order to image the tissue without painful compression and without ionizing radiation (like x-rays). This study demonstrated the ability of the device to detect lesions in breast cancer patients due to elevated levels of total hemoglobin concentration in tumor vasculature. The hand-held has a potential to not only image the breast contours, but the probe was flexible to image the surrounding chest wall regions, thus expanding its application to image lymphatic spread as well. (more…)
Author Interviews, Emergency Care, OBGYNE, Primary Care / 30.10.2015

MedicalResearch.com Interview with: Alfred Sacchetti, M.D. Department of Emergency Medicine Our Lady of Lourdes Medical Center, Camden, NJ Thomas Jefferson University, Philadelphia, PA Medical Research: What is the background for this study? Dr. Sacchetti: Much of the value of the "Affordable Care Act" is based on the concept that a primary care provider will limit the need for Emergency Department visits.  Unfortunately, this has never been proven, particularly for women's health issues. The purpose of our study was to determine if a relationship with a primary care provider did limit the need to access Emergency Department services. Medical Research: What are the main findings? Dr. Sacchetti: What our results demonstrated was that patients with a primary care Obstetrical / Gynecologic provider utilized the emergency department to the same extent as patients without a documented primary OB/GYN relationship.   Patients with women's health issues still required the services of the ED, even with an established primary care provider.  What was very interesting was that Emergency Department use was not restricted to off hours in the evenings and on weekends.  In fact the use of the ED occurred as much during the 9-5 hours on the weekdays as it did during other times.  The majority of the ED visits were for ambulatory complaints, with most patients being discharged to home after their care. (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Heart Disease / 30.10.2015

MedicalResearch.com Interview with: Dr. Yung-Tai Chen MD Division of Nephrology Department of Medicine Taipei City Hospital Heping Fuyou Branch Taipei, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Chen: Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors can provide glycemic control but also raised concerns about the risk of heart failure in patients with Type 2 Diabetes Mellitus (T2DM). However, large-scale studies of the effects of DPP-4 inhibitors versus sulfonylureas (SUs) on cardiovascular outcomes when used as add-ons to metformin therapy remain scarce. Our study showed that compared to SUs, DPP-4 inhibitors were associated with a lower risk of all-cause mortality, stroke and hypoglycemia as an add-on to metformin. Besides, dipeptidyl peptidase-4 inhibitors had comparable risks of hospitalization for heart failure to sulfonylureas as add-ons to metformin. (more…)
AHA Journals, Author Interviews, Electronic Records, Heart Disease / 30.10.2015

MedicalResearch.com Interview with: Jonathan R. Enriquez, MD Assistant Professor of Medicine Division of Cardiology University of Missouri- Kansas City Director, Coronary Care Unit Truman Medical Center  Medical Research: What is the background for this study? Dr. Enriquez:  
  • In 2009, U.S. legislation appropriated tens of billions of dollars to promote the use of electronic health records (EHRs).
  • Approximately 4 million hospitalizations for cardiovascular diagnoses occur annually in the U.S., which are more hospitalizations than for any other category of disease.  Therefore, evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.
(more…)
Antibiotic Resistance, Author Interviews, Dermatology, NYU, Pharmacology / 30.10.2015

MedicalResearch.com Interview with: Arielle Nagler MD Instructor, Department of Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Medical Research: What is the background for this study of acne patient who eventually require isotretinoin? Dr. Nagler: Isotretinoin is a highly effective medication for the treatment of severe acne. In fact, it is the only medication that has been shown to provide patients with a durable cure for acne. However, its use is limited by its known teratogenicity as well as controversies regarding its relationship with psychiatric disturbances and inflammatory bowel disease. For many patients, systemic antibiotics provide an effective treatment for inflammatory acne. However, antibiotics do not provide the long term clearance that isotretinoin provides. Moreover, antibiotics are getting increasing attention due to fears of emerging bacterial resistance. There has been a recent emphasis on limiting antibiotic use in acne. As a result, this study sought to understand antibiotic use patterns amongst patients who eventually received isotretinoin.  (more…)
Author Interviews, Cancer Research, End of Life Care, Nursing / 30.10.2015

Dr-Hsien-SeowMedicalResearch.com Interview with: Dr. Hsien Seow, PhD Associate Professor Department of Oncology Cancer Care Ontario Research Chair in Health Services Research Associate Member, Department of Clinical Epidemiology & Biostatistics McMaster University Canadian Institutes of Health Research Young Investigator Hamilton, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Seow: Despite being commonplace in healthcare systems, little research has described the effectiveness of publicly-provided generalist homecare nursing to reduce unnecessary acute care use at end-of-life, such as emergency department (ED) visits. It is also unclear how homecare nursing intent, which varies by standard care or end-of-life, affects this relationship. Our study examined a population-based cohort of cancer decedents in Ontario, Canada who used homecare nursing in their last six months of life. Specifically, we examined the relationship between homecare nursing rate in a given week on the ED visit rate in the subsequent week. In our cohort of 54,576 decedents, there was a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week. Homecare nursing for those who are receving end of life care will find that it can provide immediate assistance when needed. (more…)
Author Interviews, Orthopedics, Pediatrics / 30.10.2015

