Accidents & Violence, Author Interviews, JAMA, Pediatrics / 21.09.2015

Dr. Ziming Xuan ScD, SM, MA Assistant Professor, Community Health Sciences School of Public Health Boston University MedicalResearch.com Interview with: Dr. Ziming Xuan ScD, SM, MA Assistant Professor, Community Health Sciences School of Public Health Boston University  Medical Research: What is the background for this study? Dr. Xuan: With respect to background, among the 15000 some teenagers died annually in the US, the 3 leading causes of death were unintentional injuries, homicide, and suicide. Among these fatal youth injuries, 83% homicides were gun-related, and about half of suicides involved a gun (45%). So, The purpose of the study was to investigate the association between state gun law environment and youth gun carrying in the United States, and whether this association is mediated by adult gun ownership. Medical Research: What are the main findings? Dr. Xuan:
  • Among 38 states in our study, 5.7%of high school students living in the 19 states with stricter gun laws carried a gun in past 30 days while 7.3% of students living in states with the weaker gun laws carried a gun.
  • A 10-point increase in the strictness of the state gun law score was associated with a 9% decrease in the odds of youth gun carrying.
  • Across states, restrictive gun laws may reduce youth gun carrying by limiting adult gun ownership.
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Author Interviews, Clots - Coagulation, Heart Disease, JACC / 21.09.2015

MedicalResearch.com Interview with: Renato Valenti, MD David Antoniucci, MD Cardiology Department; Careggi Hospital Florence; Italy Medical Research: What is the background for this study? Response: Previous data have shown that high residual platelet reactivity in patients receiving clopidogrel is associated with high risk of ischemic events and cardiac death after PCI at short-  and long-term follow-up. Clopidogrel nonresponders patients of  the  REsponsiveness to CLOpidogrel and StEnt thrombosis (RECLOSE-2) ACS study received an increased dose of clopidogrel or switched to ticlopidine under light transmittance aggregometry (LTA) adenosine diphosphate  (ADP) test guidance. Despite some decrease of ADP test after treatment adjustment, there was no improvement on clinical outcome. Currently no evidence exists that the achievement of an optimal platelet aggregation inhibition in clopidogrel nonresponders  modifies  the risk profile of  these patients. The RECLOSE-3  study invesigated if a new antiplatet therapy with prasugrel in clopidogrel nonresponders can modify the risk profile of these patients and improve the outcome in term of cardiac mortality. From the RECLOSE-3 registry we identified  302 consecutive  patients who were clopidogrel nonresponders.  Nonresponders  switched to prasugrel therapy.  Due to the nonrandomized study design the clinical outcome of clopidogrel nonresponders switched to prasugrel (from RECLOSE-3 study) was compared with the historical cohort of clopidogrel nonresponders of the RECLOSE-2 ACS (248 patients)  study. The primary endpoint of the study was cardiac mortality. The 2-year cardiac mortality rate was  4.0% in the RECLOSE-3 group and 9.7% in the RECLOSE-2 group (p=0.007). The difference in 2-year cardiac mortality remained also considering exclusively patients  with ACS on admission: 3.2% and 9.7%, respectively, p=0.023.At the final model of multivariable analysis, prasugrel treatment was inversely related to the risk of  2-year cardiac death (HR 0.32; p=0.036)  after adjusting for ACS and other well known covariates related to the outcome. Medical Research: What are the main findings? Response: The main finding of the RECLOSE-3 study is that nonresponsiveness to clopidogrel may be a “modifiable risk factor” for cardiac death after PCI. Prasugrel treatment overcomes nonresponsiveness to clopidogrel and results in thrombotic risk similar to the one of clopidogrel responders. (more…)
Author Interviews, Cancer Research, Cost of Health Care / 21.09.2015

Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer CenteMedicalResearch.com Interview with: Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer Centers Medical Research: What is the background for this study? What are the main findings? Response: The Trends in Cancer Programs annual survey, which began in 2009, provides key insight into nationwide developments in the business of cancer care. It’s a joint project between the Association of Community Cancer Centers and Lilly Oncology.  The goals of the survey are to:
  • Provide ACCC with information to help guide its education and advocacy mission
  • Assist member organizations to understand nationwide developments in the business of cancer care
  • Assist members in evaluating their own cancer program’s performance relative to similar organizations through a consistent and meaningful benchmark.
This year’s key findings show that patient-centered services – like nurse navigation, psychological counseling, survivorship care and palliative care – are continuing to grow in U.S. cancer programs. However, the biggest challenge facing cancer centers is reimbursement for these types of services. Additionally, mirroring what we are seeing in the industry in general, measurement is becoming more and more important. More cancer programs are now using quality metrics to show payers the value of care provided. More information about our findings can be viewed here: http://www.accc-cancer.org/surveys/pdf/Trends-in-Cancer-Programs-2015.pdf. (more…)
Author Interviews, Dental Research, Heart Disease / 21.09.2015

