Author Interviews
30 Jun Surgery for GERD May Improve Reflux But Risks Complications
MedicalResearch.com Interview with:
John Maret-Ouda MD, PhD candidate
Upper Gastrointestinal Surgery
Department of Molecular medicine and Surgery
Karolinska Institutet
Stockholm, Sweden
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Maret-Ouda : This review is part of the BMJ series “Uncertainties pages”, where clinically relevant, but debated, medical questions are highlighted and discussed. The present study is assessing treatment of severe gastro-oesophageal reflux disease, where the current treatment options are medical (proton-pump inhibitors) or surgical (laparoscopic antireflux surgery). The clinical decision-making is often left to the clinician and local guidelines. We evaluated the existing literature to compare the two treatment options regarding reflux control, complications, future risk of oesophageal adenocarcinoma, health related quality of life, and cost effectiveness.
The main findings were that surgery might provide slightly better reflux control and health related quality of life, but is associated with higher risks of complications compared to medication. A possible preventive effect regarding oesophageal adenocarcinoma remains uncertain. Regarding cost effectiveness, medication seems more cost effective in the short term, but surgery might be more cost effective in the longer term. Since medication provides good treatment of severe gastro-oesophageal reflux disease, but with lower risks of complications, this remains the first line treatment option.
30 Jun Sugar and Fat Absorption Increased In Obesity
MedicalResearch.com Interview with:
Prof. Karine Clément MD, PhD
Director ICAN - Institute of Cardiometabolism And Nutrition
Hôpital La Pitié-Salpêtrière, Paris
www.ican.paris
k.clement@ican-institute.org
Medical Research: What is the background for this study? What are the main findings?
Dr. Clément: Obesity, associated with insulin resistance, is a chronic inflammatory disease revealed by a moderate but long-term increase in the levels of inflammatory molecules in the blood.
Our groups and others have shown that several organs such as adipose tissues, liver, pancreas and muscles are also sites of inflammation with accumulation of immune cells such as macrophages and lymphocytes. This low-grade inflammatory state perturbs the tissue biology and contributes to the development and/or maintenance of insulin resistance and diabetes. In addition our teams and others showed that the intestinal functions are altered in obesity such as sugar and lipid absorption of and enteroendocrine nutrient signaling to the whole body.
Our teams showed modifications of immunity in the obese intestine, and particularly in the jejunum part where most of sugar and lipid absorption takes place. Obesity increases the absorptive surface of the intestine and the colonization of the epithelium by CD8αβ T lymphocytes not affecting tissue integrity, thus differing from IBD inflammation. The cytokines secreted by the CD8 T cells of obese, but not lean subjects, are able to inhibit insulin action in enterocytes. In these patients, the increase of intestinal CD8 T cell density correlates with sugar absorption capacity and with the level of obesity and associated complications such as liver disease (NASH – Non-Alcoholic SteatoHepatitis) and dyslipidemia.
30 Jun Women With PTSD At Higher Risk For Heart Disease
MedicalResearch.com Interview with:
Jennifer A. Sumner, Ph.D.
Columbia University Mailman School of Public Health
New York, NY 10032
Medical Research: What is the background for this study? What are the main findings?
Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men.
My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure.
Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.
30 Jun Active Surveillance Utilization For Prostate Cancer Remains Low
MedicalResearch.com Interview with:
Hui Zhu, MD, ScD
Section Chief, Urology Section
Louis Stokes Cleveland Veterans Affairs Medical Center
and Staff, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Cleveland, Ohio
MedicalResearch: Tell me a little bit about the impetus for this study. What gap in knowledge were you trying to fill?
Dr. Zhu: Prostate cancer is a very challenging disease to understand and manage. For the minority of men, prostate cancer is a lethal disease, and in fact, it is the second leading cause of cancer death in American men, behind only lung cancer. However, for the majority of men, prostate cancer poses little risk of death. In fact, about 1 man in 7 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 38 will die from prostate cancer.
In an effort to avoid suffering and death from prostate cancer for those men with the lethal form, the early detection of prostate cancer (before the disease has reached a stage when it is no longer curable) through widespread prostate cancer screening was instituted in the late 1980s and early 1990s. As a result, prostate cancer diagnosis increased substantially, and most prostate cancers were detected at an early, treatable stage. Screening successfully reduced the risk of death from prostate cancer by 20%.
Unfortunately, our best available screening tests, i.e. prostate-specific antigen (PSA) testing and the digital rectal exam, do not differentiate well between lethal and nonlethal prostate cancer. Consequently, screening is associated with a high risk of overdiagnosis of nonlethal prostate cancer. As a result, about 800 men must be screened and about 30 men must be diagnosed and treated to avoid one death from the prostate cancer, according to recent results from the largest prostate cancer screening trial.
Since the natural history of newly diagnosed screen-detected prostate cancer is difficult to predict (i.e. lethal or nonlethal), most prostate cancers have been treated aggressively, leading to overtreatment of many nonlethal cancers. Aside from receiving unnecessary treatment, these men are exposed to the potential side effects and complications of treatment, including erectile dysfunction and urinary incontinence.
