MedicalResearch.com Interview with: Dr. H. Jaap Bonjer, PhD, FRCSC Professor of Surgery Chair Department of Surgery VU University Medical Center Amsterdam Amsterdam Medical Research: What is...
MedicalResearch.com Interview with:
Henri van Werkhoven
PhD student and
Douwe Postma
PhD student
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht, Utrecht, The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Response: Community-acquired pneumonia is an important cause of hospitalization and death worldwide. Recommendations for antibiotic treatment in patients hospitalized to a non-ICU ward vary widely between guidelines, because the optimal antibiotic strategy is unknown. Interpretation of the available evidence from clinical studies is complicated by the heterogeneity in designs and findings. In our study, we hypothesized that the most conservative strategy, beta-lactam monotherapy, would be non-inferior to strategies with a broader range of antibiotic coverage. The latter strategies are potentially related to increased antibiotic resistance.
For this purpose, we randomized hospitals to follow three different strategies of preferred antibiotic treatment in consecutive periods of four months. Physicians were allowed to deviate from the preferred antibiotic treatment for medical reasons. We found that a strategy with beta-lactam monotherapy (e.g. amoxicillin) as the preferred treatment was non-inferior to the strategies with beta-lactam/macrolide combination therapy or fluoroquinolone monotherapy for 30 and 90-day all-cause mortality. Also there was no difference in length of hospitalization and rate of complications.
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MedicalResearch.com Interview with:
Elizabeth Lowenthal, MD MSCE
Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Medical Research: What is the background for this study? What are the main findings?
Dr. Lowenthal: Between 2005 and 2012, HIV related deaths declined by 30% worldwide. However, during the same time period, HIV related deaths increased 50% among adolescents. Over 90% of HIV-infected children and adolescents live in sub-Saharan Africa and HIV is the leading cause of death among adolescents in Africa. Treatment is available that can allow babies born with HIV to live to be healthy adults. However, strict adherence to these medicines is necessary and often becomes a great challenge during adolescence. In our study of 300 adolescents (ages 10-19) in Botswana, my team found that adolescents who come to clinic without a parent or guardian have a 4.5X greater odds of failing their HIV treatment.
(more…)MedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Assistant Professor of Medicine Harvard Medical School Assistant Professor of Nutrition Harvard T. H. Chan School of...
MedicalResearch.com Interview with:
Adam Culvenor Ι B.Physio(Hons), PhD
Division of Physiotherapy
School of Health & Rehabilitation Sciences
The University of Queensland
Medical Research: What is the background for this study?
Dr. Culvenor: Knee injury, such as anterior cruciate ligament (ACL) rupture, is a well-recognised risk factor for the accelerated development of knee osteoarthritis (OA). Previous studies report high rates of knee osteoarthritis with radiographs (x-rays) more than 5-10 years following ACL injury and reconstruction (ACLR). However, once OA becomes well-established and visible on radiographs, management options are limited. Potential therapies may be better placed to target the early stages of disease when management strategies, such as optimising knee load, may be more efficacious. Magnetic resonance imaging (MRI) enables the assessment of early osteoarthritis features affecting any joint tissue. Yet, MRI has not previously been used to assess early knee OA within the first year following ACLR.
Medical Research: What are the main findings?
Dr. Culvenor: Of the 111 patients who were one year following an anterior cruciate ligament rupture, the prevalence of early knee OA assessed with MRI was much higher than previously recognised. Medial and lateral tibiofemoral osteoarthritis was observed in 6% and 11%, respectively, while 17% had patellofemoral OA. These patterns of early OA are similar to previous radiographic findings; the patellofemoral joint is at particular risk of OA. Specifically, the femoral trochlea was the region most affected by bone marrow lesions, cartilage lesions and osteophytes. The prevalence of structural pathology was much higher than the uninjured control group of similar age and activity level, highlighting the impact of knee trauma (injury and/or surgery).