Boxi Zhang PhD Student School of Health and Medical Sciences Örebro University MedicalResearch.com Interview with: Boxi Zhang  PhD Student  School of Health and Medical Sciences Örebro University   Medical Research: What is the background for this study? What are the main findings? Response: In the past decade, many studies raise concerns about the increased prevalence of cardiovascular disease and mortality among patients with periodontitis. Porphyromonas gingivalis is the major pathogen causing periodontal disease. This bacterium also plays a significant role in the pathogenesis of atherosclerosis. In this study, we infect human aortic smooth cells with P. gingivalis and show that this periodontal pathogen affects gene and protein expression in human aortic smooth muscle cells associated with increased inflammation and atherosclerosis. (more…)
Author Interviews, Cognitive Issues, Exercise - Fitness, Nutrition / 21.09.2015

Beetroot juice WikipediaMedicalResearch.com Interview with: Chris Thompson BSc MSc ANutr AFHEA University of Exeter St. Luke's Campus Exeter Devon Medical Research: What is the background for this study? Response: Dietary nitrate has been shown to favourably alter the contractility of type II muscle fibres and enhance blood flow to working muscles that are predominantly type II. Dietary nitrate may also improve perfusion to areas of the brain responsible for cognitive function. It is therefore possible that through these mechanisms, nitrate-rich beetroot juice supplementation may improve both physical and cognitive performance during exercise which reflects the high intensity intermittent nature of team sport play. Medical Research: What are the main findings? Response: Participants were able to complete greater total work during an intermittent sprint test following nitrate-rich beetroot juice supplementation. We also found that dietary nitrate enabled a reduction in response time to decision making during the cognitive tasks performed throughout the exercise test. (more…)
Author Interviews, Diabetes, Outcomes & Safety, Technology / 21.09.2015

Wencui Han PhD Assistant Professor Business Administration University of Illinois at Urbana ChampaignMedicalResearch.com Interview with: Wencui Han PhD Assistant Professor Business Administration University of Illinois at Urbana Champaign Medical Research: What is the background for this study? What are the main findings? Dr. Han: Well-designed disease registries integrate a variety of information, including patient demographics, laboratory results, pharmacy data, and comorbidity data, to serve a variety of functions outside the clinical encounter. However, the adoption of disease registries by healthcare organizations is associated with significant direct and indirect costs. The impacts of using disease registries that meet meaningful use (MU) requirements in improving health outcomes and creating cost savings are understudied. This study examines the impact of using a registry for patient reminders and for improvement of the quality of care, hospital utilization, and cost saving. The results suggest that the use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes. (more…)
Author Interviews, BMJ, Exercise - Fitness / 21.09.2015

Yi-Wen Chen PhD Candidate, and Darlene Reid, BMR(PT), PhD Professor and Chair Department of Physical Therapy University of Toronto Toronto, OntarioMedicalResearch.com Interview with: Yi-Wen Chen PhD Candidate, and Darlene Reid, BMR(PT), PhD Professor and Chair Department of Physical Therapy University of Toronto Toronto, Ontario Medical Research: What is the background for this study? Response: Tai Chi is a time-honored exercise in China, developed during the Sung Dynasty, which has gained increased popularity in Western society. Most styles of Tai Chi consist of slow rhythmic movements that often emphasize typical attributes of exercise including range of motion, strengthening, balance, and postural alignment. In addition, there are spiritual aspects of Tai Chi that focus on relaxation, breath control, and cultivating internal energy. Several studies have demonstrated its multifaceted benefits in the elderly and in people living with chronic diseases including cancer, cardiovascular diseases, respiratory disorders and arthritis. If you were interested in seeing videos of beginner practices, check out some tai chi online to better clarify the motions previously described. Many individuals that require increased exercise and physical fitness also have one or more comorbidities; 9 out 10 Canadians live with more than one chronic condition and this proportion increases to 98% in adults over the age of 65 years. Increased fitness can increase quality of life and decrease risk of mortality and morbidity in older persons and in many chronic conditions. However, treatment, including exercise is often prescribed within a single specialty. Rarely is information provided to health professionals that integrates therapeutic approaches across several common chronic disorders. Accordingly, we performed a systematic review to determine if Tai Chi is an effective physical activity that improves symptoms, physical function, quality of life and depression in cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD)? We also examined if Tai Chi had similar effects for the same outcome measures across different chronic conditions? (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Genetic Research, Journal Clinical Oncology, Race/Ethnic Diversity / 20.09.2015