In response to the harms associated with screening and treatment, the US Preventative Services Task Force issued a statement in 2011 (formalized in 2012) recommending against prostate cancer screening in all men. Unfortunately, while minimizing the risks of overdiagnosis and overtreatment for men with nonlethal prostate cancer, this solution eliminates any of the potential benefits of screening for those men with the lethal form of the disease.
As urologists, our solution is different. Rather than throw the baby out with the bathwater, we prefer to preserve PSA screening and its benefits by addressing and hopefully minimizing its associated risks. To achieve this, our goal is to better distinguish between those men who have lethal vs. nonlethal prostate cancer, limiting treatment only to those men who have the lethal form of the disease at an early stage when it is still curable. The dilemma is that our currently available diagnostic tests are unable to accurately differentiate lethal from nonlethal prostate cancer with 100% certainty at the time of initial diagnosis.
The solution, or at least part of the solution, is active surveillance. In men who appear to have nonlethal (“low risk”) cancer at the time of diagnosis, it now appears to be safe to observe these cancers, at least initially. This is the concept behind active surveillance. Active surveillance entails carefully monitoring men with low-risk prostate cancer using serial testing and reserving the option of treatment for those men with prostate cancers that exhibit lethal characteristics. In this way, active surveillance preserves the benefits of screening while minimizing the harms of overdiagnosis and overtreatment.
Active surveillance was first introduced in the early 2000s, but its efficacy and safety have only been elucidated recently over the last 5 years. Given that active surveillance may be one solution to the screening dilemma, we wanted to evaluate contemporary active surveillance utilization, which is the impetus for our study. Based on the most recent data available to us, we chose the years 2010-2011, which coincide to the time immediately before and during the release of the US Preventative Services Task Force statement against PSA screening.
30 Jun Lymph Node Cancer Metastases Do Not Require Growth of New Blood Vessels
MedicalResearch.com Interview with:
Timothy P. Padera, PhD
Edwin L. Steele Laboratories
Department of Radiation Oncology
MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School
Boston, Massachusetts 02114
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Padera: Systemic therapy benefits cancer patients with lymph node metastases; however all phase III clinical trials to date of antiangiogenic therapy have failed in the adjuvant setting. We have previously reported the lack of efficacy of antiangiogenic therapies in pre-clinical models of spontaneous lymphatic metastasis, however there were no mechanistic data to explain these observations. Here, we developed a novel chronic lymph node window model to facilitate new discoveries in the mechanisms of growth and spread of lymph node metastases. Our new data provide pre-clinical evidence along with supporting clinical evidence that angiogenesis does not occur in the growth of metastatic lesions in the lymph node. These results reveal a mechanism of treatment resistance to antiangiogenic therapy in adjuvant setting, particularly those involving lymph node metastases.
29 Jun More Sunshine Linked to Better IVF Outcomes
MedicalResearch.com Interview with:
Frank Vandekerckhove, MD, PhD
Clinical Head, Centre for Reproductive Medicine
University Hospital Ghent
Belgium
Medical Research: What is the background for this study? What are the main findings?
Dr. Vandekerckhove: Several retrospective studies have evaluated seasonal variations in the outcome of IVF treatment. Some also included weather conditions, mostly temperature and hours of daylight. The results were conflicting. We focused on individual variables provided as monthly results by our national meteorological institute. We shifted the results in IVF outcome to the weather results of one month earlier, as we supposed that the selection of good quality oocytes may start in the weeks before.
Between January 2007 and December 2013, the IVF outcome of all Belgian patients treated in our university center was compared to the quarter of the year and monthly mean values of temperature, rain fall, rainy days and sunshine hours during the month when gonadotropins were started or the month before.
11494 patients started an IVF cycle and were included. Firstly bivariate correlation was performed by linear modelling between monthly weather conditions and IVF results. Secondly the same IVF outcome variables were plotted against the weather results stratified per quartile for each individual meteorological variable.
There was no relationship between IVF outcome and the quarter of the year.
When looking for a linear correlation between IVF results and the mean monthly values for the weather, the results were inconsistent.
However, when the same analysis was repeated with the weather results of 1 month earlier, there was a clear trend towards better IVF outcome with higher temperature, less rain and more sunshine hours. The live birth rate per cycle was significantly different (p 0.019) between different groups (Q=quartile) of mean number of sunshine hours (Q1=60.75, Q2=136.00, Q3=174.50).
29 Jun Flu Vaccine Less Effective This Year Because Flu Virus Acquired A Mutation
MedicalResearch.com Interview with:
Scott E. Hensley, Ph.D.
Assistant Professor
Wistar Institute
Philadelphia, PA 1910
Medical Research: What is the background for this study? What are the main findings?
Response: Previous studies documented that the the 2014-2015 H3N2 flu vaccine strain was antigenically distinct compared to most recent H3N2 flu strains. Recent H3N2 strains possess several mutation and it was previously unknown which of these mutations contributed to the 2014-2015 vaccine mismatch. We used a reverse-genetic engineering approach to identify specific viral mutations that contributed to the 2014-2015 vaccine mismatch.
29 Jun Acidification May Be Counterproductive For Some Patients With Urinary Tract Infections
MedicalResearch.com Interview with: Jeffrey P. Henderson, M.D., Ph.D. Assistant Professor of Medicine and Molecular Microbiology Center for Women's Infectious Diseases Research Division of Infectious Diseases and Robin Shields-Cutler, Ph.D Ph.D. Student, Molecular Microbiology and Microbial Pathogenesis Washington University School of Medicine St. Louis, Missouri Medical Research: What is the background for this study? Response: Increasing antibiotic resistance, together with an appreciation that many patients are particularly susceptible to recurrent Urinary Tract Infections UTIs following antibiotic therapy, motivated interest in the events that occur during early stages of UTI pathogenesis. Abundant evidence suggests that uropathogenic E.coli must obtain iron from human hosts in order to cause a clinical infection. Early in infection, human cells secrete a protein called siderocalin that is known to limit bacterial growth by sequestering iron. This protein is detectable in the urine of Urinary Tract Infections patients. Medical Research: What are the main findings? Response: We obtained urine from a diverse panel of healthy volunteers, inoculated them individually with a uropathogenic E.coli strain, and monitored growth in the presence and absence of a fixed amount of siderocalin. Siderocalin exhibited a remarkably wide range of activity between individuals. We traced this variation back to differences in urinary pH and to phenolic urinary metabolites. We could significantly facilitate siderocalin’s antibacterial activity in urine by alkalinizing it above 6.5 and adding phenolic metabolites. The metabolites that potentiate siderocalin’s antibacterial effect have been linked to dietary sources such as coffee, tea, and berries. Some of these compounds may further derive from the actions of gut microbes on dietary phenols. The functional basis for these compounds’ properties seems to arise from siderocalin’s ability to use them as molecular grips that chelate iron ions in a form that is difficult for bacteria to access. From the pathogen perspective, we found that enterobactin, a molecule secreted by E.coli, acts as a microbial countermeasure to urinary siderocalin. Adding a drug-like inhibitor to urine that blocks enterobactin biosynthesis greatly increased siderocalin’s antibacterial effect.27 Jun High-Performance Work Practices Can Reduce Central Line Infections
MedicalResearch.com Interview with:
Ann Scheck McAlearney, Sc.D., M.S.
Professor, Family Medicine
Vice Chair for Research, Department of Family Medicine
College of Medicine Ohio State University
Columbus, Ohio
MedicalResearch: What is the background for this study? What are the main findings?
Dr. McAlearney: In this study, we sought to explore the potential role high-performance work practices (HPWPs) may play in explaining differences in the success of central line-associated blood stream infection (CLABSI) reduction efforts involving otherwise similar organizations and approaches. We analyzed data from 194 key informant interviews across eight hospitals participating in the federally funded ‘‘On the CUSP: Stop BSI’’ initiative. We found evidence that at sites more successful at reducing central line-associated blood stream infection, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites.
In this paper we present examples of management practices and illustrative quotes categorized into four HPWP subsystems:
(a) staff engagement,
(b) staff acquisition/development,
c) frontline empowerment, and
(d) leadership alignment/development.
26 Jun Easing of Pet Travel Restrictions Means More Dogs At Risk Of Rabies Entering Europe
MedicalResearch.com Interview with: Siv Klevar, DVM,PhD. Norwegian Veterinary Institute Department of Diagnostics Section of Immunology Oslo Medical Research: What is the background for this study? Dr. Klevar: Border control veterinary officers reported a surge in the number of imported dogs after the pet travel regulations were relaxed in 2012. At the same time rescue groups, through social media advertisement, encouraged and facilitated the adoption of dogs from shelters in Eastern Europe. The removal of the requirement regarding individual serological testing for antibodies to rabies before importing pets into UK, Ireland, Sweden, Malta and Norway, made it much easier to import pets into these countries. Previously import required several months of preparation and additional costs whereas under the new regulations it could be done after a single vaccination and a 3 week wait. The Norwegian Food Authority initiated a project to look at exotic pathogens in these re-homed dogs. This study reports the rabies antibody levels detected in some of the rehomed stray dogs entering Norway during 2012. The Norwegian Veterinary Institute and National Veterinary Institute in Sweden carried out the study. Medical Research: What are the main findings? Dr. Klevar: Our results showed that a high proportion of stray dogs, compared to a control group of pet dogs from Sweden, didn’t have sufficient protection against rabies virus after vaccination. Although we do not know exactly why this was the case, the exceedingly low levels of antibodies detected in some of the stray animals would suggest that they were not properly vaccinated, even though all the paperwork showed they were fully compliant with Pet Travel Regulations. The main issue highlighted by this study is that the current regulations are not sufficient to prevent rabies introduction when importing rescue dogs from countries where the virus is present to countries free from the disease. The reason for this is that the current regulations do not require a check to see if the pet has been properly vaccinated (by testing the animal’s blood for antibodies). In addition to this, the 21 day waiting period after vaccination isn’t long enough for rabies to develop if the dog had been infected prior to vaccination.26 Jun Tumor DNA In Saliva and Plasma May Be Biomarker For Head and Neck Cancer
MedicalResearch.com Interview with:
Nishant Agrawal M.D.
Associate Professor of Otolaryngology
Johns Hopkins University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Agrawal: The idea of the study really arose from the specificity of genetic changes that characterize and are the hallmark of cancer cells. Only cancer cells contain these mutations so their detection in bodily fluids was a reasonable expectation. The current study builds on previous work from our group that tumor DNA can be detected in the bodily fluids of patients with many different types of solid malignancies. The main findings of the study are that tumor DNA in saliva and plasma provides a non-invasive biomarker for head and neck cancer. The take home message is that tumor DNA has potential to be used as a biomarker for screening, early detection, monitoring during treatment, and surveillance after cancer treatment is completed.
26 Jun Brain Scans May Predict Which OCD Patients Will Relapse After Cognitive-Behavioral Therapy
MedicalResearch.com Interview with: Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences Director, Adult OCD Program Director, Eating Disorder and Body Dysmorphic Disorder Research Program Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, CA 90095 Medical Research: What is the background for this study?...
26 Jun Gut Microbiome May Drive Colon Cancer
MedicalResearch.com Interview with:
Michael B. Burns, Ph.D.
HHMI Post-Doctoral Fellow
Dept. of Genetics, Cell Biology and Development
Dept. of Ecology, Evolution, and Behavior
Masonic Cancer Center
Dept. of Biology Teaching and Learning
University of Minnesota Twin Cities
St. Paul, MN 55108
Medical Research: What is the background for this study?
Dr. Burns: Recent technological advances have made it possible to survey all the of microbes that are in, on, and around us. One of the surprising things is the sheer quantity and diversity of the bacteria in our environments and our microbiomes. Many researchers have begun the systematic characterization of the microbes that are associated with specific disease states, including cancer. With regard to colorectal cancer, there have been numerous studies that have identified specific bacteria that are linked to the presence of the disease. There have been many reports that have identified particular potentially important microbes that may be causing the cancer, driving the cancer, or some combination of the two. Among these microbes, one of the best studied so far is a group of bacteria called Fusobacterium.
Medical Research: What are the main findings?
Dr. Burns: In our work, we set out to perform another characterization of the bacteria in the gut microbiome that are specifically associated with colorectal tumors. We used samples of normal colon tissue from the same individuals as controls, which allowed us to account for much of the variability in the different bacteria we found that might have been simply the result of, for instance, diet. In our analysis, we confirmed the previous results related to Fusobacterium, and additionally discovered a new potential culprit in colorectal cancer, a group of bacteria named Providencia.
The finding of another new set of microbes that might be causing or driving cancer is not surprising. As indicated above, there are many groups who have found other potential candidate microbes that could be implicated in the disease. Our next question was to determine if there was some reason why there might be so many different bacteria that are linked with the disease and what it might be able to tell us about what these bacteria are doing. To that end, we used computational approaches to assess what these two groups of bacteria might be doing at a functional level and if there were any similarities. We found that there was a great deal in common between Fusobacterium and Providencia, including a finding that one of the common functions was related to a large group of virulence genes.
26 Jun Drug Nanocarrier Helps Overcome Medication Resistance
MedicalResearch.com Interview with: Jose A. Garcia Salcedo, PhD. Unidad de Enfermedades Infecciosas Hospital Universitario San Cecilio Instituto de Investigación Biosanitaria de Granada Granada Spain Medical Research: What is the background for this study? Response: Drug resistance is complicating the treatment of parasitic diseases including African trypanosomiasis, a fatal disease if left untreated. Development of a vaccine is unlikely due to parasite antigenic variation. Current chemotherapy relies primarily on four drugs. Three of these drugs access the cell’s interior through surface transporters and resistance mechanisms are largely associated with loss-of-function mutations in the involved surface drug transporters.26 Jun JAK Inhibitors Offer Hope For Vitiligo
MedicalResearch.com Interview with: Brett King, M.D., Ph.D. Assistant Professor of Dermatology Yale University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. King: Treatment options for vitiligo are limited and often ineffective. This report highlights the possibility of targeted therapy of vitiligo using a relatively new...
26 Jun Electromagnetic Interference Between Smart Phones and Cardiac Devices Rare But Possible
MedicalResearch.com Interview with:
Dr. Carsten Lennerz
Deutsches Herzzentrum
München
Medical Research: What is the background for this study? What are the main findings?
Response: The number of cardiovascular implantable electronic devices (CIEDs) is increasing. Worldwide more than 4 million people rely on an implanted pacemaker (PM) or implantable cardioverter defibrillator ICD. Sensing intrinsic cardiac electrical activity is the core principle of all CIED devices, however in case of electromagnetic interference (EMI) exogenous electric and magnetic fields can be picked up by the sensing circuit and mistakenly interpreted as a cardiac signal by the CIED. PM can respond to EMI with pacing-inhibition, leading to bradycardia or asystole and resulting in syncope. In ICDs EMI may be detected as a life threatening ventricular arrhythmia with the subsequent delivery of inappropriate shocks.
Early studies on EMI, run more than 10 years ago, have identified mobile phones as a source of EMI with pacemakers. Based on these pacemaker studies the CIED manufacturer and the regulatory authorities (e.g. Food and Drug Administration [FDA]) currently recommend a safety distance, i.e. hold the phone to the contra-lateral ear and avoid placing a turned-on phone next to the generator pocket.
In the meantime telecommunication and the CIED techniques have dramatically evolved. The classic mobile phone has been replaced by modern smartphones, furthermore the network standards have changed from GSM to UMTS (3G) and LTE (4G). New cardiac devices are now in use including more devices for cardiac resynchronisation therapy (CRT) or for the protection from sudden cardiac death (ICD); some of them are even compatible for MRI diagnostics.
With the use of a hemertic titanium shell, new filtering properties of the feed-throughs, sense amplifiers and noise protection algorhythms as well as the predominant use of bipolar leads the CIED may be better shielded against external influences and adverse effects of EMI.
In light of the above, the purpose of our study was to evaluate if previous precautions recommended to cardiovascular implantable electronic devices recipients are still up-to-date or if they can be abandoned. By today there are neither studies focusing on EMI between modern smartphones and modern CIEDs nor on newer mobile network standards (UMTS or LTE).
In a cross-sectional study we enrolled 308 patients and exposed them to the electromagnetic field of three smartphones (Samsung Galaxy 3, Nokia Lumia, HTC One XL) by placing the handhelds directly over the pulse generator. Installing an own base mobile network station we ensured that each smartphone went through a standardized protocol that included the entire calling process (connecting, ringing, talking), the handovers between all current network standards (GSM, UMTS, LTE where applicable) and operation at maximal transmission power.
More than 3.400 tests on electromagnetic interference were performed. One out of 308 patients (0.3%) was repeatedly affected by EMI caused by smartphones. The patient’s MRI compatible CRT-defibrillator malfunctioned with short-term ventricular and atrial oversensing when exposed to Nokia or HTC smartphones operating at GSM and UMTS.
26 Jun Menopausal SSRIs Increases Risk of Bone Fractures
MedicalResearch.com Interview with: Dr Matthew Miller Department of Health Science Northeastern University Department of Health Policy and Management, Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts and Yi-Han Sheu Department of Epidemiology Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts Medical Research: What is the background for this study? Response: Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally.. Medical Research: What are the main findings? Response: We found that SSRIs treatment for non-psychiatric conditions at doses customarily used to treat depression is, all else equal, associated with higher rates of fractures -- an effect that first became evident several months after beginning treatment and, importantly, persisted over the five year study period.25 Jun Trial of First Fasting Mimicking Diet Safely Improves Biomarkers of Aging
MedicalResearch.com Interview with: Todd Morgan, Ph.D. Chief Scientific Officer L-Nutra, Inc Culver City, CA 90232 Medical Research: What is the background for this study? Dr. Longo: Despite health benefits, even short periods of fasting are difficult to maintain for most people, as it can lead to electrolyte abnormalities and malnutrition in at-risk individuals, such as the...
25 Jun Intense Education Shortens Arrival Time To ER For Stroke Patients
MedicalResearch.com Interview with:
Dr. Bernadette Boden-Albala MPH, DrPH
Associate Dean of Program Development
NYU’s College of Global Public Health
Medical Research: What is the background for this study? What are the main findings?
Response: Stroke is a leading cause of morbidity and mortality globally and in the US. The US Food and Drug Administration has approved tissue plasminogen activator (tPA) as treatment for acute ischemic strokes within 3 hours of the onset of stroke symptoms. However, less than 25% of eligible stroke patients arrive to an emergency department (ED) in time to receive treatment with tPA. Our study, the Stroke Warning Information and Faster Treatment (SWIFT), compares the effect of an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times.
The II group included in-hospital interactive group sessions consisting of a community placed preparedness PowerPoint presentation; a stroke survivor preparedness narrative video; and the use of role-playing techniques to describe stroke symptoms. Both groups received standardized educational materials focused on being prepared to recognize and react to stroke symptoms plus a medical alert bracelet so medical professionals would recognize them as SWIFT participants.
We found that at follow-up, 42 percent of these patients arrived to the emergency room within 3 hours compared to only 28 percent at baseline, a 49 percent increase in the proportion of all patients arriving within three hours of symptom onset. Among Hispanics, there was a 63 percent increase. While there was no difference in the proportion arriving within 3 hours between intervention groups, the intensive intervention appeared to be more beneficial in those with early recurrent events within the first 30 days.
25 Jun Consciousness May Arise Unconsciously
MedicalResearch.com Interview with: Ezequiel Morsella, Ph.D. Associate Professor of Neuroscience Department of Psychology San Francisco State University Assistant Adjunct Professor Department of Neurology University of California, San Francisco Boardmember, Scientific Advisory Board Institute of Cognitive Neurology (INECO), Buenos Aires Medical Research: What is the background for this study? What are the main findings? Dr. Morsella: The theoretical framework, Passive Frame Theory, builds on an action-based, theoretical project that first appeared in Psychological Review, in 2015. The framework is a synthesis of hypotheses from disparate fields. It reveals that consciousness serves as a frame that constrains and directs skeletal muscle output, thereby yielding adaptive behavior. From this unique, action-based perspective, consciousness is in the service of the somatic nervous system. How consciousness achieves this is more counterintuitive, ‘low level,’ and passive than the kinds of functions that theorists have attributed to consciousness.25 Jun Many US Infants Found To Be Vitamin D Deficient
MedicalResearch.com Interview with:
Katherine Ahrens Ph.D. MPH
National Center for Health Statistics
Centers for Disease Control and Prevention
Hyattsville, MD
Medical Research: What is the background for this study?
Dr. Ahrens: In 2008, the American Academy of Pediatrics (AAP) revised their recommended minimum daily intake of vitamin D for infants and children to 400 IU.
Medical Research: What are the main findings?
Dr. Ahrens: Approximately one quarter of US infants aged 0 to 11 months met the 2008 AAP vitamin D recommendations on a given day in 2009 to 2012. Fewer than 1 in 5 breastfed infants met the vitamin D recommendations compared to nearly 1 in 3 non-breastfed infants.
25 Jun Patient Controlled Medication Found Effective For Abdominal Pain In ER
MedicalResearch.com Interview with: Prof. Jason Smith Consultant in Emergency Medicine, Derriford Hospital, Plymouth, UK Royal College of Emergency Medicine Professor Defence Professor of Emergency Medicine, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, UK Honorary Professor in Emergency Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, UK Medical Research: What is the background for this study? Prof. Smith: Patients commonly present to emergency departments in pain. When patients are asked about their emergency department experience, they often say that more could have been done to manage their pain. Routine care for patients in moderate or severe pain who present to emergency departments usually involves intravenous (IV) morphine, delivered by a nurse. There may be a delay when patients are admitted to a hospital ward before they are reviewed by the admitting medical team, when their pain needs are reassessed. Patient controlled analgesia (PCA) is used to good effect elsewhere in the hospital. The aim of this study was to compare PCA with routine care in patients presenting to emergency departments with either traumatic injuries or non-traumatic abdominal pain, who require admission to hospital. Medical Research: What are the main findings? Prof. Smith: We found that significant reductions in pain were possible using patient controlled analgesia in patients with abdominal pain. Patients spent significantly less time in moderate or severe pain, and were more likely to be very or perfectly satisfied with their pain management. In patients with traumatic injuries, a modest (but non-significant) reduction in pain was seen in patients allocated to the PCA group compared with the routine care group. Patients in the PCA group were more likely to be very or perfectly satisfied with their pain management.25 Jun No Knee-Jerk Antibiotics Campaign Aims To Reduce Antibiotic Overusage
Posted at 20:53h
in AHRQ, Antibiotic Resistance, Author Interviews, Baylor College of Medicine Houston, JAMA, Urinary Tract Infections
MedicalResearch.com Interview with:
Barbara W. Trautner, MD, PhD
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
Section of Infectious Diseases
Department of Medicine
Baylor College of Medicine, Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Trautner: Reducing antimicrobial overuse, or antimicrobial stewardship, is a national imperative. If we fail to optimize and limit use of these precious resources, we may lose effective antimicrobial therapy in the future. CDC estimates that more than $1 billion is spent on unnecessary antibiotics annually, and that drug-resistant pathogens cause 2 million illnesses and 23,000 deaths in the U.S. each year. The use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized and nursing home patients, especially among patients with urinary catheters. In catheterized patients, ASB is very often misdiagnosed and treated as catheter-associated urinary tract infection (CAUTI). Therefore, we designed the “Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign intervention” to reduce overtreatment of ASB and to reduce the confusion about distinguishing CAUTI from asymptomatic bacteriuria.
This study evaluated the effectiveness of the Kicking CAUTI intervention in two VAMCs between July 2010 and June 2013. The primary outcomes were urine cultures ordered per 1,000 bed-days (inappropriate screening for ASB) and cases of ASB receiving antibiotics (overtreatment). The study included 289,754 total bed days, with 170,345 at the intervention site and 119,409 at the comparison site. Through this campaign, researchers were able to dramatically decrease the number of urine cultures ordered. At the intervention site, the total number of urine cultures ordered decreased by 71 percent over the course of the intervention. Antibiotic treatment of asymptomatic bacteriuria decreased by more than 75 percent during the study. No significant changes occurred at the comparison site over the same time period. Failure to treat catheter-associated urinary tract infection when indicated did not increase at either site.