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MedicalResearch.com Interview with:
Michael J Sadowsky Ph.D
Director, BioTechnology Institute
University of Minnesota
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Sadowsky: Fecal microbiota transplantation (FMT) has become increasingly common in the treatment of patients with refractory Clostridium difficile infection (CDI). It also holds promise for the treatment of medical conditions ranging from inflammatory bowel and Crohn’s disease to diabetes and metabolic syndrome. In contrast to standard antibiotic therapies, which further disrupt intestinal microflora and may contribute to the recurrence of CDI, FMT restores intestinal microbiome and healthy gut function.
Despite therapeutic successes, little is known about the stability of transplanted microbiota over time. This report contributes to our understanding of the short-and long-term composition of gut microbiota following Fecal microbiota transplantation.
In this study, fecal samples collected before and after treatment were compared with data from the Human Microbiome Project (HMP). Treatment using FMT resulted in the rapid normalization of microbial composition in the patient, with the post-treatment profiles closely resembling the normal distribution of fecal microbiota from the donor. While the composition of fecal microbiota in the donor and recipient varied over time, both remained in the large band characterized as normal in hundreds of healthy individuals collected as part of the HMP. Furthermore, while the composition of the microflora in Fecal microbiota transplantation recipients and donors diverges over time, the recipient profiles stay within the same dynamic range as the original implanted donor material.
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MedicalResearch.com Interview with:
Dr. Julie Magno Zito, PhD
University of Maryland, Baltimore, MD 21201
MedicalResearch: What is the background for this study?
Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.
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MedicalResearch.com Interview with:
Judith Haber, PhD, APRN, BC, FAAN
Associate Dean, Graduate Programs
The Ursula Springer Leadership Professor in Nursing
New York, NY 10003
Medical Research: What is the background for this study? What are the main findings?
Dr. Haber: The background of the project originally aligns with publication of the Surgeon General's Report (2000), challenging health providers to think about the "mouth as a window to the body". More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue. However, there is a dearth of curricular focus on oral health in the curriculum of health professionals. The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014. Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions. We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach. When a health professional uses the HEENOT approach, he or she cannot forget about oral health.
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MedicalResearch.com Interview with:
Maria L. Wei, M.D., Ph.D.
Associate Professor of Dermatology
Director, Melanoma Surveillance Clinic
Multidisciplinary Melanoma Program
University of California, San Francisco
Staff Physician
Veterans Affairs Medical Center, San Francisco
Medical Research: What is the background for this study?
Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
MedicalResearch.com Interview with:
Marc Ryser PhD
Visiting Assistant Professor Department of Mathematics
Duke University Durham, North Carolina
Medical Research: What is the background for this study
Dr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical.
The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years. However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response.
Interestingly, recent studies about the stem cell dynamics in epithelial tissues - the types of tissues that are affected by HPV - have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections.
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MedicalResearch.com Interview with:
Alan J. Wolfe PhD, Professor
Department of Microbiology and Immunology
Stritch School of Medicine, Loyola University Chicago
Maywood, IL
MedicalResearch.com Interview with:
Sayan Sen, PhD
International Centre for Circulatory Health, National Heart and Lung Institute
Imperial College London
London, United Kingdom
Medical Research: What is the background for this study? What are the main findings?
Dr. Sayan Sen: Intra-aortic balloon pumps (IABP) are often used in Acute Myocardial Infarction, particularly in patients with cardiogenic shock. We analysed the available Randomized Controlled Trials (RCT) and observational studies, spanning 30 years, to establish the evidence for this use.
There is no identifiable group of patients with Acute Myocardial Infarction that have been demonstrated to derive a mortality benefit from insertion of an IABP. The studies, including over 17000 patients, have studied mortality in patients receiving IABP in comparison to mortality of patients that received no IABP in the era of no reperfusion, fibrinolysis and primary percutaneous intervention. This lack of mortality reduction with IABP in AMI is consistent in patients with and without cardiogenic shock across both RCTs and observational studies; questioning the continued use of this technology in Acute Myocardial Infarction.