MedicalResearch.com Interview with: Alex L. Gornitzky Medical Student and Theodore J. Ganley, M.D. Director of Sports Medicine, The Children’s Hospital of Philadelphia Associate Professor of Orthopaedic Surgery, The University of Pennsylvania School of Medicine Medical Research: What is the background for this study? Response: Currently, more than half of all high school students participate in organized athletics, and with increasing participation the incidence of ACL injury and subsequent reconstruction are also rising. Furthermore, researchers also know that adolescent and high school athletes have a number of unique risk factors that differentially affect their ACL injury risk profile as compared to older and/or more experienced athletes. To our knowledge, however, no previous studies have described sport-specific seasonal risk for ACL tears in the high school athlete by gender and by sport. More specifically, parents and athletes currently have no available information to more accurately define what their personal risk is for such an important and devastating injury. Therefore, the purpose of our study was to pool data from across the literature in order to objectively quantify an average high school athlete’s risk for ACL injury per season across a variety of varsity-level sports. If a student is injured while playing sports and the school doesn't deal with the injury correctly then it could make the issue worse. This is why it is important for schools to correctly identify is the player has suffered an ACL injury. If you have suffered an injury at school that wasn't properly dealt with then you may want to check out someone like these new york personal injury lawyers to see if you can get compensation. This study will hopefully help students see the risk of them getting an injury meaning they can take measures to prevent one happening to them. Medical Research: What are the main findings? Response: Overall, there is an approximately 1.6 times greater rate of ACL tear per athletic exposure in high school female athletes as compared to males. On a per-season basis, the highest risk sports in females were soccer, basketball and lacrosse at 1.1%, 0.9% and 0.5% risk of ACL tear per athletic season. Comparatively, in males, the highest risk sports were football, lacrosse and soccer at 0.8%, 0.4% and 0.3% risk of ACL tear per athletic season. Looking further at the year-round, multi-sport athlete, this may correspond to either a 2.5% risk per-year or 10% risk per high school career for the female athlete who participates in soccer, basketball and lacrosse, or 1% and 4%, respectively, for the male athlete who plays football, basketball and baseball. (more…)
Alcohol, Author Interviews, Smoking / 30.10.2015

MedicalResearch.com Interview with: Mahesh Thakkar, Ph.D. Associate professor and director of research School of Medicine's Department of Neurology Missouri University Medical Research: What is the background for this study? What are the main findings? Dr. Thakkar: It is well known that “smokers drink and drinkers smoke.” The question is why. In our previous research, we had observed that alcohol promotes sleepiness by inhibiting the brain region known as the basal forebrain. So we asked, “Does nicotine override alcohol-induced inhibition and activate the basal forebrain?” This study was performed to address these questions. The main finding of this study is that nicotine, when co-used with alcohol, attenuates alcohol-induced sleepiness by overriding alcohol-induced inhibition of the basal forebrain region. (more…)
Author Interviews, Weight Research / 30.10.2015

MedicalResearch.com Interview with: Joshua H. West, Ph.D., MPH Department of Health Science Brigham Young University Provo, UT 84602 Medical Research: What is the background for this study? What are the main findings? Dr. West: Americans consume too much food. Yet most of our focus is on the qualitative aspects of food. Overconsumption of ‘good’ food can also negative outcomes. Most diets are confusing, costly to the individual, and difficult to adhere to. Even counting calories can be cumbersome and time-consuming. We found that participants lost weight by prioritizing worrying less about what they were eating and simply reducing how much they were eating, as estimated using a bite counting method. (more…)
Author Interviews, Gender Differences, Neurological Disorders, Radiology / 30.10.2015

Dr-Lise-EliotMedicalResearch.com Interview with: Lise Eliot PhD Associate Professor of Neuroscience Chicago Medical School Rosalind Franklin University North Chicago, IL 60064    Medical Research: What is the background for this study? Dr. Eliot: The hippocampus participates in many behaviors that differ between men and women, such as episodic memory, emotion regulation, and spatial navigation.  Furthermore, the hippocampus is known to atrophy in diseases such as depression, anxiety disorders, and Alzheimer's disease, all of which are more prevalent in women.  It is conceivable that a premorbid difference in hippocampal volume contributes to females' greater vulnerability.  In the scientific literature, the hippocampus is often said to be proportionally larger in females than males.  We set out to test this by doing a systematic review of the literature for hippocampal volumes in matched samples of healthy males and females, measured using structural MRI data collected from over 6000 participants of all ages. (more…)
Author Interviews, CDC, Cost of Health Care, HPV, Vaccine Studies / 30.10.2015