Aditya Bardia MBBS, MPH Attending Physician, Massachusetts General Hospital Cancer Center, Assistant Professor, Harvard Medical School Boston, MA 02114MedicalResearch.com Interview with: Aditya Bardia MBBS, MPH Attending Physician, Massachusetts General Hospital Cancer Center, Assistant Professor, Harvard Medical School Boston, MA 02114   Medical Research: What is the background for this study? What are the main findings? Response:  Multiple studies have consistently shown that African American women with cancer, including breast cancer, have worse outcomes than Caucasian counterparts. While socioeconomic issues, including access to care plays an important role, the contribution of tumor biology has been less clear. In this study, utilizing exome sequencing data, we linked the racial distribution of primary breast cancer with tumor genotypic traits, including somatic mutations, gene-expression profiles and intra-tumor heterogeneity. We observed that in addition to having a higher prevalence of triple negative breast cancer than Caucasian women (something that has been documented in the literature), African American women had a significantly higher prevalence of TP53 mutations, TNBC basal-like 1 and mesenchymal stem-like tumors, and intratumor genetic heterogeneity, and all of which suggest more aggressive tumor biology, suggesting that differences in tumor genomic profile contribute, at least partly, to the known racial disparity in survival between African Americans and Caucasians breast cancer patients. (more…)
Author Interviews, Cost of Health Care, Flu - Influenza, Geriatrics, Lancet, Vaccine Studies / 20.09.2015

Dr Ayman Chit PhD Sanofi Pasteur Swiftwater, PA 18370MedicalResearch.com Interview with: Dr Ayman Chit PhD Sanofi Pasteur Swiftwater, PA 18370 Medical Research: What is the background for this study? What are the main findings? Dr. Chit: Our analysis used data from a large-scale, multi-center efficacy trial, in which a higher-dose split-virus inactivated influenza vaccine (IIV-HD, Fluzone® High-Dose vaccine, Sanofi Pasteur) was compared to a standard-dose split-virus inactivated influenza vaccine (IIV-SD, Fluzone vaccine, Sanofi Pasteur) in persons 65 years of age and older.  These data were supplemented with US healthcare cost data. In the efficacy trial, a total of 31,989 adults 65 years of age and older were randomly assigned in a 1:1 ratio to receive either IIV-HD or IIV-SD and followed for six to eight months post-vaccination for the occurrence of influenza, serious adverse events, and medical encounters. Healthcare utilization (HCU) data were captured for all participants through a surveillance program that covered each influenza season, including the following events occurring within 30 days after any respiratory illness: use of prescription and non-prescription medications (limited to antipyretics/analgesics/non-steroidal anti-inflammatory drugs, antivirals and antibiotics), emergency room visits, non-routine or urgent care visits, and hospitalizations. In addition, all hospitalizations were captured for participants for the entire duration of the study. The primary results from the efficacy trial were published in The New England Journal of Medicine, which reported that IIV-HD was 24.2% (95% confidence interval [CI], 9.7% to 36.5%) more effective in preventing laboratory-confirmed influenza-like illness compared to IIV-SD.1 In the current supplemental analysis of the trial, we used US healthcare cost data to evaluate economic impacts of using IIV-HD compared to IIV-SD within the efficacy trial participants. In this analysis, total healthcare payer costs (the combined costs of study vaccine, prescription drugs, emergency room visits, non-routine and urgent-care visits, and hospital admissions) were about $116 less per person.
  1. DiazGranados et al, NEJM, 2014;14;371(7):635-45 
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Author Interviews / 20.09.2015

Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center Memphis, TN, 38163 MedicalResearch.com Interview with: Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center Memphis, TN, 38163 Medical Research: What is the background for this study? What are the main findings? Response: Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all-cause mortality, incident coronary heart disease, stroke and chronic kidney disease. From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow-up time of 8.1 years (interquartile range: 7.0–8.5years)] with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m2, a propensity-matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined:
  • (1) all-cause mortality;
  • (2) incident coronary heart disease;
  • (3) incident strokes; and
  • (4) incident chronic kidney disease defined as estimated glomerular filtration rate <60 mL/min/1.73 m2.
Compared with restless legs syndrome-negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70–2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26–4.84) and 3.89 (3.07–4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74–3.66)] compared with restless legs syndrome-negative counterparts. These associations was independent from other confounders such as demographic data, comorbidities and other sleep disorders (sleep apnea and periodic limb movements in sleep). (more…)
Author Interviews / 20.09.2015

Mohammed K. Ali, MBChB, MSc, MBA Associate Professor of Global Health and Epidemiology Rollins School of Public Health Emory University MedicalResearch.com Interview with: Mohammed K. Ali, MBChB, MSc, MBA Associate Professor of Global Health and Epidemiology Rollins School of Public Health Emory University Medical Research: What is the background for this study? What are the main findings? Dr. Ali: The background of this study is that we attempted to provide a comprehensive overview so that readers could see what has been happening for the 4 most common sets of chronic non-communicable diseases (cardiovascular diseases, diabetes, common cancers, and chronic respiratory diseases) over the past 30 years (1980-2012). We looked at one measure: death due to these conditions as that is the longest-standing way to understand what diseases are most common in society and warrant efforts to address them. And, we picked these 4 groups of conditions because together, they account for one out of every two deaths worldwide. We compiled data for 49 countries where over 70% of deaths in the country are documented and reported to the World Health Organization’s Mortality Database. What we found is that:
  • Between 1980 and 2012, death rates for many conditions (heart disease and stroke; cervical and stomach cancers) declined worldwide.
  • Second, deaths due to diabetes, liver cancers, and female lung cancer and female respiratory diseases increased worldwide.
  • And third, there were disparities between high-income countries (like the US, Australia, European countries) and low- and middle-income countries (like Mexico or Eastern European countries) in that these latter countries experienced less impressive declines in deaths due to heart disease, stroke, stomach, and cervical cancers, and actual increases in deaths due to breast cancers and colon cancers.This suggests that we have made important strides in high-income countries, largely due to efforts to lower tobacco exposure, and that awareness, access to healthcare, screening, and earlier treatments seem to be having an effect on prolonging survival from many cancers. Similarly, greater attention to and treatment of cardiovascular risk factors may be yielding benefits. However, more efforts are needed in low- and middle-income countries, and these disparities should not be overlooked.
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Author Interviews, BMJ, Hearing Loss, Heart Disease, Occupational Health / 20.09.2015

Wenqi Gan, MD, PhD Assistant Professor Department of Preventive Medicine and Environmental Health University of Kentucky College of Public Health Lexington, KY 40536MedicalResearch.com Interview with: Wenqi Gan, MD, PhD Assistant Professor Department of Preventive Medicine and Environmental Health University of Kentucky College of Public Health Lexington, KY 40536 Medical Research: What is the background for this study? Dr. Wenqi Gan: In epidemiologic studies on health effects of noise exposure, community noise is typically assessed using noise prediction models, occupational noise is assessed using self-reports or historical records. These methods are able to estimate community noise exposure in residential areas and occupational noise exposure in the workplace; however, these methods are not able to accurately reflect actual personal noise exposure in the home and workplace. The lack of personal noise exposure information is a major limitation of previous studies, which could cause underestimations of the true health effects of noise exposure. Bilateral high-frequency hearing loss, an objective indicator for long-term exposure to loud noise, may be used to investigate health effects of noise exposure. Medical Research: What are the main findings? Dr. Wenqi Gan: This study includes 5223 people aged 20-69 years who participated in the US National Health and Nutrition Examination Survey 1999-2004. Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease. This association was particularly striking for people who were chronically exposed to loud noise in the workplace or leisure time. For example, for currently employed workers with occupational noise exposure history, the possibility of having coronary heart disease increased more than four times. This study confirms that chronic exposure to loud noise is associated with increased risk of coronary heart disease. (more…)
Author Interviews, Endocrinology, JAMA, Prostate Cancer / 18.09.2015

MedicalResearch.com Interview with: Sindy Magnan, MD, MSc, FRCPC Division of Radiation Oncology, Department of Medicine CHU de Québe Université Laval Québec City, Québec, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Magnan : Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. Intermittent administration of this treatment could offer several advantages over the standard continuous administration by delaying the development of castration-resistant disease and by reducing the drugs’ adverse effects. However, this mode of administration remains controversial. We thus conducted a systematic review with meta-analysis of randomized controlled trials to compare the effectiveness and tolerability of intermittent versus continuous androgen deprivation. Intermittent therapy was non-inferior to continuous therapy with respect to overall survival. No major difference in global quality of life was observed between the two interventions, but some quality-of-life criteria, mainly in relation with physical and sexual functioning, seemed improved with intermittent therapy. (more…)
Author Interviews, Dermatology, Pain Research / 18.09.2015

psoriasis foundationMedicalResearch.com Interview with: Alexander Egeberg, MD Department of Cardiology Herlev and Gentofte Hospital Hellerup, Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Egeberg: Psoriasis is a common chronic skin disease, with a strong inflammatory component. Within the last decade, our understanding of psoriasis have advanced significantly, and psoriasis is now widely regarded as a systemic disease, where the skin is a direct marker of disease activity. The inflammatory pathways in psoriasis have also been implicated in several central nervous system diseases such as depression, uveitis, and multiple sclerosis. Moreover, pain generation and sensitization can occur as a result of the pro-inflammatory mediators which are upregulated in psoriasis. In the present study, we investigated the association between psoriasis and psoriatic arthritis, and the risk of new-onset migraine. The main finding was a psoriasis-severity dependent increased risk of new-onset migraine, and patients with severe skin psoriasis, and psoriatic arthritis appeared to have the highest risk. (more…)
Author Interviews, Heart Disease, Sleep Disorders / 18.09.2015