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MedicalResearch.com Interview with:
Dr. Mala Sachdeva MD
North Shore University Hospital, Long Island Jewish Medical Center
Assistant Professor, Nephrology, Internal Medicine
Hofstra North Shore-LIJ School of Medicine
Medical Research: What is the background for this study?
Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.
Medical Research: What are the main findings?
Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis.
Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths.
Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL. 75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.
There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception.
So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.
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MedicalResearch.com Interview with:
Prof Xi-Chun Hu, Department of Oncology
Shanghai Medical College
Fudan University, Shanghai 200032, China
MedicalResearch: What is the background for this study? What are the main findings?
Prof. Hu: Triple-negative breast cancer (TNBC) is associated with higher rates of recurrence, shorter disease free survival, and poorer overall survival. Molecular targeting agents tried against Triple-negative breast cancer have nearly all failed. TNBC, concordant with BRCA-associated and basal-like breast cancer, has abnormal DNA repair and genome-wide instability, supporting the use of DNA-damaging agents such as platinum. However, platinum monotherapy is not very potent, combination with other agents, such as gemcitabine has a synergistic effect.
The GP regimen could be an alternative or even preferential first-line doublet chemotherapy strategy for patients with mTNBC.
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MedicalResearch.com Interview with:
Jorge E. Chavarro, M.D., Sc.D.
Assistant Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine
Harvard Medical School Boston, MA 02113
Medical Research: What is the background for this study?
Dr. Chavarro: Previous studies have shown that occupational exposure to pesticides is harmful to sperm production. However, whether the same is true for pesticide residues in our food, the most important source of exposure to pesticides for most people, is unclear.
Medical Research: What are the main findings?
Dr. Chavarro: Bottom line, men who consumed the greatest amounts of fruits and vegetables with large amounts of pesticide residues had significantly lower sperm counts and fewer morphologically normal sperm.
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MedicalResearch.com Interview with:
Dr. Jean-Luc Margot PhD
Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,
University of California, Los Angeles
Medical Research: What is the background for this study? What are the main findings?
Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times. This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.
Results of a new analysis have been published online in the journal Nursing Research. The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. (more…)
MedicalResearch.com Interview with:
Gulshan Sharma, MD, MPH
Division of Pulmonary Critical Care and Sleep Medicine
University of Texas Medical Branch
Galveston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).
Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.
Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.
Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury. (more…)[caption id="attachment_13080" align="alignleft" width="199"] CDC Image: Cardiorespiratory Fitness[/caption] MedicalResearch.com Interview with: Susan G. Lakoski, M.D. Assistant Professor of Medicine, Hematology/Oncology DivisionDepartment of Medicine...
MedicalResearch.com Interview with:
Thomas Perls, MD, MPH Professor
Boston University School of Medicine
Medical Research: What is the background for this study?
Dr. Perls: For years now, Gerontology scholars continue to state that 25% of what they interchangeably call aging, longevity, life expectancy and life span is genetic and 75% is due to the environment and health-related behaviors. This assertion is based on Scandinavian twins reared apart, but the oldest participants in those studies lived to their 70s and 80s. Part of the problem here is the lack of consistency in what people mean by the terms Aging, Life Span and Longevity.
In fact, the Seventh Day Adventists, who generally have a high prevalence of healthy behaviors (vegetarian, daily exercise, eat in moderation, abstain from tobacco and alcohol, and activities that help manage stress well) have an average live expectancy of approximately 88 years. Yet, 7th Day Adventists are ethnically and racially heterogeneous and thus it appears that those healthy behaviors explain the vast majority of the variation in how old these people live to be. This finding is consistent with the optimistic view of the twin studies, that much of living to one's 80's is in our hands. Living to only our 50s-70's is also in our hands (e.g. 75% behaviors) if we choose to smoke, eat red meat frequently, be obese, not exercise, be exposed to gun violence, have unsafe sex, do IV drugs, etc. So it is safe to say, in my opinion, that 75% of the variation in how old we live to be, is on average due to our behavior and exposure choices. The empowering and important point is that if we all lived like the Seventh Day Adventists, average life expectancy would increase almost 8 years and health costs would markedly decline because we would be getting to these older ages because we are healthier not because we are pouring more resources into more effectively treating diseases.
The New England Centenarian Study, which I direct, and a number of other studies of nonagenarians (people in their 90s) have demonstrated via direct genetic studies as well as studies of family trees where at least some family members get to these very old ages, that with older and older ages of survival beyond age ~95 years, variations in genetic profiles explain a greater and greater proportion of the variation in how old people live to be at these ages. So much so that I believe the findings to date are consistent with the roles of genes and environment being reversed for survival to age 106+ years, that is, 75% genetics and 25% environment/behaviors. This supposition is based upon several observations:
(1) as people reach the age of 105+ years, they become more and more alike in terms of what age-related diseases they get and when they get them. Consistent with Jim Fries; "Compression of Morbidity" hypothesis, people who survive to ages 110+ (called supercentenarians) and who therefore approximate the limit of human lifespan are on average disease and disability-free up until the last 5 or so years of their lives. This increasing homogeneity, especially compared to the increasing heterogeneity in the rates of aging and incidences of age-related diseases at younger percentiles or ages of survival, suggests underlying genetic similarities (similar genetic profiles) amongst groups of these supercentenarians; and
(2) the New England Centenarian Study previously discovered genetic signatures (made up of longevity-associated variations of about 130 genes) that were associated with surviving to age 106+ years with 80% accuracy, but with only 60% accuracy for accurately picking out people living to ~100 years. This increasing accuracy with older and older ages also suggests a stronger and stronger genetic influence upon survival to these rarest percentiles of survival.
With the above background, we set out in this study and subsequent paper, to
(1) assess sibling relative risk using the largest-ever collection of validated pedigrees of centenarians,
(2) to assess the risk of a sibling achieving the same age as their very old sibling (e.g. ages 95, 100, or 105+ years) relative to average people born around the same time, and
(3) to look at how when a person was born (eg before or after 1890) made a difference in these relative risks.
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MedicalResearch.com Interview with:
Andrew Blauvelt, M.D., M.B.A.
President and Investigator
Research Excellence & Personalized Patient Care
Portland, OR 97223
Medical Research: What is the background for this study? What are the main findings?
Dr. Blauvelt: A2303E1 is a multicenter, double-blind, randomized withdrawal extension to the FIXTURE and ERASURE pivotal phase III studies. The purpose of this extension study was to collect additional long term efficacy, safety, and tolerability data on secukinumab (i.e., Cosentyx) in patients who demonstrated a PASI 75 response to Cosentyx at Week 52 of these core studies in moderate-to-severe plaque psoriasis.
In the extension phase, 995 patients who achieved Psoriasis Area Severity Index (PASI) 75 responses after 52 weeks of therapy received either Cosentyx 300 mg, Cosentyx 150 mg, or placebo for an additional year (Week 104). After two full years of therapy in patients treated with Cosentyx 300 mg, almost 9 out of 10 (88.2%) patients maintained their PASI 75 response, 7 out of 10 (70.6%) had clear or almost clear skin (PASI 90), and 4 out of 10 (43.9) had clear skin (PASI 100) at Week 104. For patients treated with Cosentyx 150 mg, 75.5% maintained their PASI 75 response, 44.6% had clear or almost clear skin (PASI 90), and 23.5% had clear skin (PASI 100) at Week 104. In addition, 94.8% of patients who initially received placebo (at the start of the extension), and were switched to receive Cosentyx 300 mg after relapse, were able to achieve PASI 75 and 70.3% achieved PASI 90 within 12 weeks of re-starting Cosentyx. (more…)
MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?
Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.
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