MedicalResearch.com Interview with: Shannon Stokley, MPH Epidemiologist in the CDC Immunization Services Division Medical Research: What is the background for this study? What are the main findings? Response: To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who complete the recommended HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage level for female adolescents among commercial and Medicaid plans was 12% and 19%, respectively (ranges = 0%–34% for commercial plans, 5%–52% for Medicaid plans). The results of this study indicate that there are significant opportunities for improvement as HPV vaccination coverage among female adolescents was low for both commercial and Medicaid plans. (more…)
AHA Journals, Author Interviews, Health Care Systems, Outcomes & Safety, Stroke / 29.10.2015

MedicalResearch.com Interview with: Mathew J. Reeves BVSc, PhD, FAHA Professor, Department of Epidemiology and Biostatistics, Michigan State University East Lansing, MI 48824  Medical Research: What is the background for this study? Dr. Reeves: The National Institutes of Health Stroke Scale (NIHSS) is the single most important prognostic factor in predicting outcomes of individual stroke patients. NIHSS data is obviously important at the patient level but also at a hospital level since the case mix of stroke patients are assumed to vary widely across different hospitals and referral centers. Measuring stroke outcomes at a hospital level is becoming increasingly important as work proceeds in the US to develop integrated stroke systems of care. But it is also very relevant to the new payment models being introduced by CMS which are based on hospital rankings that are developed from statistical risk adjustment models. One would expect that NIHSS would be a major contributor to these models but currently a major limitation is that NIHSS is incompletely documented in clinical registries such as GWTG-Stroke, and is completely absent from administrative data. The problem of missing NIHSS data plays havoc with the ability to risk adjust stroke outcomes across hospitals. Missing data results is a smaller number of stroke cases being included in the risk adjusted calculations for a given hospital which results in greater uncertainty over what the actual hospital outcomes are. Further there is concern that NIHSS data is not missing at random, and so the NIHSS data that is documented may represent a biased selection of all the cases that a hospital admits. This too could have important consequences for hospital rankings. To determine the degree of potential bias in the documentation of NIHSS data this study examined trends in and predictors of documentation of NIHSS across 10 years of data (2003-2012) in the GWTG-Stroke program. (more…)
Author Interviews, Education, Pediatrics / 29.10.2015

MedicalResearch.com Interview with: Chadi El Saleeby, MD. MS. Assistant Professor of Pediatrics, Harvard Medical School Pediatric Hospital Medicine and Pediatric Infectious Disease Units Mass. General Hospital for Children Boston, MA 02114  Medical Research: What is the background for this study? What are the main findings? Dr. El Saleeby: The Institute of Medicine, the Accreditation Council of Graduate Medical Education, and the American Board of Pediatrics stress the importance of appropriate supervision of trainees to reduce errors, lower patient mortality, and improve quality of care.  However, how appropriate supervision should be implemented in clinical practice is not well defined. After-hours supervision can be especially difficult when attendings or fellows may not be immediately available on-site and residents must determine when to contact a supervising physician regarding a clinical issue. The purpose of this study was to evaluate expectations when a pediatric resident should a contact a supervising physician while working after hours. To that effect, we developed 34 scenarios of the most common or the most serious issues encountered by residents on a general pediatric floor. We included these scenarios in an online survey, which was sent to the residents, fellows and attendings, asking for each scenario, if they would communicate immediately to discuss, or delay communication until the following day. There were two main findings of the study. First, in half of the scenarios, there were significant differences in communication preferences between residents and their supervisors. In all of these 17 discrepant scenarios without one single exception, more supervising clinicians wanted immediate communication compared to the residents. Second, there was no internal agreement between supervising physicians themselves. The junior attendings were more similar in their responses to residents while the more senior group (attendings with 5 or more years of clinical experience) asked to be immediately contacted much more frequently. (more…)
Author Interviews, JAMA, Surgical Research / 29.10.2015

MedicalResearch.com Interview with: Luke Rudmik, MD Division of Otolaryngology–Head and Neck Surgery Department of Surgery University of Calgary Calgary, Alberta, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Rudmik: The main findings were that patients with chronic sinusitis who have lower impairments in their quality of life can have their work productivity maintained with continuing medical therapy. Although there were no 'improvements' in the patients productivity with continuing medical therapy, it is important to note that patients in this study had better baseline quality of life and better baseline productivity compared to patients who chose to receive sinus surgery who had worse baseline quality of life and baseline productivity impairment. (more…)
Author Interviews, Cancer, Cancer Research, JAMA / 29.10.2015

Jiemin Ma, PhD, MHS Director of Surveillance and Health Services Research American Cancer SocietyMedicalResearch.com Interview with: Jiemin Ma, PhD, MHS Director of Surveillance and Health Services Research American Cancer Society Medical Research: What is the background for this study? What are the main findings? Dr. Ma: This study is an analysis of long-term trends in mortality for all causes combined and for 6 leading causes of death, including heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), unintentional injuries, and diabetes, in the United States from 1969 through 2013. We found that death rates for all causes and for five of these 6 leading causes (except COPD) decreased during this time period, although the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. COPD death rates doubled during this time period, although the rate began to decrease in men since 1999. (more…)