25 Jun Opioids and Barbituates Commonly Prescribed For Headaches
Posted at 20:33h
in Author Interviews, Neurological Disorders, NYU/NYMC, Opiods, Pain Research, Pharmacology
MedicalResearch.com Interview with:
Dr. Mia T. Minen, MD, MPH
Director, Headache Services
NYU Langone Medical Center
Assistant professor, Department of Neurology
Medical Research: What is the background for this study? What are the main findings?
Dr. Minen: We conducted a survey on opioid and barbiturate use among patients visiting a headache center to find out which medications they were receiving for treatment. There’s limited evidence that long-term use of these medications can help treat headaches or migraines, and even short-term use in small quantities can cause medication overuse headache. It is important to determine which providers start these medications so that educational interventions can be tailored to these physician specialties to try to prevent situations such as incorrect prescribing practices and medication overuse.
In this sample of patients from a specialty headache center, approximately 20 percent of patients -- or 1 in 5 -- were using opioids or barbiturates, and about half had been prescribed these medications at some point in the past for their headaches. These findings show that opioids and barbiturates are commonly prescribed to patients with headaches. While two-thirds of patients found opioids or barbiturates helpful, many did not like them, were limited by side effects or did not find them to be helpful. Emergency department physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent prescribers of barbiturate-containing medications. Primary care physicians were also identified as frequent first prescribers of these medications.
25 Jun New Blood Biomarker Panel May Detect Melanoma Micro-Metastases
MedicalResearch.com Interview with:
Mitchell S. Stark
Senior Research Assistant/PhD Student
Oncogenomics Group
QIMR Berghofer Medical Research Institute
Herston, Brisbane, Australia
Medical Research: What is the background for this study?
What are the main findings?
Response: Melanomas are among the most commonly occurring cancers with the number of new cases rising each year. Melanoma is currently is listed as the 4th and 6th most common cancer in Australia and the USA with >11,000 and >76,000 news diagnoses each year. The overall 5-year survival for melanoma is 91%, which is largely due to curative surgery for early stage disease. However, cure rates are <15% if distant metastasis occurs (stage IV). We now have evidence that current therapeutic options for late stage disease are more effective if the disease is treated with a lower disease burden. 2010). Hence, melanoma must be treated in earlier stages to maximize the chances of patient survival. Therefore, the ability to identify signs of melanoma progression sooner would be a valuable clinical tool.
The use of melanoma progression markers have been used for many years however it is clear from the survival rates that melanoma must be detected before disease progresses thus highlighting that the current methods of progression detection are inadequate. We have identified a seven-microRNA panel (MELmiR-7) that has the ability to detect the presence of melanoma with high sensitivity and specificity which is superior to currently used markers for melanoma progression, recurrence, and survival. This panel may enable more precise measurement of disease progression and may herald an increase in overall survival.
25 Jun Caesarean Section Linked to Increased Autism Rate
MedicalResearch.com Interview with: Ali S. Khashan, Ph.D. Irish Centre for Fetal and Neonatal Translational Research (INFANT) Cork, Ireland Medical Research: What is the background for this study? What are the main findings? Dr. Khashan: The Caesarean section rate is increasing worldwide reaching 30% in some western countries and 50% in China and Brazil. As a result, it is becoming increasingly important to understand the long-term effects this procedure may have on both mother and child. Previously, our group conducted a systematic review and meta-analysis of published literature and found birth by Caesarean to be associated with approximately 20% increased risk of autism spectrum disorder (ASD), compared to birth by vaginal delivery. This means if the risk of ASD in children born by vaginal delivery were 1%, and the association was causal, the risk of autism spectrum disorder in children born by Caesarean section is 1.2% i.e. two additional ASD cases per 1000 births. However, studies were limited, and we were unable to determine what was driving this association. In our new study, now published in JAMA Psychiatry, we investigated this issue further with the largest study on this subject to date, including all children born in Sweden between 1982 and 2010. Our study included data on over 2.9 million people and accounted for variety of factors known to be associated with both Caesarean section and autism spectrum disorder. After controlling for known confounders, such as maternal age and psychiatric history as well as various other perinatal and socio-demographic factors, we confirmed our previous findings that birth by Caesarean was associated with approximately 20% increased risk of autism spectrum disorder, compared to birth by vaginal delivery. However, with this analysis it remained unclear whether the increased risk was due to the Caesarean section itself, or some genetic or environmental factor that we were unable to measure. To determine if it was birth by Caesarean section or another unknown factor which led to an increased risk of ASD, we compared children with autism spectrum disorder to their non-diagnosed brothers and sisters. In other words, we analysed pairs of siblings in which one was diagnosed with ASD and one was not, to determine if birth by Caesarean was associated with increased risk of ASD within families. In this way, we attempted to indirectly account for genetic and family environment factors that are shared by siblings but we were unable to measure in the general population. In this analysis, which included data on over 13,000 sibling pairs, there was no longer any association between birth by Caesarean section and ASD. Overall, these results indicate that though birth by Caesarean section may be associated with an increased risk of ASD, it is likely due to family factors such as genetics or environment, rather than the Caesarean section itself. These findings are more informative than many previous studies as we had the largest sample size on this topic to date and estimated the association between Caesarean section and the risk of autism spectrum disorder while comparing siblings born by different methods of delivery. This allowed us to control for many factors that other studies did not.25 Jun Majority of Medical Cannabis Products Found To Be Mislabeled
MedicalResearch.com Interview with:
Ryan Vandrey, Ph.D.
Associate Professor
Behavioral Pharmacology Research Unit
Johns Hopkins University School of Medicine
Baltimore, MD 21224
Medical Research: What is the background for this study? What are the main findings?
Dr. Vandrey: The background for the study was that I have had several conversations with individuals that led me to believe that there was insufficient regulation of products of all types being sold in medical cannabis dispensaries. In order to evaluate that, we needed to do a study. We decided to test edible products because that is a growing market, and, because it involves some level of manufacturing, there is greater chance for dose variability and inaccuracy. The main finding was that the majority of products were purchased from retail stores selling cannabis products for medical use were significantly mislabeled with regards to the dose of THC and other cannabinoids.
25 Jun Robotic-Assisted Cardiac Surgery: Higher Cost But Shorter Hospital Stay
MedicalResearch.com Interview with:
Vanita Ahuja, MD, MPH
Department of General Surgery
York Hospital, York, Pennsylvania
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Ahuja: Robotic-assisted surgery has been slowly accepted within the medical community. Felger et al. (1999), Falk et al. (2000), and Loumet et al. (2000) state that specific to cardiac surgery, the advantages of the robot in coronary artery bypass grafting (CABG) and valvular operations were demonstrated with increased visualization, ease of harvest, and quality of vascular anastomoses as early as 1999. However, Giulianotti, et al. (2003), Morgan et al. (2005), and Barbash et al. (2010) suggest that although safety and efficacy are supported, it is not conclusive yet that robot-assisted surgery is cost-effective, given the high cost of the robot itself, longer operating times, and the short life of the robotic instruments. The purpose of our paper was to compare outcomes of complications, length of stay (LOS), actual cost, and mortality between non-robotic and robotic-assisted cardiac surgery.
In general surgery and subspecialties, the use of the robot has increased significantly over the past few years. It has been noted that robotic surgery improves on laparoscopic surgery by providing increased intra-cavity articulation, increased degrees of freedom, and downscaling of motion amplitude that may reduce the strain on the surgeon.
The biggest growth in robotic surgery has been seen in the fields of gynecology and urology. Recently, Wright et al. reported an increase in robotic assisted hysterectomy from 0.5 percent of the procedures in 2007 compared to 9.5 percent in 2010 for benign disease. In their study, robotic assisted surgery had similar outcomes to laparoscopic surgery but higher total cost of $2,189 more per case. In urologic surgery, Leddy et al. reported in 2010 that radical prostatectomy remains the biggest utilization of robotic assisted surgery in urology with 1% in 2001 to 40% of all cases in 2006 performed in the United States.
Utilizing a nationwide database from 2008-2011, subjects were propensity matched by 14 patient characteristics to reduce selection bias in a retrospective study. The patients were then divided into three groups by operation types: valves, vessels and other type. Univariate analysis revealed that robotic-assisted surgery, compared to non-robotic surgery, had higher cost ($39,030 vs. $36,340), but lower LOS (5 vs. 6 days) and mortality (1% vs. 1.9%, all p<0.001). For those who had one or more complications, robotic-assisted cardiac surgery had fewer complications (27.2%) to non-robotic cardiac surgery (30.3%, p < .001).
25 Jun Placement of Hand Sanitizer Dispensers Important For Staff Compliance
MedicalResearch.com Interview with:
Laila Cure, Ph.D.
Assistant Professor
Dept. of Industrial and Manufacturing Engineering
Wichita State University
Medical Research: What is the background for this study? What are the main findings?
Response: It is widely known that healthcare work, particularly inpatient care work, is mostly knowledge-based. Healthcare workers are constantly assessing the clinical state of their patients and making decisions that affect their workflow. This type of work is difficult to study and organize as a whole using traditional work design techniques, which are mostly designed for routine, repetitive work. Nevertheless, there are components of inpatient work that can be improved using basic workstation design principles. Hand hygiene is one of them.
Hand hygiene is still the single most important intervention to prevent infection in hospitals. Guidelines state that health care workers should clean their hands before touching a patient, before an aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings. Hand sanitizer dispensers are practical resources to support hand hygiene because they can be placed almost anywhere throughout hospital units. This study aimed at determining whether “good” placement of sanitizer dispensers correlates with compliance of staff in using the sanitizer. “Good placement” was defined in terms of usability characteristics extracted from hand hygiene literature recommendations. Of the usability characteristics included in the study, visibility and accessibility had some statistical influence on improving compliance.