Dr Manolis Kallistratos MD,PhD FESC,EHS Cardiologist at Asklepieion Voula General Hospital Athens, Greece MedicalResearch.com Interview with: Dr Manolis Kallistratos MD,PhD FESC,EHS Cardiologist at Asklepieion Voula General Hospital Athens, Greece  Medical Research: What is the background for this study? What are the main findings? Dr Kallistratos: We all know that lifestyle changes represent the cornerstone of treatment of arterial hypertension. Lifestyle changes include restriction of salt and alcohol, physical activity, smoking cessation and weight loss. On the other hand, we know that many individuals especially the elders are sleeping at noon. Unfortunately there are few studies assessing mid-day sleep. A study in healthy individuals affirmed that sleeping at noon resulted in a decrease of 12% of the relative risk of coronary mortality in healthy subjects.  So the question regarding this habit is: Is it only a custom, a behavioral adaptation or is it also beneficial? Should mid-day sleep be included in the life style changes suggested by the doctors in patients with arterial hypertension? because we all know that nowadays is almost a privilege for a few due to the “nine to five” working culture, and the intense daily routine. For this purpose we prospectively studied 386 middle-aged patients (200 males and 186 females) from our outpatient hypertensive clinic. We observed that hypertensive patients that slept at noon presented lower pulse wave velocity levels (less stiff arteries), lower daytime and nighttime as well as average systolic blood pressure levels (24-hours SBP) . In general mid-day sleep decreased systolic blood pressure levels (during 24 hours) for approximately 6 mm of Hg. 60 minutes of mid-day sleep, decreased average SBP in our patients for about 4 mmHg. In addition, there was a trend, patients who slept at noon to be under fewer medications. (more…)
Author Interviews, Nutrition, Pediatrics / 18.09.2015

Juliana F. W. Cohen, ScD, ScM Harvard T. H Chan School of Public Health Department of Health Sciences, Merrimack College North Andover, MAMedicalResearch.com Interview with: Juliana F. W. Cohen, ScD, ScM Harvard T. H Chan School of Public Health Assistant Professor Department of Health Sciences School of Science and Engineering Department of Health Sciences, Merrimack College North Andover, MA  Medical Research: What is the background for this study? What are the main findings? Dr. Cohen:  There is a substantial amount of variation in the amount of time students have to eat lunch because there are no national standards for lunch period lengths. This study found that when students had less than 20 minutes of seated time in the cafeteria, they were less likely to select a fruit and consumed significantly less of their entrees, milk and vegetables compared with students who had at least 25 minutes to eat their lunch. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Lifestyle & Health, McGill / 18.09.2015

MedicalResearch.com Interview with: Sylvie S.L. Leung Yinko, MSc, RD Division of Clinical Epidemiology Research Institute of McGill University Health Centre (RI MUHC) Montreal (QC) and Louise Pilote, MD, MPH, PhD Professor of Medicine McGill University and Director of the Division of General Internal Medicine McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Response: Patients with premature acute coronary syndrome (ACS) are a vulnerable population of young or middle-aged adults at risk for future cardiovascular events. However, while health behaviors such as diet, physical activity, smoking, alcohol consumption and recreational drug use are important lifestyle factors that can influence cardiovascular risk, there is limited information about health behaviors in this population group. Additionally, there is indication in the literature regarding sex and age differences in health behaviors, but whether such differences exist in patients with premature acute coronary syndrome remained to be explored. Using data from GENESIS-PRAXY (GENdEr and Sex determInantS of Cardiovascular Disease from bench to beyond in PRemature Acute Coronary Syndrome), a large-scale prospective cohort study across Canada, US and Switzerland, we explored the health behavior profile of patients with premature ACS. As well, we examined whether there is a change in health behaviors 1 year post-ACS and assessed sex differences. Our results showed that the health behavior profile of men and women with premature Acute Coronary Syndrome are worse than that of the general population. We found a high prevalence of poor health behaviors in a young population with only modest changes after Acute Coronary Syndrome. Health behaviors remained suboptimal and worse than the general population, especially with regards to diet, smoking and recreational drug use. Sex differences existed in the prevalence of these behaviors at baseline and 1 year post-ACS but not in the magnitude of change after the ACS event. (more…)
Author Interviews, BMJ, Outcomes & Safety / 18.09.2015

MedicalResearch.com Interview with: Dr Daniel Boden Emergency Medicine Consultant Derby Hospitals NHS Foundation Trust Medical Research: What is the background for this study? What are the main findings? Dr. Boden: The overall objective was to evaluate whether there is an association between an intervention to reduce medical bed occupancy and both performance on the 4-hour target and hospital mortality. We undertook a before-and-after study in Derby teaching Hospitals NHS Foundation Trust (a large UK District General Hospital) over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the four-hour target and hospital mortality (HSMR, SHMI and Crude Mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the four-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention. Medical Research: What are the main findings? Dr. Boden:
  • Mean medical bed occupancy decreased significantly from 93.7% to 90.2% (p=0.02).
  • The trend change in 95% target performance, when comparing pre- and post-intervention, revealed a significant improvement (p=0.019). The intervention was associated with a mean reduction in all markers of mortality (range 4.5% - 4.8%). SHMI (p=0.02) and Crude Mortality (p=0.018) showed significant trend changes after intervention.
  • Our conclusion is that lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% four hour target. Whole system transformation is required to create lower average medical bed occupancy.
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Author Interviews, Lifestyle & Health, Sugar / 18.09.2015

Louise Brunkwall Nutritionist, MPH and Phd-student Diabetes and Cardiovascular Disease, Genetic Epidemiology Lund University, Clinical Sciences Malmö, Sweden MedicalResearch.com Interview with: Louise Brunkwall Nutritionist, MPH and Phd-student Diabetes and Cardiovascular Disease, Genetic Epidemiology Lund University, Clinical Sciences Malmö, Sweden  Medical Research: What is the background for this study? What are the main findings? Response: There has been a huge interest for sugar sweetened beverages (SSB) the last years and SSB has been associated with various diseases like type 2 diabetes and obesity, while juice for example which have approximately the same amount of energy have not. We find this very interesting and wanted to know more about who the people were that consumed a lot of these different beverages. We started of by looking at diet and found that the different beverages were associated with different dietary patterns. Sugar sweetened beverages were associated with a more unhealthy diet while juice was associated with a more healthy diet. We see the same for tea which is a beverage previously associated with a lower risk of several diseases, that it is associated with an overall very healthy diet. Therefore we draw the conclusions that beverages are a part of the overall diet which might contribute to the previous findings of associations with different diseases. This also tells us that it is of great importance to know more about the overall diet than just consumption of a single product when investigating beverages-dieases association studies. (more…)
AHA Journals, Author Interviews, Blood Clots, Brigham & Women's - Harvard, Medical Imaging / 17.09.2015

Peter Caravan, PhD Co-Director, Institute for Innovation in Imaging (I3) Martinos Center for Biomedical Imaging Massachusetts General Hospital Associate Professor of Radiology Harvard Medical SchoolMedicalResearch.com Interview with: Peter Caravan, PhD Co-Director, Institute for Innovation in Imaging (I3) Martinos Center for Biomedical Imaging Massachusetts General Hospital Associate Professor of Radiology Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Caravan: The motivation for this work was to develop a technique that would allow the detection of thrombus (clot) anywhere in the body after injection of a molecular probe called 64Cu-FBP8.  Current techniques for thrombus detection are limited to specific vascular territories.  In instances where the location of the thrombus is unknown or if there is suspicion of multiple thrombi, then multiple imaging tests must be performed.  We sought to develop a test that could be used to find clots anywhere:  brain, thorax, abdomen, legs and in arteries, veins, or the cardiac chambers.  In addition to whole body thrombus detection, we sought a technique that could address some of the limitations with current thrombus imaging techniques.  For example computed tomography (CT), which is used to detect pulmonary emboli, requires a contrast agent that cannot be used in patients with poor kidney function.  Transesophageal echocardiography used to identify thrombus in the chambers of the heart requires that the patient be sedated. Our approach is to use a small peptide that recognizes the protein fibrin, which is a key component of blood clots.  We tagged the peptide with an isotope of copper, Cu-64, that allows the peptide to be detected by positron emission tomography (PET). 64Cu-FBP8 binds specifically to fibrin but not to other proteins in the blood and this means that the uptake in the clot is high while background signal is very low.  We combined PET imaging which finds the clot with CT imaging or magnetic resonance imaging (MRI).  By overlaying the PET image with the CT or MRI image, we could precisely localize the clot within the We were interested to see if the age of the clot impacted our ability to detect it.  We imaged animals with a total of 42 arterial or venous clots and then the images were analyzed by two reviewers who had no prior knowledge of the location of the clot.  Overall the accuracy was 98% for detection. Another key finding was that the uptake of 64Cu-FBP8 strongly correlated with the amount of fibrin in the clot and that younger, fresher clots had more fibrin than older clots.  This could be very useful in distinguishing newer clots which may be the source of cardiovascular events from older, clots that may pose less risk. We also showed using combined PET-MRI that we could detect multiple blood clots in the animal in a single whole body scan.  The procedure involves a single intravenous administration of 64Cu-FBP8 and clots in the deep veins of the legs or in the carotid arteries were readily detected. (more…)
Author Interviews, Cost of Health Care, Primary Care / 17.09.2015

Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT 84108MedicalResearch.com Interview with: Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT  84108   Medical Research: What is the background for this study? What are the main findings? Dr. Magill: The Patient Centered Medical Home (PCMH) model of primary care is becoming more common. The model focuses on team delivery of care with other medical staff joining the primary care provider/clinician to provide for all patients’ healthcare needs.  However, the cost of sustaining PCMH functions is not well understood. This  study assessed direct personnel cost of delivering PCMH services in 20 diverse primary care practices in Utah and Colorado. The main finding is that PCMH services cost on average around $105,000 per clinician FTE per year, or around $4.00 per member per month for an imputed panel size of 2000 patients per FTE clinician.  (more…)
Author Interviews, Hand Washing / 17.09.2015

hand washingMedicalResearch.com Interview with: Min Suk Rhee, Ph.D. Professor Department of Biotechnology Department of Food Bioscience & Technology College of Life Sciences & Biotechnology Korea University Seoul Korea  Medical Research: What is the background for this study? What are the main findings? Dr. Min Suk Rhee: In December 2013, the US FDA (United States Food and Drug Administration) proposed an amendment that manufacturers of antibacterial hand soaps intended for use with water must demonstrate that they are safer and more effective than plain soap. As triclosan is the most common active antiseptic ingredient used in soap and its potential risk remains controversial, we investigated the effectiveness of antibacterial soap containing triclosan 0.3% from in vitro and in vivo experiment. The main finding of this study is that presence of antiseptic ingredients (in this case, triclosan) in soap does not always guarantee higher antimicrobial efficacy during hand washing. (more…)
Author Interviews, Biomarkers, Mayo Clinic, Melanoma / 17.09.2015

Dr. Roxana S. Dronca, M.D Assistant Professor of Oncology Assistant Program Director of Hematology-Oncology Fellowship Mayo Clinic College of Medicine Rochester, Minnesota MedicalResearch.com Interview with: Dr. Roxana S. Dronca, M.D Assistant Professor of Oncology Assistant Program Director of Hematology-Oncology Fellowship Mayo Clinic College of Medicine Rochester, Minnesota  Medical Research: What is the background for this study? What are the main findings? Dr. Dronca: We previously showed that Bim (BCL-2-interacting mediator of cell death ) is a downstream signaling molecule of PD-1 pathway reflecting the degree of PD-1 interaction with its ligand PD-L1 (unpublished data). In the current study we found that patients who experienced clinical benefit (CR/PR/SD) after 4 cycles of anti-PD1 therapy had higher frequency of Bim+ PD-1+ T-killer cells in the peripheral blood at baseline compared to patients with radiographic progression, likely reflecting an abundant PD-1 interaction with its tumor-associated ligand PD-L1 (B7-H1). In addition, the frequencies of Bim+ PD-1+ CD8 T cells decreased significantly after the first 3 months of treatment in responders compared to nonresponders, indicating tumor regression and therefore less PD-1 engagement with tumor-associated PD-L1. (more…)
Author Interviews, Brigham & Women's - Harvard, Hospital Readmissions, JAMA / 17.09.2015

J. Michael McWilliams MD, PhD Associate Professor andMedicalResearch.com Interview with: J. Michael McWilliams MD, PhD Associate Professor and Dr. Michael Barnett MD Researcher and General Medicine Fellow Dept. of Health Care Policy Harvard Medical School Boston MADr. Michael Barnett MD Researcher and General Medicine Fellow Dept. of Health Care Policy Harvard Medical School Boston MA Medical Research: What is the background for this study? Response: The financial impact of Medicare’s Hospital Readmissions Reduction Program on hospitals is growing.  In this year’s round of penalties, nearly 2,600 hospitals were collectively fined $420 million for excess readmissions. There has been concern that the risk-adjustment methods used by Medicare to calculate a hospital’s expected readmission rate is inadequate, meaning that hospitals disproportionately serving sicker and more disadvantaged patients are being penalized because of the populations they serve rather than their quality of care.  Specifically, Medicare accounts only for some diagnoses, age and sex but no other clinical or social characteristics of patients admitted to the hospital. No study to date has examined the impact adjusting for a comprehensive set of clinical and social factors on differences in readmission rates between hospitals. We did this by using detailed survey data from the Health and Retirement Study linked to information on admissions and readmissions in survey participants’ Medicare claims data.  We then compared differences in readmission rates between patients admitted to hospitals in the highest vs. lowest quintile of publicly reported readmission rates, before vs. after adjusting for a rich set of patient characteristics.  These included self-reported health, functional status, cognition, depressive symptoms, household income and assets, race and ethnicity, educational attainment, and social supports. Medical Research: What are the main findings? Response: Our two most important findings were: 1) Patients admitted to hospitals with higher readmission rates are sicker and more socially disadvantaged in a variety of ways than patients admitted to hospitals with lower readmission rates. 2) After adjusting for all measurable patient factors that are not accounted for in standard Medicare adjustments, the difference in readmission rates between hospitals with high vs. low readmission rates fell by nearly 50%. (more…)
Author Interviews, Diabetes, Lancet, Surgical Research / 17.09.2015

Martin Neovius PhD Department of Medicine, SolnaMedicalResearch.com Interview with: Martin Neovius PhD Department of Medicine, Solna Medical Research: What is the background for this study? What are the main findings? Dr. Neovius: Long-term real world data on economic effects of bariatric surgery versus nonsurgical treatment are scarce. We have previously looked at long-term drug costs, inpatient and outpatient care in the overall bariatric surgery population (Neovius, Narbro et al, JAMA 2012). However, overall findings may mask important subgroup variations. Based on data from the Swedish Obese Subjects (SOS) study, we documented large drug cost savings over 15 years after bariatric surgery versus non-surgically treated controls in patients who had diabetes and prediabetes before intervention. No savings were seen in patients who were euglycemic at baseline. In terms of overall healthcare costs, we saw cost-neutrality versus non-surgically treated patients for the diabetes group, while costs were higher for both patients with normal blood glucose and those with prediabetes (due to the initial high cost of surgery and inpatient care). For the subgroup of patients with diabetes, we also found that patients with recent diabetes onset had more favorable economic outcomes than patients with established diabetes.  (more…)
Alcohol, Author Interviews, Cancer Research, Heart Disease / 17.09.2015

MedicalResearch.com Interview with: Dr Andrew Smyth PhD Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr Smyth: Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms and previous studies were mostly done in high income countries. In this study we explored the associations between alcohol consumption and clinical outcomes in a prospective cohort study of 12 countries from different economic levels. Over an average of four years of follow-up of almost 115,000 participants, we found that although current drinking was associated with a 24% reduction in risk of heart attack, there was no reduction in the risk of death or stroke, and there was a 51% increase in risk of alcohol-related cancers (mouth, oesophagus, stomach, colorectum, liver, breast, ovary and head and neck) and a 29% increase in risk of injury. For a combination of all outcomes, we found no overall benefit from current alcohol use. We also found differences between countries of different income levels: for higher income countries current drinking was associated with a 16% reduction in risk of the combined outcome, but in lower income countries there was a 38% increase in risk. (more…)
Author Interviews, Cancer Research, Leukemia, Lymphoma / 17.09.2015

Angelica Loskog, PhD Professor of Immunotherapy (adjunct) Dept of Immunology, Genetics and Pathology Uppsala University Uppsala SwedenMedicalResearch.com Interview with: Angelica Loskog, PhD Professor of Immunotherapy (adjunct) Dept of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Loskog: CAR T cells have shown remarkable effect in patients with B cell malignancy in the US using 2nd generation CAR T cells. Acute leukemia (ALL) seems easier to treat than lymphomas and one of the reasons may be difficulties for CAR T cells to penetrate a solid lesion or due to a higher local presence of immunosuppressive cells within a lesion. As one of the first centers outside US we are evaluating 3rd generation CAR T cells in both lymphoma and ALL aiming to compare the responses and investigating biological reasons for the different responses. So far we have treated 11 patients and 6 of them had initial complete responses. Unfortunately, some progressed later. (more…)
Author Interviews, Cannabis, Gender Differences, Pediatrics / 16.09.2015

MedicalResearch.com Interview with:Renee M. Johnson, PhD, MPH Assistant Professor Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health Deputy Director, Drug Dependence Epidemiology Training Program (DDET) Baltimore MD Renee M. Johnson, PhD, MPH Assistant Professor Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health Deputy Director, Drug Dependence Epidemiology Training Program (DDET) Baltimore MD Medical Research: What is the background for this study? What are the main findings? Dr. Johnson: There has been a lot of policy change with regard to marijuana. Several states have enacted laws regarding medical marijuana and decriminalization, and now four states and the District of Columbia have legalized use for adults. Along with these policy changes, there’s been concern that adolescent marijuana use would skyrocket. This prompted me to think about what’s happened over the past 15 years, and so I decided to examine past 15-year trends in adolescent marijuana use among US high school students. Our research team analyzed data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance Study, or YRBS. It is a nationally-representative survey of high school students. A lot of the information we have about adolescents’ risk behavior comes from the YRBS. What we found is that marijuana use among US high school students has gone down over the time period. In 1999, 47% of high school students reported lifetime use of marijuana. By 2013, 41% reported lifetime use. Use was lowest in 2009, with 37% of high school students reporting lifetime use. The increase in use from 2009 to 2013 was not statistically significant, so we aren’t sure whether it represents random fluctuation or whether it indicates a reversal in trend. We also found that gender differences have gotten smaller over the time period, reflecting a real change. Boys have historically had higher rates of use, but that’s changing. In 1999, 51% of boys and 43% of girls reported lifetime marijuana use. By 2013, 42% of boys and 39% of girls reported lifetime use. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, Pediatrics / 16.09.2015

Yang Bai Graduate research assistant Department of Kinesiology College of Human Science Iowa State University, Ames, IAMedicalResearch.com Interview with: Yang Bai Graduate research assistant Department of Kinesiology College of Human Science Iowa State University, Ames, IA Medical Research: What is the background for this study? What are the main findings? Yang Bai: The last national youth physical fitness survey that covered the full developmental age range was conducted more than 25 years ago. A new study conducted by The Cooper Institute known as the NFL PLAY 60 FITNESSGRAM Partnership Project offers potential to study youth fitness on a national level. The NFL PLAY 60 FITNESSGRAM Partnership Project is a participatory research network that tracks health and fitness data from over 1000 schools across the country. The present study describes the distribution of health-related fitness in 1st-12th grade youth from this large nationwide sample of schools. The main finding included that the fitness levels varied greatly based on gender and age and the percentage of youth had adequate aerobic fitness and healthy BMI were low. For example, there were 62.1％ to 37.6％ (different from grade 4th to 12th) boys meeting the requirements for healthy aerobic capacity, and the range for girls were 50.8％to 26.1％. Aerobic capacity among boys started to decline in the sixth grade, while girls experienced a continual decline with age. There was less variation among boys and girls with a healthy BMI, which ranged 52.7% to 65.0%. (more…)