MedicalResearch.com Interview with:Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard School of Public Health / Brigham & Women's Hospital
Boston, MA 02115
MedicalResearch.com: What are the main findings of the study?Dr. Sommers: We find that over the first four years since Massachusetts' 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period. We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health. Overall, we estimate that the health reform law prevented over 320 deaths per year in the state - or one life saved per 830 adults gaining health insurance. Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease. We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities.
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MedicalResearch.com Interview with:
Niklas Mattsson MD, PhD
University of California San Francisco
Center for Imaging of Neurodegenerative Diseases
VA Medical Center
San Francisco, CA 94121,...
MedicalResearch.com Interview with:Amit Singal MD MS
Assistant Professor of Medicine
Medical Director, Liver Tumor Program
Dedman Scholar of Clinical Care
Division of Digestive and Liver Diseases
University of Texas Southwestern
Dallas TX 75201 - 8887
MedicalResearch: What are the main findings of the study?Dr. Singal: We conducted a meta-analysis of current studies to characterize the association between hepatocellular carcinoma surveillance and early detection, curative treatment rates, and overall survival in patients with cirrhosis. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had hepatocellular carcinoma detected by surveillance. