MedicalResearch.com Interview with:
Dr. Mary Vaughan SarrazinPh.D.
Associate Professor
University of Iowa Roy and Lucille Carver College of Medicine, and
Iowa City VA Medical Center, Center for Comprehensive Access & Delivery
Research and Evaluation (CADRE)
Iowa City, IA
Dr. Rajesh Kabra MD
Division of Cardiology, Department of Internal Medicine
University of Tennessee Health Science Center, Memphis, Tennessee
MedicalResearch: What is the background for this study? What are the main findings?
Response: Atrial fibrillation is associated with high risk of stroke and death. It is not known if these outcomes are different in whites, blacks and Hispanics.
In our study of over 500,000 Medicare patients over the age of 65 years with newly diagnosed atrial fibrillation, we noted that compared to whites, blacks and Hispanics had a higher risk of mortality (46% and 11% higher respectively) and stroke (66% and 21% respectively). However after correcting for other co-morbidities and illnesses, the risk of mortality was the same in all the races; the higher risk of stroke was decreased in blacks and eliminated in Hispanics. This suggests that in blacks and Hispanics, atrial fibrillation is a marker for higher mortality and identifies patients at higher risk of death.
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MedicalResearch.com Interview with:
José C. Nicolau, MD, PhD, FACC
Professor -University of São Paulo Medical School
Director - Acute Coronary Disease Unit, Heart Institute
MedicalResearch: What is the background for this study?
Dr. Nicolau: Previous studies, mainly performed in patients undergoing percutaneous coronary intervention (PCI), have shown that concomitant use of proton-pump inhibitors (PPIs) diminishes the antiplatelet effect of the drug clopidogrel. This diminished response to clopidogrel has in turn been associated with an increased risk of stent thrombosis and ischemic events. Our paper presented results from a secondary analysis performed in patients enrolled in the TRILOGY ACS randomized clinical trial. Our study is the first to examine the influence of interactions between PPIs and clopidogrel or the newer, more potent antiplatelet drug prasugrel, as well as correlations with platelet reactivity and clinical outcomes in high-risk patients who were receiving medical management without revascularization following acute coronary syndrome (ACS).
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MedicalResearch.com Interview with:
Mehdi Ardavan
Concordia University/Université Concordia
Medical Research: What is the background for this study?Response: That thousands patients die each year in US hospitals due to medical errors that could be prevented if medical staff were provided with instant access to patient records. Wireless technology (such as portable tablets) is one way of providing this instant access. But using such devices can cause electromagnetic interference (EMI) with electronic medical devices and can lead to dangerous consequences for patients. Hospitals may have a policy of minimum separation distance (MSD) which means that the staff members carrying wireless devices cannot approach sensitive medical devices closer than the specified MSD. The problem was that the recommend values of the minimum separation distance were not based on a quantitative and thorough analysis of the problem. We wanted to see what is the correct value of MSD, and how it's determined.
Medical Research: What are the main findings?Response: We developed new and fast methods for estimating the electromagnetic field distribution. We also mathematically modeled the roaming nature of the staff members carrying the wireless transmitters. Then we modeled the minimum separation distance policy and added an option to account for a possibility of non-compliance with the policy.
First, we assumed a full compliance with MSD policy and found that the risk of interference decreased constantly as the minimum separation distance was increased. Quantitative recommendations are made for the value of the MSD. But once we considered a small non-compliance probability, an interesting and unexpected phenomenon was observed: the EMI risk does not decrease beyond a certain value and remains almost constant for all MSDs bigger than a value we call the optimal MSD. If we increase the minimum separation distance beyond its optimal value, the risk of EMI does not decrease but more restrictions and thus more inconvenience is put on the staff members. So larger values of MSD are not necessarily safer and are not recommended. We also find that the risk and the optimal minimum separation distance are both sensitive to the rate of compliance with the MSD policy.
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MedicalResearch.com Interview with:
Christoph Czarnetzki MD, MBA
Division of Anesthesiology
Geneva University Hospitals
Geneva, Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Czarnetzki: In the US, about 40 million patients undergo a general anesthetic each year, and approximately 12,000 broncho-aspirate. Broncho-aspiration of gastric juice may lead to acute respiratory distress syndrome, carrying a 40% mortality rate. The risk is increased 10-fold in patients undergoing emergency surgery. Trauma patients may have ingested food before their accident, or have swallowed blood from oral or nasal injuries. Also, gastric emptying is delayed due to head injury, stress, pain, and opioid medication. Non-trauma patients may have delayed gastric emptying due to paralytic ileus and critical illness, leading to significant residual stomach content even after long fasting periods. Erythromycin, a macrolide antibiotic, and motilin receptor agonist induces antral contractions, and increases the lower esophageal sphincter tone, which is an important barrier against gastro-esophageal reflux. Although gastric emptying properties of erythromycin are well known, its efficacy in patients undergoing emergency surgery has never been investigated before to our knowledge.
