MedicalResearch.com Interview with:
Robert M Centor, MD, MACP
Chair ACP Board of Regents
Regional Dean, UAB Huntsville Regional Medical Campus
Huntsville, AL 35801
Professor, General Internal Medicine
UAB Birmingham, AL 35294-3407
Medical Research: What is the background for this study? What are the main findings?Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis. This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess). The organism also causes around 80% of the Lemierre Syndrome. We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis. The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis. (more…)
MedicalResearch.com Interview with:Caroline Watts| PhD Candidate
Cancer Epidemiology and Services Research | Sydney School of Public Health
The University of Sydney
MedicalResearch: What is the background for this study? What are the main findings?Response: A clinic for people at high risk of melanoma was established at the Royal Prince Alfred Hospital, Sydney in 2006 to look at the impact of surveillance regime which included regular full body skin examination supported by dermoscopy and total body photography at 6 monthly intervals. If a suspicious lesion was identified, the lesion was either removed or sequential digital dermoscopy was performed and the patient returned in 3 months for review. This study aimed to estimate the costs associated with surveillance in this type of specilaised clinic.
The mean number of clinic visits per year was 2.7 (95% CI, 2.5-2.8) for surveillance and 3.8 (95% CI, 3.4-4.1) for patients requiring surgical excisions. The mean annual cost per patient to the health system was A $882 (95% CI, A $783-$982) (US $599 [95% CI, US $532-$665]) and mean annual societal cost per patient (excluding health system costs) was A $972 (95% CI, A $899-$1045) (US $660 [95% CI, US $611-$710). Diagnosis of melanoma or non-melanoma skin cancer and frequent excisions for benign lesions in a relatively small number of patients was responsible for skewed health system costs.
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MedicalResearch.com Interview with:
Valerie Cluzet, MD
Hospital of the University of Pennsylvania
Division of Infectious Diseases
Philadelphia, PA 19104
MedicalResearch: What is the background for this study? What are the main findings?Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way.
There are a few major points that emerged from our study.
1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization.
2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents.
3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients.
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MedicalResearch.com Interview with:
Dr. Alexander Turchin M.D.,M.S.
Director of Informatics ResearchDivision of Endocrinology, Brigham and Women’s Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion.
Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause.
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MedicalResearch.com Interview with:
David S. Black, Ph.D., M.P.H.
Associate Professor of Preventive Medicine
Keck School of Medicine of USC.
Medical Research: What is the background for this study? What are the main findings?
Dr. Black: Sleep disturbances pose a significant medical and public health
concern for our nation’s aging population. An estimated 50% of people
aged 55 years and older suffer from some form of sleep problem,
including initiating and maintaining sleep. Sleep can be affected by a number of things. There are obvious factors like disturbances, dealing with insomnia or any form of aches and pains. But there is also one that many people have probably not considered. Traffic noise. Just like the factors listed previously, there is always a solution to a problem. There isn't anything that cannot be fixed. If you are someone that is having trouble sleeping due to the high level of traffic noises around your area, it may be best to look into a site like soundproofpanda.com to find a solution that can help reduce this issue and eventually provide you with a good's night sleep. Older adults report the highest prevalence of sleep problems compared to younger age groups when quantified by both self-report and biological assessment.
Moderate sleep complaints in older adults are often associated with
deficits in daytime functioning, including elevated levels of fatigue,
disturbed mood such as depressive symptoms and reduced quality of
life, and lead to the onset of clinical insomnia. Addressing moderate
sleep complaints and sleep-related daytime dysfunction using
community-accessible programs is a promising public health approach.
Our main findings indicate that the mindfulness training program,
which is available to the general community, resulted in improvement
in sleep quality at post-intervention relative to a highly active and
standardized sleep hygiene education program. Effect size for
improvement in sleep quality was large (0.89) and of clinical
relevance considering that effect sizes obtained from all types of
behavioral interventions on self-reported sleep quality outcomes
averages 0.76 in older adults. Meta-analyses comparing treatment
modalities indicate that the mean effect size for self-reported sleep
improvements resulting from pharmacotherapy (0.87) (i.e.,
benzodiazepines, benzodiazepine receptor agonists) and behavioral
therapy (0.96) are of medium-to-large magnitude in mixed-age adult
samples with primary insomnia. Thus, our observed changes are
consistent with previous studies and are at the level of a minimally
important difference for insomnia severity. The mindfulness program
also yielded relative improvements on sleep-related daytime
impairments of depression and fatigue symptoms that were of
medium-to-large effect size.
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MedicalResearch.com Interview with:
Xiao Xu, PhD Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Yale University School of Medicine and
Harlan M Krumholz MD, SM
Harold H. Hines, Jr. Professor of Medicine (Cardiology) and Professor of Faculty of Arts and Sciences, of Investigative Medicine and of Public Health (Health Policy); Co-Director, Clinical Scholars Program; Director, Yale-New Haven Hospital Center for Outcomes Research and Evaluation New Haven, CT 06510
Medical Research: What is the background for this study? What are the main findings?
Response: Prior research of heart attack has mostly examined older patients, while few studies have focused on younger patients. Although we know that younger women differ from men and older patients in heart attack etiology and mortality, there is limited data on non-mortality outcomes of younger women and factors influencing their recovery. Mental stress is a particularly relevant factor for younger women as prior research showed higher stress in women than in men and an inverse association between age and stress. Therefore, in this study, we compared women and men 18-55 years old with heart attack and examined gender difference in mental stress and its potential role in explaining the worse recovery in women.
We addressed these questions using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) project, which is the largest prospective observational study of young and middle-aged women and men with heart attack and has comprehensive information on patients’ clinical and psychosocial characteristics. Our findings showed significantly higher stress in women than in men. Moreover, mental stress is associated with worse recovery in multiple health outcomes 1 month after heart attack, such as angina-specific and overall quality of life. The greater stress in women may partially contribute to their worse recovery.
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MedicalResearch.com Interview with:Dr Syed M R GillaniDiabetes Centre, New Cross Hospital,
Wolverhampton, UKMedicalResearch: What is the background for this study? Dr. Gillani: NHS is facing the greatest challenge of its history in the form of A&E pressures and bed availabilities. Unplanned admissions are considered one of the key reasons. With an aging population, multiple co-morbidities and increasing pressures on social and primary care, we need to develop a proactive strategy to deal with this situation. It is a high priority agenda for the DOH. Initiatives such as “named GP for over 75” and “directly enhanced services to avoid unplanned admissions” have been rolled out by DOH in the last 2 years. In order to find an innovative way to assist in reduction of unplanned admissions, we decided to conduct an audit on all recurrent unplanned admissions with diabetes in the hospital over 12 months period. Its objective was to determine any unmet patient needs during an index admission to explore potential of changes in the service and to utilize available resources more effectively in an attempt to prevent next hospital admission for that patient.
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MedicalResearch.com Interview with:
Dr. May Nour MD PhD
Neurology Fellow
UCLAMedical Research: What is the background for this study? What are the main findings?
Dr. Nour: In October of 2014, results from the MR CLEAN trial were the first to demonstrate better functional outcomes in stroke patients as a result of endovascular therapy. Among patients whose stroke was caused by clot blocking a large vessel responsible for delivering blood to the vital tissue of the brain, the use of endovascular therapy, primarily utilizing second-generation clot retrieval devices, showed improved outcomes in most cases evaluated in combination with medical therapy, when compared to medical therapy alone. Currently, the standard of care involves delivery of intravenous tissue plasminogen activator (IV tPA) within a short time window (up to 3-4.5 hrs) with the intention of dissolving, rather than physically removing the clot as in the case of endovascular retrieval.
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MedicalResearch.com Interview with: Dr Jill Stocks PhD, Research Fellow
Centre for Occupational and Environmental Health,
Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care
Institute of Population Health, University of Manchester, UK.
Medical Research: What is the background for this study? What are the main findings?
Dr. Stocks: Reducing healthcare-associated infections has been a priority in the UK over recent decades; and this has been reflected in interventions and guidelines focussing on improving hygiene procedures. During 2004 to 2008 the Cleanyourhands campaign promoted hand hygiene in all NHS trusts. There was anecdotal evidence from dermatologists and occupational physicians that irritant contact dermatitis was on the increase in healthcare workers, and that it was caused by hand hygiene. We investigated whether or not there was an increase in the incidence of irritant contact dermatitis in healthcare workers due to hand hygiene or other types of hygiene coinciding with the interventions and guidelines promoting hygiene. We used reports made by dermatologists to the Occupational and Health reporting network, a voluntary surveillance scheme collecting reports of work-related ill-health. Trends in incidence of irritant contact dermatitis due to hygiene in healthcare workers were compared with trends in control groups (irritant contact dermatitis in workers with other jobs) using a quasi-experimental (interrupted time series) design. We found a 4.5 fold increase in irritant contact dermatitis due to hand hygiene and hygiene in general in healthcare workers between 1996 and 2012. The results also suggested a steepening of the increase in incidence during the rollout period of the Cleanyourhands campaign but the limitations of the data made this less clear cut.
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MedicalResearch.com Interview with:
Joshua D. Safer MD, FACP
Director, Endocrinology Fellowship Training and Endocrinology Education
Boston University Medical Center
Associate Professor of Medicine and Molecular Medicine
Boston University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Safer: This is a review of the current medical literature in favor of the biologic nature of gender identity. The main barrier to medical care for transgender patients is lack of physicians with the knowledge and willingness to provide that care. A major concern of physicians is that this is a mental health issue, meaning that transgender hormone therapy and surgery may be too drastic a response to an individual who should be counseled instead. The review lays out the evidence to make it clear that a major component of gender identity is biologic even if we don’t have the exact details worked out. Therefore, counseling alone cannot address the disconnect between transgender individuals’ gender identity and their physical bodies.
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MedicalResearch.com Interview with:
Dr. Jeremy Van Raamsdon PhD
Laboratory of Aging and Neurodk egenerative Disease (LAND),
Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan, Deptment of Translational Science and Molecular Medicine, Department of Genetics, Michigan State University, East Lansing, Michigan,Dep. of Biology, McGill University, Montreal, Quebec, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Van Raamsdonk : The free radical theory of aging is one of the most widely accepted theories of aging. This theory suggests that reactive oxygen species (ROS), which are also known as free radicals, cause a type of damage, called oxidative damage, that accumulates over time to cause the functional decline associated with aging. ROS have also been proposed to play a role in many diseases including neurodegenerative disorders such as Parkinson’s disease and Huntington’s disease.
However, recent work has demonstrated that ROS are not necessarily detrimental. ROS perform functional roles in the body and thus it is possible to have too little ROS. We previously showed that increasing ROS by decreasing the levels of an antioxidant enzyme called superoxide dismutase (SOD) does not decrease lifespan even when all of the SOD genes are removed. We also showed that in some cases treatment with an antioxidant, such as Vitamin C, can lead to decreased lifespan. This finding is consistent with human clinical trials in which it has not been possible to show a beneficial effect of antioxidants on longevity.
In this paper we further examine the relationship between ROS and aging. We use a simple genetic model organism, the worm Caenorhabditis elegans, which has been used extensively in aging research, to determine how location impacts the effect of ROS on lifespan. We used a genetic approach to increase the levels of ROS in different parts of a cell and found that location is crucial in determining the effect of ROS on lifespan. Mildly increasing the levels of ROS in the mitochondria increases lifespan, while increasing ROS in the cytoplasm has the opposite effect of decreasing lifespan.
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MedicalResearch.com Interview with:
Ying Wang, PhD, MPH
Data Management, Analysis & Research
Office of Primary Care and Health System Management
New York State Department of Health
Empire State Plaza Albany, NY 12237
Medical Research: What is the background for this study? What are the main findings?
Dr. Wang: The purpose of the study was to examine the survival of children with one or more of 21 major birth defects in the United States. We used data from 12 population-based birth defects surveillance programs that participate in the National Birth Defects Prevention Network. The study included nearly 100,000 infants born with birth defects between 1997 and 2007.
We found that children who were born with hypoplastic left heart syndrome (a severe congenital heart defect) had the lowest chance of survival across multiple ages (up to 28 days of life, 1 year, 2 years, and 8 years of life), compared to children with any other birth defects studied. We also found that the chances of survival up to 1 year of life was greater than 90% for babies born with spina bifida, cleft palate, cleft lip with or without cleft palate, pyloric stenosis, gastroschisis, or Down syndrome. For most birth defects, survival was poorer among non-Hispanic black mothers and Hispanic mothers compared to non-Hispanic white mothers.
(more…)
MedicalResearch.com Interview with:
Sheena M. Patel, MPH, ORISE, Fellow
Division for Heart Disease and Stroke Prevention
CDC
MedicalResearch: What is the background for this...
MedicalResearch.com Interview with:
Michael D Hill, MD MSc FRCPC
Calgary Stroke Program
Professor, Dept Clinical Neurosciences
Hotchkiss Brain Institute
University of Calgary, Cumming School of Medicine
Calgary, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Hill: ESCAPE examine endovascular therapy for major acute ischemic stroke.
The study found that among acute stroke patients with proximal occlusions (blocked ICA or MCA), good collaterals and fast endovascular treatment, there was a substantial reduction in morbidity (24% absolute reduction) and in mortality (a 9% absolute and 50% relative reduction in death).
Medical Research: What should clinicians and patients take away from your report?Dr. Hill: The finding are a major and compelling validation of endovascular treatment of major ischemic stroke. In combination with results from other studies - MRCLEAN, SWIFT-prime, EXTEND-IA, we believe that the standard of care for major acute ischemic stroke has been definitively changed.
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MedicalResearch.com Interview with: Kristen Hess ORISE Fellow
Division of HIV/AIDS Prevention,
National Center for HIV, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention Atlanta, GA
MedicalResearch:What is the background for this study? Response: Men who have sex with men (MSM) of all races continue to be the risk group most severely affected by HIV in the United States. CDC’s most recent HIV incidence data show that the number of new infections among MSM increased 12 percent between 2008 and 2010, with an even steeper increase among the youngest MSM. These data clearly show the urgent need to better understand the factors that affect their risk and to develop effective prevention interventions.
One specific factor is excessive alcohol use, which is responsible for 88,000 deaths in this nation each year, and cost the U.S. about $224 billion in 2006. Binge drinking (consuming ≥5 drinks for men on an occasion; ≥4 drinks for women) is the most common form of excessive alcohol consumption. The association between excessive alcohol consumption, including binge drinking, and risky sexual behaviors among MSM has had mixed results in the literature with some studies finding an association and others not. One limitation of previous work is that the definition of excessive alcohol consumption varies between studies, so results are not easily compared between studies and populations.
Our study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status.
MedicalResearch:What are the main findings? Response: We assessed the prevalence of binge drinking, using a standard definition, among a sample of MSM recruited from 20 cities across the U.S. We also examined the association between binge drinking and several risky sexual behaviors.
The findings show that 6 in 10 MSM reported binge drinking. Those who binge drank, in comparison to non-binge drinkers, were more likely to engage in risky sexual behaviors such as sex with an HIV-positive or unknown status partner and exchange sex for money or drugs at last sex, as well as more likely to have concurrent partners and more condomless sex partners in the past year.
We also found that the likelihood of risky sexual behaviors went up with increased frequency of binge drinking. In fact, MSM who reported 10 or more binge-drinking episodes in the past month were more likely to report risky behaviors. This is a critical point, especially given that, among those who binged, 22 percent reported 10 or more binge drinking episodes in the past month. (more…)
MedicalResearch.com Interview with: Dr. rer. nat. Detlef Bartkowiak
Klinik für Strahlentherapie und Radioonkologie
Universitätsklinikum Ulm Albert-Einstein-Allee
MedicalResearch: What is the background for this study? What are the main findings?Dr. Bartkowiak: After surgery of prostate cancer, the lab marker for prostate specific antigen PSA should fall below detection limits. If the PSA does not decline, this can be a due to residual normal prostate tissue but also due to tumor cells remaining in the patient. If it is tumor cells residing in or near the area of the resected prostate, then this can be treated locally with radiotherapy. If the tumor has already produced metastases at remote sites of the body, irradiating the prostate region is pointless. In our clinical trial into post-operative therapy options, patients who did not achieve an undetectable PSA after radical prostatectomy received additional radiotherapy with 66 Gy. Despite this immediate treatment, the risk of recurrence within 10 years was 37%. Therefore, a more aggressive early treatment should be considered in such patients.
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MedicalResearch.com Interview with: Kyoon Lyoo, M.D., Ph.D
Ewha W. University
Seoul, South Korea
MedicalResearch: What is the background for this study? What are the main findings?Dr. Lyoo: Recent studies increasingly suggested that the developing brain shows unique characteristics of neuroplasticity to environmental stimuli. Still, it remains unclear whether the adolescent brain would undergo adaptive or dysfunctional changes when exposed to highly neurotoxic substances including methamphetamine. However, despite an increasing prevalence of methamphetamine use in this population, human studies have not yet found clear answers to these questions regarding the effects of methamphetamine exposure on the adolescent brain.
This study reports novel in vivo findings in adolescent methamphetamine users, and thus provides a new perspective regarding adolescent-specific brain correlates of methamphetamine-induced neurotoxicity. Using cortical thickness and diffusion tensor image analyses, we found greater and more widespread gray and white matter alterations, particularly affecting the frontostriatal system, in adolescent methamphetamine users compared with adult users. Our findings highlight that the adolescent brain, which undergoes active myelination and maturation, is much more vulnerable to methamphetamine-induced neurotoxicity than the adult brain. This may help explain why adolescent-onset methamphetamine users show more severe and chronic clinical course than adult-onset users.(more…)
MedicalResearch.com Interview with:
Professor Khalid Khan
Women's Health Research Unit
Multi-disciplinary Evidence Synthesis Hub
The Blizard Institute
Medical Research: What is the background for this study? What are the main findings?
Prof. Khan: My co-author talked me into helping him with his online dating and so we embarked on this project. We were fascinated to see if there was any scientific evidence which could help people in their online pursuit of love - and to our surprise there was lots of attraction and persuasion research. There were 86 published studies on attraction and persuasion which met our criteria, and these covered literature in psychology, sociology, and computer behavioural and neurocognitive sciences. Their design features included randomisation in 28 studies, cohort follow-up in 13 studies, cross-sectional evaluation in 37 studies, qualitative analysis in 5 studies and systematic review in 3 studies. We found that Success in converting initial online contact to a first date is not a complex formula. It relates to simple factors such as a fluent headline, truthfulness of profile, and reciprocity in communication. Just like when you meet someone in real life, simple actions such as showing interest in the other person (commenting on something in their profile rather than just talking about yourself) goes a long way. (more…)
MedicalResearch.com Interview with:
Robert M. Kaplan
Office of Behavioral and Social Sciences Research
National Institutes of Health
Bethesda, MD 20892
Medical Research: What is the background for this study? What are the main findings?Response: Years of formal education is one of the strongest correlates of life expectancy. The purpose of this study was to examine the relationship between educational attainment and life expectancy with adjustments for other social, behavioral, and biological factors. Using data from a large cohort of nearly 30,000 adults, we found that education was a very strong predictor of survival and that biological and behavioral factors only partially explained the relationship.
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MedicalResearch.com Interview with:
Prof. Jozef Gecz
NH&MRC Senior Principal Research Fellow
Professor of Human Genetics
School of Paediatrics and Reproductive Health
Faculty of Health Sciences The University of Adelaide at the Women's and Children's Hospital North Adelaide, SA Medical Research: What is the background for this study? What are the main findings?
Prof. Gecz: Cerebral palsy is the most frequent movement disorder of children for many years considered to be due to brain injury. Given that cerebral palsy incidence has not changed dramatically over many years while medical care is constantly improving, we look for other causes and specifically genetic mutation. By investigating 183 children with cerebral palsy and for many also one or both of their parents we find that for at least 14% of these we can find plausible explanation in genetic mutation being involved in the causation of their cerebral palsy. Importantly, we find that 10% of these mutations are de novo, which means that these mutations are not present in the parents (specifically in their blood as that is the tissue source we tested). 4% of mutations were inherited from unaffected mothers to affected sons. Previous estimates suggested 2% genetic contribution to Cerebral palsy. We now know that it is at least 14% and likely more. If you are looking for compensation for this condition, contact an Indiana cerebral palsy lawyer.
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MedicalResearch.com Interview with:
John Romley Ph.D
Economist at the Leonard D. Schaeffer Center for Health Policy and Economics
Research Assistant Professor Sol Price School of Public Policy
University of Southern California, Los Angeles.
MedicalResearch: What is the background for this study? What are the main findings?Dr. Romley: The need for better value in US health care is widely recognized. Existing evidence suggests that improvement in the productivity of American hospitals—that is, the output that hospitals produce from inputs such as labor and capital—has lagged behind that of other industries. However, previous studies have not adequately addressed quality of care or severity of patient illness. Our study, by contrast, adjusts for trends in the severity of patients’ conditions and health outcomes. We studied productivity growth among US hospitals in treating Medicare patients with heart attack, heart failure, and pneumonia during 2002–11. We found that the rates of annual productivity growth were 0.78 percent for heart attack, 0.62 percent for heart failure, and 1.90 percent for pneumonia. (more…)
MedicalResearch.com Interview with:
Ezekiel Jonathan Emanuel MD PhD
Department of Medical Ethics and Health Policy
Perelman School of Medicine and
Department of Health Care Management
The Wharton School University of Pennsylvania
Philadelphia, PA
Editor’s note: Dr. Emanuel is a medical oncologist as well as director of the department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel was kind enough to answer several questions regarding his most recent study, published in the new JAMA Oncology journal, Patient Demands and Requests for Cancer Tests and Treatments.
Medical Research: What is the background for this study? What are the main findings?Dr. Emanuel: The genesis for this study is twofold.
One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers...all were more to blame than doctors themselves for the high cost of US health care.
Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience.
In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters).
We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means.
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MedicalResearch.com Interview with:
Paul F. Pinsky, PhDMPH
Acting Chief Early Detection Research Group
National Cancer Institute
Bethesda, MD, 20892
Medical Research: What is the background for this study? What are the main findings?
Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial .
The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens.
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MedicalResearch.com Interview with:
Carol Mathews
Professor, PsychiatryUCSF School of Medicine
Medical Research: What is the background for this study? What are the main findings?Dr. Mathews: The background for this study is that, as a part of ongoing genetic studies of Tourette Syndrome, the Tourette Syndrome Association International Genetics Collaborative (TSAICG) has collected a wealth of information about commonly co-occurring psychiatric disorders in individuals with Tourette Syndrome and their families, providing us with an opportunity to explore questions about Tourette Syndrome that are relevant to individuals with Tourette Syndrome, their families, and their treating clinicians.
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MedicalResearch.com Interview with:
Dr. Therese Tillin
Research Fellow, Cardiometabolic Phenotyping Group
Institute of Cardiovascular Science
Faculty of Pop Health Sciences
Medical Research: What is the background for this study? What are the main findings?
Dr. Tillin: The global burden of type 2 diabetes is rising rapidly and people of South Asian origins (from the Indian subcontinent) remain at much higher risk of developing diabetes than people of European origin. Why is this? Although it is thought that increased levels of obesity around the waist level, diet, physical activity levels and genetic factors contribute, no study to date has been able to tease out fully the underlying causes for the added risk in South Asian people. However, it is likely that complex metabolic disturbances may play an important role.
We have been studying a British cohort of people of European and South Asian origin for nearly 20 years and have used nuclear magnetic resonance spectroscopy to build a profile of amino acids in blood samples that were collected at the start of the study between 1988 and 1991. We found that higher levels of some amino acids, in particular tyrosine, were already present in non-diabetic South Asian individuals back then. Some of these amino acids, again especially tyrosine, more strongly predicted later development of type 2 diabetes in the South Asian people than in the Europeans in our study, even after adjustment for other risk factors such as obesity and insulin resistance. A given increase (one standard deviation) in tyrosine increased risk of developing diabetes by just 10% in Europeans, while in South Asians the increase in risk was 47%.
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MedicalResearch.com Interview with:
Kenneth L. Kehl, MD
Division of Cancer Medicine, MD Anderson Cancer Center
Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions. We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication. We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication. This effect was independent of patients' stated preferences regarding involvement in decision-making.
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MedicalResearch.com Interview with:
Elizabeth Walker, PhD, MPH, MAT
FIRST Postdoctoral Fellow
Center for Behavioral Health Policy Studies
Rollins School of Public Health, Emory University
Medical Research: What is the background for this study?
Response: Mental disorders are a major cause of disability globally and are associated with premature mortality. Quantifying and understanding excess mortality among people with mental disorders can inform approaches for reducing this burden. The purpose of this study was to systematically review the literature in order to estimate individual- and population-level mortality rates associated with mental disorders. We conducted a comprehensive systematic review and meta-analysis, which included 203 studies from 29 countries.
Medical Research: What are the main findings?
Response: We estimated that 8 million deaths worldwide per year are attributable to mental disorders. People with mental disorders have over 2 times the risk of mortality compared to the general population or people without mental disorders. This translates to a median of 10 years of life lost. In total, 67.3% of people with mental disorders died from natural causes, 17.5% from unnatural causes, and the remainder from unknown causes.
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MedicalResearch.com Interview with:Dr Bruce Campbell MBBS(Hons), BMedSc, PhD, FRACP
Consultant Neurologist, Head of Hyperacute Stroke
Department of Neurology Royal Melbourne Hospital
NHMRC Early Career Research Fellow
Melbourne Brain Centre @ RMH Department of Medicine
University of Melbourne Australia
MedicalResearch: What is the background for this study? What are the main findings?Dr. Campbell: EXTEND-IA was a randomised trial comparing standard thrombolysis with tPA plus endovascular stent-thrombectomy versus tPA alone in ischemic stroke patients selected for the presence of major vessel occlusion and salvageable brain tissue using CT perfusion imaging. It was designed in 2011 at a time when there was uncertainty about the effectiveness of endovascular therapy which deepened in 2013 with the publication of 3 neutral trials. The recent publication of the Dutch MR-CLEAN study showing improved outcomes with stent-thrombectomy was a major advance and prompted a data safety and monitoring committee review of the EXTEND-IA data leading to early termination of the trial for efficacy.
The key findings from EXTEND-IA were that the addition of stent-thrombectomy to tPA led to a dramatic increase in restoration of blood flow to the brain from 34% to 89%. This translated to markedly improved outcomes at 3 months with 71% of stent-thrombectomy patients compared with 40% of tPA-only patients regaining independence. The 3 trials released today were remarkably consistent in their outcomes and this provides a solid evidence base to recommend stent-thrombectomy as the new standard of care for patients with large vessel ischemic stroke.
Patients who were treated with stent-thrombectomy in EXTEND-IA had more than double the rate of reperfusion (restoration of blood flow to the brain) compared to the standard tPA patients and this translated to a 31% absolute increase in the proportion of patients living independently at 3 months.
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MedicalResearch.com Interview with:
Dr. Cornejo-Juárez
Department of Infectious Disease,
Instituto Nacional de Cancerología
Tlalpan Mexico
MedicalResearch: What is the background for this study?
Dr. Cornejo: Critically ill patients in the intensive care unit are at major risk of hospital-acquired infections. Immunosuppressed patients have a higher risk related with continuous exposure to the hospital setting, mucositis and disruption of skin integrity, presence of indwelling catheters and abnormal immune system because of primary malignancy or chemotherapy. Our aimed was to investigate prevalence and outcome of hospital-acquired infections in an oncology ICU.
MedicalResearch: What are the main findings?
Dr. Cornejo: We found that hospital-acquired infections are a major problem in the ICU. Hospital-acquired infections are related with higher mortality. Multidrug resistant bacteria are frequently involved in these infections, and are associated with increased mortality.
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MedicalResearch.com Interview with:
Markus Juonala, MD, PhD
University of Turku Finland
Medical Research: What is the background for this study? What are the main findings?
Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness.
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MedicalResearch.com Interview with:
Robert M Centor, MD, MACP
Chair ACP Board of Regents
Regional Dean, UAB Huntsville Regional Medical Campus
Huntsville, AL 35801
Professor, General Internal Medicine
UAB Birmingham, AL 35294-3407
Medical Research: What is the background for this study? What are the main findings?
Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis. This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess). The organism also causes around 80% of the Lemierre Syndrome. We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis. The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis. (more…)