In our study we included 132 patients undergoing general anesthesia for emergency procedures and we could show that erythromycin increased the proportion of clear stomach and decreased acidity of residual gastric liquid. Dependent of the definition of empty stomach (less than 40 ml and absence of solid food or completely empty stomach) the absolute risk reduction ranged from 17% to 24%, equivalent to a number needed to treat of four to six patients to produce one completely cleared stomach. Erythromycin was particularly efficacious in non-trauma patients. Adverse effects were minor.
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MedicalResearch.com Interview with:
Francis de Zegher, MD, PhD
Department of Development and Regeneration, University of Leuven
Leuven, Belgium &
Lourdes Ibáñez, MD, PhDHospital Sant Joan de Déu, University of Barcelona
Barcelona, SpainMedical Research: What is the background for this study?
Response: Hyperinsulinemic androgen excess is the most frequent hormonal disorder of adolescent girls. It seems to be mainly driven by an excessive and/or inappropriate storage of fat due to a chronically positive energy balance.
The traditional approach (not approved by FDA or EMA) is to silence the ovaries by giving an oral contraceptive.
An alternative approach is to change the storage of fat by giving an insulin-sensitizing combination of generics in low dose.
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MedicalResearch.com Interview with:Jaana Halonen Ph.D
Finnish Institute of Occupational Health
Kuopio, FinlandMedicalResearch: What is the background for this study? What are the main findings?Dr. Halonen: Research on predictors of cardiovascular disease has increasingly focused on exposures to risk factors other than the conventional behavioral and biological ones, such as smoking, hypertension, dyslipidaemia, or diabetes. One of the potential predictors beyond the conventional risks is exposure to childhood psychosocial adversities. Previous studies have found that people who had experienced financial difficulties, serious conflicts and long-term disease in the family in childhood have a higher level of cardiovascular risk factors and increased cardiovascular morbidity in adulthood, but the underlying mechanisms linking childhood exposure to adult disease remain unclear. It is possible that childhood adversity sets an individual on a risk pathway leading to adverse future exposures. An important source of adversity experienced in adulthood is residence in a socioeconomically disadvantaged neighborhood. However, no previous study had examined the combined effect of childhood psychosocial adversity and adult neighborhood disadvantage on cardiovascular disease risk.
We found that exposure to childhood psychosocial adversity and adult neighborhood disadvantage in combination was associated with a doubling of the risk of incident cardiovascular disease in adulthood when compared to the absence of such exposures. This association was not explained by conventional cardiovascular risk factors. Neither childhood psychosocial adversity nor adult neighborhood disadvantage alone were significantly associated with incident CVD, although they were associated with CVD risk factors.
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MedicalResearch.com Interview with:
Kristian Pietras, Ph.D.
Göran & Birgitta Grosskopf Professor of Molecular Medicine
Strategic Director of Cancer Research Lund University
Dept of Laboratory Medicine Lund
Div of Translational Cancer Research Lund, SwedenMedical Research: What is the background for this study? What are the main findings?
Dr. Pietras: Breast cancer is the largest malignant disease among women with 1.7 million new cases worldwide each year (25% of all new cancer cases for women). The prognosis for breast cancer patients is relatively good when the disease is detected at early stages (close to 90% of patients are still alive 5 years after diagnosis). Nevertheless, metastatic disease is the cause of 90% of all cancer-related deaths. Thus, learning more about the metastatic process and finding new cures for widespread disease is justifiably at the center of clinical attention.
The current study is part of our ongoing efforts to map support functions performed by the various cell types comprising the tumor stroma with the premise that decisive treatment benefit can only be achieved by targeting multiple, but distinct, cell types and pathways that collectively sustain the growth of tumors. The development of a rich vascular supply is recognized as a key hallmark of a growing tumor necessary for the development into a clinically relevant disease.
Our focus is the role of the tumor vasculature in preventing or promoting metastatic dissemination from the primary tumor. For a metastasis to form, a cancer cell must,
1) detach from its neighboring cells in the mother tumor,
2) traverse the vascular wall to escape into the blood stream,
3) exit the vasculature to enter the metastatic site, and
4) colonize the metastatic site.
Recent evidence points to that the transmigration into and out of the vasculature is a regulated process of previously unrecognized importance for the metastatic process. Importantly, the fact that the process of escape into/from the vasculature is regulated also implies that it is possible to use drugs to block this process.
In the present study, we have combined functional studies in advanced models of cancer and computational biology approaches to investigate the specific contribution to the metastatic process of a molecular signaling pathway emanating from the ALK1 protein expressed by endothelial cells in the vasculature. Using information from 2 different patient cohorts including a total of nearly 2000 breast tumors, we found that patients specifically having high levels of ALK1 in the vasculature of their tumor were much more likely to develop metastatic/recurrent disease. Accordingly, therapeutic administration of a drug (dalantercept) blocking the action of ALK1 prevented metastatic dissemination in multiple mouse models of breast cancer to a large degree. In addition, combination therapy of dalantercept and a commonly used chemotherapeutic drug (docetaxel) was exceedingly effective in preventing spread of the primary tumor to the lungs.
Our results suggest that the molecular features of the tumor vasculature are important to consider as potential determinants of breast cancer dissemination and that metastatic spread can be delayed by targeting the tumor vasculature.
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MedicalResearch.com Interview with:
Isabelle Bedrosian, M.D., F.A.C.S.
Associate Professor, Department of Surgical Oncology, Division of Surgery,
Medical Director, Nellie B. Connelly Breast Center
The University of Texas MD Anderson Cancer Center, Houston, TX
Medical Research: What is the background for this study? What are the main findings?Dr. Bedrosian: There have been a number of reports on the rates of Breast Conserving Therapy (BCT) and mastectomy among women with early stage breast cancer. These reports have been discordant, with some suggesting that index mastectomy rates have increased and others suggestion Breast Conserving Therapy rates have actually increased. We hypothesized that these differences in reporting may be due to data source (ie tertiary referral centers vs population based studies) and turned to the NCDB, which captures 70% of cancer cases in the US and as such provides us with the most comprehensive overview on patient treatment patterns.
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MedicalResearch.com Interview with:Mr. Angus Turnbull
Imperial College School of Medicine,
London UK
Medical Research: What is the background for this study? What are the main findings?
Mr. Turnbull: Autopsy has been used to advance medical knowledge and understanding of pathological processes for millennia but increasing evidence indicates its decline in the UK and elsewhere. This study not only confirms that but suggests autopsy for learning purposes has almost disappeared.
In the United Kingdom autopsy is divided into medico-legal autopsy (that required by law under the jurisdiction of HM Coroner) and consented autopsy (performed with the consent of the bereaved or their family). Over the past half-century, small single site studies have noted a marked decline in consented autopsy rates, however there has been no study for over 20 years to determine the extent of the decline nationwide.
This study examined all acute NHS Trusts within England, NHS Boards in Scotland and Wales and Social Care Trusts in Northern Ireland. We found that the average autopsy rate (the percentage of adult inpatient deaths which under go consented autopsy) in the United Kingdom in 2013 was only 0.7%. The study showed that in nearly a quarter (23%) of all NHS Trusts in the United Kingdom, consented autopsy is now extinct.
These findings may have implications for training, for research and for learning from mortality – a key aspect of patient safety. (more…)
MedicalResearch.com Interview with:
Stella Yi, PhD, MPH
New York University Langone School of Medicine,
Department of Population Health
New York, NY 10016
MedicalResearch: What is the background for this study? What are the main findings?Dr. Yi: Sedentary behaviors, such as sitting time, are an emerging risk factor in the field of physical activity epidemiology. Recent studies have demonstrated the negative health consequences associated with extended sitting time, including metabolic disturbances and decreased life expectancy independent of the effects of regular exercise.
We also assessed mean values of self-reported sitting time to characterize these behaviors in a diverse, urban sample of adults. The average New York City resident sits more than seven hours a day—greatly exceeding the three hours or more per day that is associated with decreased life expectancy.
Among the findings:
At the lower economic end, individuals spent 6.3 hours per day sitting, while those with higher incomes spent 8.2 hours per day sitting
College graduates spent 8.2 hours per day sitting, compared with 5.5 hours per day for those with less than a high school education
Whites spent on average 7.8 hours per day sitting, African Americans spent 7.4 hours sitting, Hispanics spent 5.4 hours sitting, and Asian Americans spent 7.9 hours per day sitting
Sitting time was highest in Manhattan, compared to other boroughs.
In the current analysis, we also assessed the validity of a two-question survey method of sitting time during waking hours using accelerometers to measure sedentary time in a subsample of our study participants. The correlation between sitting time reported in the survey and accelerometer-measured sedentary time was modest (r=0.32, p<0.01) with wide limits of agreement. We interpreted this to mean that while self-reported sitting might be useful at the population-level to provide rankings and subgroups, it may be limited in assessing an individual’s actual behavior.
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MedicalResearch.com Interview with:
Dr. Stephan Glund Ph.D.
Boehringer Ingelheim Pharma GmbH & Co. KG
Transl. Medicine & Clin. Pharmacology
Medical Research: What is the background for this study? What are the main findings?
Dr. Glund: There are currently no specific reversal agents available for any of the non-Vitamin K antagonist oral anticoagulants (NOACs). We are working on the development of idarucizumab, a specific reversal agent to dabigatran, the first approved NOAC. The study now published in The Lancet investigated, for the first time in healthy volunteers, the reversal of the anticoagulant effect of dabigatran by idarucizumab.
Our study in healthy male volunteers showed that idarucizumab led to immediate, complete and sustained reversal of the anticoagulant effect of dabigatran. Participants first received dabigatran and then idarucizumab. The specific reversal agent was given two hours after the last dose of dabigatran, when dabigatran concentrations were at peak levels. After a five-minute infusion of idarucizumab, anticoagulation was immediately reversed back to baseline levels. The reversal effect was sustained for more than 24 hours for all doses of 2g and above. Idarucizumab was well tolerated by the study participants.
In addition, our study also showed that administration of idarucizumab reversed dabigatran-induced inhibition of wound-site fibrin formation, which plays a key role in the blood clotting mechanism. This suggests that idarucizumab might also reverse impaired haemostasis due to dabigatran anticoagulation at a wound site.
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MedicalResearch.com Interview with:
Professor Phyo Kyaw Myint MBBS MD FRCP(Edin) FRCP(Lond)
Clinical Chair in Medicine of Old Age
Epidemiology Group, Division of Applied Health Sciences
University of Aberdeen
Scotland
Medical Research: What is the background for this study? What are the main findings?
Response: The research was carried out by academics from the Universities of Aberdeen, Manchester, Cambridge and East Anglia, as well as the Lancashire Teaching Hospital, the Medical Research Council Epidemiology Unit, Cambridge and the Academic Medical Centre, Amsterdam. It has been published online in the journal Heart. The team base their findings on almost 21,000 adults taking part in the EPIC-Norfolk study, which is tracking the impact of diet on the long term health of 25,000 men and women in Norfolk, England, using food frequency and lifestyle questionnaires. The researchers also carried out a systematic review of the available international published evidence on the links between chocolate and cardiovascular disease, involving almost 158,000 people—including the EPIC study participants.
The EPIC-Norfolk participants (9214 men and 11 737 women) were monitored for an average of almost 12 years, during which time 3013 (14%) people experienced either an episode of fatal or non-fatal coronary heart disease or stroke. Around one in five (20%) participants said they did not eat any chocolate, but among the others, daily consumption averaged 7 g, with some eating up to 100 g.
Higher levels of consumption were associated with younger age and lower weight (BMI), waist: hip ratio, systolic blood pressure, inflammatory proteins, diabetes and more regular physical activity —all of which add up to a favourable cardiovascular disease risk profile. Eating more chocolate was also associated with higher energy intake and a diet containing more fat and carbs and less protein and alcohol.
The calculations showed that compared with those who ate no chocolate higher intake was linked to an 11% lower risk of cardiovascular disease and a 25% lower risk of associated death. It was also associated with a 9% lower risk of hospital admission or death as a result of coronary heart disease, after taking account of dietary factors. And among the 16,000 people whose inflammatory protein (CRP) level had been measured, those eating the most chocolate seemed to have an 18% lower risk than those who ate the least. The highest chocolate intake was similarly associated with a 23% lower risk of stroke, even after taking account of other potential risk factors.
Of nine relevant studies included in the systematic review, five studies each assessed coronary heart disease and stroke outcome, and they found a significantly lower risk of both conditions associated with regular chocolate consumption. And it was linked to a 25% lower risk of any episode of cardiovascular disease and a 45% lower risk of associated death.
The study concluded that cumulative evidence suggests higher chocolate intake is associated with a lower risk of future cardiovascular events.
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MedicalResearch.com Interview with:
Arlene Ash Ph.D., Professor
David Hoaglin Ph.D., Professor and
Aimee R. Kroll-Desrosiers, MS
Department of Quantitative Health Sciences
University of Massachusetts Medical School
Worcester, MA
Medical Research: What is the background for this study? What are the main findings?
Response: The Long Life Family Study (LLFS) is an international collaborative investigation of the genetics and familial components of exceptional survival, longevity, and healthy aging. It has enrolled members of long-lived sibships, their offspring, and spouses of either group. Medicare claims data is a unique, nationally representative source of data on all treated diseases for most Americans over the age of 65.
Our main question was: Does membership in a long-lived family protect against disease?
For each American LLFS participant who was at least age 65 in 2008 and alive in 2009, we selected four persons from the general Medicare population who matched the participant on age, sex, and ZIP code of residence. We then used 2008–2010 Beneficiary Annual Summary Files from the Centers for Medicare & Medicaid Services (CMS) to compare the prevalence of 17 conditions among 781 LLFS participants in Medicare with those of 3,227 non-LLFS matches.* Analyses accounted for nesting within LLFS families and adjusted for age, sex, race, and year.
Among LLFS participants identified as members of a long-lived sibship, 7 of the 17 conditions were significantly less common than for similarly aged controls (Alzheimer’s, hip fracture, diabetes, depression, prostate cancer, heart failure and chronic kidney disease); in contrast, 4 (arthritis, cataract, osteoporosis and glaucoma) were significantly more common. Spouses, offspring and offspring spouses of these long-lived siblings share in significantly lower risk for Alzheimer’s, diabetes and heart failure.
Several additional analyses found suggestive (although not statistically significant) evidence of lower disease prevalence in both genetically and maritally-related LLFS cohort members.
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MedicalResearch.com Interview with:
Samuel Pannick, MA, MBBS, MRCP
Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London
West Middlesex University Hospital National Health Service Trust Middlesex, England
Medical Research: What is the background for this study? What are the main findings?
Response: Improving the quality of general medical ward care is a recognized healthcare priority internationally. Ward teams have been encouraged to structure their work more formally, with regular interdisciplinary team meetings and closer daily collaboration with their colleagues. Some early studies suggested that these changes might benefit patients, and help ward teams work more efficiently. However, team interventions on medical wards have been reported with numerous different outcome measures, and prior to this study, it was unclear what their objective benefits were.
We showed that there is little agreement on the objective outcomes that best reflect the quality of interdisciplinary team care on general medical wards. Changes to interdisciplinary care aren’t reflected in the outcome measures that researchers choose most often, like early readmission rates or length of stay. Complications of care - although harder to record - might have more promise as a measure of the quality of inpatient team care in these specific medical areas.
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MedicalResearch.com Interview with:
Chiara Martinoli, PhD
Medical Oncology of Melanoma
European Institute of Oncology
Milan, Italy
MedicalResearch: What is the background for this study? What are the main findings?Dr. Martinoli: The recent advent of new immunomodulatory drugs and targeted therapies is changing the therapeutic algorithm for metastatic melanoma patients. Immunomodulation with the anti-CTLA-4 antibody ipilimumab improves survival but is not devoid of potential risks. There is an urgent need for biomarkers to identify patients best suited to receive this therapy, in order to maximize treatment benefit and spare toxicities.
In this study, by analyzing pre-therapy hematological parameters of a large group of metastatic melanoma patients treated with ipilimumab, we showed that neutrophil-to-lymphocyte ratio is strongly and independently associated to patient outcome. Patients with a low baseline neutrophil-to-lymphocyte ratio had a double-reduced risk of disease progression and a two-to-four-fold reduced risk of death, regardless of age, sex and LDH.
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MedicalResearch.com Interview with:
Dr. Ken Uchino, MD
Cleveland Clinic Main Campus
Cleveland, OH 44195
Medical Research: What is the background for this study? What are the main findings?
Dr. Uchino: Stroke center designation started in 2003 and more hospitals have been certified as primary stroke centers over time. We asked the question how many are certified now? What are the characteristics of the hospitals that are certified?
In 2013, nearly a third (23%) of acute short-term adult general hospitals with emergency departments were certified as stroke centers. 74% of the stroke centers were certified by the Joint Commission, a non-profit organization that certifies health care facilities and programs. 20% were certified by state health departments. States varied in percentages of hospitals that were certified, ranging from 4% in Wyoming to 100% in Delaware.
Not unexpectedly larger hospitals and hospitals in urban locations were more likely to be certified as stroke centers.
But a hospital being located in a state with so-called “stroke legislation” more than tripled the chance of being a certified stroke centers, even accounting for other factors. These states passed legislation to promote stroke centers and mandated stroke patients to be preferentially transported to qualified hospitals.
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MedicalResearch.com Interview with:
Daniel E. Freedberg, MD, MS
Assistant Professor of Medicine
Division of Digestive and Liver Diseases
Columbia University, New York
Medical Research: What is the background for this study?
Dr. Freedberg: Acid suppression medications are increasingly prescribed to relatively healthy children without clear indications, but the side effects of these medications are uncertain.
Medical Research: What are the main findings?
Dr. Freedberg: Acid suppression with (proton pump inhibitors ) PPIs or (histamine-2 receptor antagonists) H2RAs was associated with increased risk for C. diff infection in both infants and older children.
Medical Research: What should clinicians and patients take away from your report?Dr. Freedberg: Increased risk for C. diff should be factored into the decision to use acid suppression medications in children. Our findings imply that acid suppression medications alter the bacterial composition of the lower gastrointestinal tract.
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MedicalResearch.com Interview with:
Deborah S. Hasin, Ph.D.
Professor of Epidemiology
Columbia University
New York, New York 10032
MedicalResearch: What is the background for this study? What are the main findings?Dr. Hasin: The background for the study was the need to identify the causes of the marked increase in marijuana use among U.S. adolescents over the last several years, given that early adolescent marijuana use leads to a number of adverse health and psychosocial consequences, including cognitive decline, into adulthood.
We had two main findings from the study:
A comparison of the rates of adolescent marijuana use between states that ever passed a medical marijuana law and those that did not revealed that states with such laws had higher rates of teen marijuana use, regardless of when they passed the law; and
When we compared the rates of teen marijuana use in these states before and after passage of the laws, we did not find a post-passage increase in the rates of teen marijuana use. This suggests that some common factor may be causing both the laws to be passed and the teens to be more likely to smoke marijuana in the states that passed these laws.
MedicalResearch.com Interview with:Ann Goding Sauer
Epidemiologist, American Cancer Society, Inc.Atlanta, GA 30303
MedicalResearch: What is the background for this study? Response: Among US women, a positive association between Pap test uptake and HPV vaccination has been shown, though potential variation of the association by race/ethnicity had not been explored previously. The prevalence of some HPV types varies across different racial/ethnic groups so it is important to explore the association between Pap test uptake and HPV vaccination in detail.
MedicalResearch: What are the main findings?Response:Pap test uptake was significantly lower among those who had not initiated HPV vaccination (81.0%) compared to women who had initiated vaccination (90.5%) (adjusted prevalence ratio = 0.93, 95% CI: 0.90–0.96). This result was seen across most of the sociodemographic factors examined, though not statistically significant for non-Hispanic blacks, Hispanics, those with lower levels of education, or those with higher levels of income.
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MedicalResearch.com Interview with:
Holly Kramer, MD, MPH
Department of Public Health Sciences
Loyola University Chicago
Health Sciences Campus
Maywood, IL
MedicalResearch: What is the background for this study? What are the main findings?Dr. Kramer: The U.S. dialysis dependent population continues to grow with 636,905 prevalent cases of end-stage renal disease (ESRD) in the U.S. as of December 31, 2012, , an increase of 3.7% since 2011. Poverty is a well described risk factor for ESRD because poverty impacts access to care and nutritious foods. The definitions for poverty in the U.S. have not changed over the past several decades despite marked changes in social structure. For example, social integration in the U.S. society currently requires a cell phone, computer and internet access and access to transportation. Healthy foods also cost more now relative to unhealthy foods compared to past decades. Thus, the link between poverty and any chronic disease or health outcome is likely dynamic due to the evolving financial burden for living in a rapidly changing industrialized society. Our study defined poverty as living in a zip code defined area with > 20% of the residents living below the federal poverty line. We show that the prevalence of adults receiving dialysis who are living in poverty has increased over time. We also show that the association between poverty and ESRD may be getting stronger over time. (more…)
MedicalResearch.com Interview with:
William S. Yancy, Jr., MD, MHSc
Research Associate
Center for Health Services Research in Primary Care
Durham, NC 27705
Associate Professor Department of Medicine
Duke University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Yancy: A number of studies have compared different diet approaches for weight management with many of these finding that several different diets can result in significant weight loss. This has led many experts to advise that we should offer a choice among these diet options to our patients who are seeking to lose weight. We know that adherence is the best predictor of weight loss during dietary interventions, so the thought is that patients will adhere better to a diet that they prefer, resulting in more successful weight loss. In addition, allowing choice enhances patient autonomy, which is patient-centered and has been shown to increase treatment adherence. However, the previous studies of various diet approaches did not let people choose a diet, so we don’t actually know if letting them choose will lead to better weight loss. Our study specifically tested this assumption. We randomized participants to a condition where they were allowed to choose between 2 common weight loss diets or to a condition where they were randomly assigned to one of the diets. The 2 diets we used were a low-carbohydrate diet without calorie restriction and a low-fat diet combined with calorie restriction. Participants received counseling about the diets, and about behavioral strategies and physical activity, in 19 group sessions over the span of 12 months. They also received 6 phone calls with motivational counseling in the latter half of the program.
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MedicalResearch.com Interview with:
Judy K. Tan, MD
Department of Nephrology
Mount Sinai Hospital
New York, New York
MedicalResearch: What is the background for this study? What are the main findings?Dr. Tan: Chronic kidney disease (CKD) is a common life-threatening medical condition, affecting approximately 26 million adults in the U.S. In Veterans Integrated Service Network (VISN) 3, veterans with CKD who reside in the Hudson Valley Veterans Affair Medical Center (VAMC) catchment area travel to the James J. Peters VAMC, a tertiary care facility in the Bronx for their nephrology care. However, because of several barriers such as (1) distance between the two facilities (approximately 60 miles) and (2) patient complexity (medical and psychiatric illnesses), patients referred to the James J. Peters VAMC renal clinic from Hudson Valley VAMC often cancel or “no show”. This poor compliance increases the long-term risk of rapid progression of CKD and the development of complications associated with it. To address this issue, the division of nephrology at the James J. Peters VAMC, in line with the veterans affairs’ focus on “patient-centered care,” developed a collaborative out-patient telenephrology service as a means to deliver care. The out-patient telenephrology service employs specialized global medical video conferencing equipment with customized medical instruments (ie stethoscopes) and Computerized Patient Record System (CPRS) accessibility to direct real-time evaluation and management of our veterans with CKD while they stay in their local VAMC. As demonstrated by Rohatgi et al, this intervention significantly increased the compliance rate of patients and reduced the travel time, miles, and cost of patients utilizing the telenephrology service.1
The hypothesis of our study is that patients with CKD remotely managed through our telenephrology service would exhibit comparable clinical outcomes and visit compliance as conventional in-person renal care.
Our provisional analysis of the subjects followed in the telenephrology service showed 117 unique patients were evaluated between 2011-2014. The mean age was 71±11years old with 98.3% males. 70% of the patients were white and 26.5% African American. The predominant etiology of chronic kidney disease was diabetic nephropathy (31.6%) followed by hypertensive nephrosclerosis (26.5%). In the 87 patients who had 1-year follow up data, estimated glomerular filtration (eGFR) was well preserved over the year (33 mL/min vs. 32 mL/min; p=0.04). Systolic blood pressure (BP) was reduced from 138±20 to 133±16 mm Hg (p=0.03), but no difference was observed in diastolic BP. Urine protein-creatinine ratio fell from 0.58 to 0.25 (p=0.07). 94% of patients had parathyroid levels checked and 70.9% were on ACE inhibitors during the first year of follow up. (more…)
MedicalResearch.com Interview with:
Eric Jonasch, MDAssociate Professor Department of Genitourinary Medical Oncology
University of Texas MD Anderson Cancer Center
Houston, TX
and
Dr. Thai H. Ho, MD Ph.D.
Department of Oncology
Mayo Clinic Scottsdale Arizona
Medical Research: What is the background for this study? What are the main findings?
Response: The blueprints of a cell are encoded in DNA strands (its genome) which are highly compressed in order to fit into a tiny cell. The reading (called the epigenome) of these DNA ‘blueprints’ determines whether that cell will develop into a kidney cell or another type of cell. However, in cancer, errors occur either in the blueprints themselves or the cell makes mistakes in reading the blueprints. Cancers of the kidney affect more than 61,000 patients annually and over 13,000 patients die annually, making it one of the top 10 leading causes of cancer deaths. Studies have revealed that mutations occur in genes that regulate how our DNA ‘blueprints’ are compacted in greater than >50% of kidney cancers, making these genes as a group the most frequently mutated. In our study, we identified that these errors that initially arise in an early kidney cancer lead to propagation of these same errors in metastases, a phenomenon in which the cancer has spread to another organ and is a major cause of death. Furthermore, we generated a detailed map of these epigenomic changes in patient-derived tumors.
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MedicalResearch.com Interview with:
Ms. Rikke Elmose Mols
Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark.
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD.
Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.
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MedicalResearch.com Interview with:
Rémi Coudroy MD
CHU de Poitiers, Service de Réanimation Médicale
CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France
Medical Research: What is the background for this study? What are the main findings?
Dr. Coudroy: Skin mottling is characterized by a red-violaceous discoloration of the skin. Its occurrence, as impaired consciousness and decreased urinary output are well-known clinical signs of shock. Skin mottling has been investigated only in patients with septic shock and recent studies have found that the extent and the persistence of skin mottling for more than 6 hours were associated with mortality. However, in daily clinical practice, we noticed that skin mottling occurred in patients without septic shock, and there was no data supporting the impact of skin mottling on the prognosis of critically ill patients.
In a retrospective monocentric observational study over a 1-year period in a 15-bed tertiary medical ICU where skin mottling over the knees is assessed by nurses, we found that skin mottling occurred in 29% of patients admitted to ICU. Nurses’ evaluation of skin mottling was highly reliable. In 60% of cases, mean arterial pressure was ≥ 65 mmHg without vasopressors. The occurrence of skin mottling was associated with mortality independently from calculated severity scores at admission (i.e. Simplified Acute Physiology Score II). Similarly, the persistence of skin mottling for more than 6 hours was associated with mortality independently from organ failure at the onset of skin mottling (i.e. the use of vasopressors, the need for mechanical ventilation and hyperlactatemia).
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MedicalResearch.com Interview with:
Dr. Gary Smith MD, DrPH
Center for Injury Research and Policy
Nationwide Children's Hospital
Columbus, Ohio
Medical Research: What is the background for this study? What are the main findings?Dr. Smith: As of January 2015, 23 states and Washington D.C. have legalized marijuana for medical use. Four of those same states and Washington D.C. have also voted to legalize marijuana for recreational use. The debate about legalization often focuses on health effects among adults, economic benefits, and crime rates. Lost in the discussion is the potential harm to young children from unintentional exposure to marijuana.
The study found that the rate of marijuana exposure among children 5 years of age and younger rose 147.5 percent from 2006 through 2013 across the United States. The rate increased almost 610 percent during the same period in states that legalized marijuana for medical use before 2000.
In states that legalized marijuana from 2000 through 2013, the rate increased almost 16 percent per year after legalization, with a particular jump in the year that marijuana was legalized. Even states that had not legalized marijuana by 2013 saw a rise of 63 percent in the rate of marijuana exposures among young children from 2000 through 2013.
Most children were exposed when they swallowed marijuana – that may be related to the popularity of marijuana brownies, cookies and other foods.
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MedicalResearch.com Interview with:
Ron Postuma, MD, MSc
Associate Professor
Department of Neurology
Montreal General Hospital
Montreal, Quebec
Medical Research: What is the background for this study? What are the main findings?Dr. Postuma: The background is that we often think about Parkinson’s Disease as a single disease. However, every clinician knows that there is a great deal of variability from patient to patient. If we can understand the main aspects that separate patients into groups, we can target therapy better.
The analysis used a semi-automated means to divide Parkinson’s patients into groups, using extensive information about motor and non-motor aspects of disease. We found that the non-motor symptoms, especially cognition, sleep disorders, and blood pressure changes were the most powerful predictors of which group a patient would be in. Based on these non-motor (and some motor aspects), the most accurate way to divide patients was into three groups - diffuse (many non-motor symptoms), pure motor, and intermediate (halfway between the other). We then followed patients over time. The diffuse group had, by far, the worse prognosis. This was not only for the non-motor aspects, but the motor as well. (more…)
MedicalResearch.com Interview with:Susan Schwab, PhD
Assistant professor at NYU Langone
Skirball Institute of Biomolecular Medicine
Medical Research: What is the background for this study? What are the main findings?Dr. Schwab: T cell acute lymphoblastic leukemia (T-ALL) remains a devastating pediatric disease. Roughly 20% of children do not respond to current therapies. Furthermore, metastasis to the central nervous system is common in T-ALL, and intrathecal chemotherapy, even when successful at eradicating the cancer, causes serious long-term cognitive side-effects.
Here we report that the chemokine receptor CXCR4 is essential for T cell acute lymphoblastic leukemia progression in both mouse and human xenograft models of disease. Consistent with sustained disease remission in the absence of CXCR4, loss of CXCR4 signaling results in decreased levels of c-Myc, which is required for leukemia initiating cell activity. T-ALL cells reside near cells generating the CXCR4 ligand CXCL12 in the bone marrow, and our data suggest that vascular endothelial cells may be an important part of the T-ALL niche.
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MedicalResearch.com Interview with:
Eric T. Roberts and Darrell Gaskin
Johns Hopkins University Bloomberg School of Public Health
Baltimore, MDMedical Research: What is the background for this study? What are the main findings?
Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults.
We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps. (more…)
MedicalResearch.com Interview with:
Cécile Gaujoux-Viala, MD, PhD
Université Montpellier I
Chef de Service de Rhumatologie
CHU de Nîmes Carémeau
France
Medical Research: What is the background for this study?Response: Chronic inflammatory rheumatic diseases – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) – confer significant patient and economic burdens : 1/5 of people with rheumatic conditions has been forced to change career, 1/3 will have stopped working within two years of onset and 1/2 will be unable to work within ten years.
The addition of biological agents in treatment strategies for rheumatic diseases have improved the possibility of controlling disease activity and slowing the progression of joint damage. But these treatments are very expensive and their effect on work participation remains unclear.
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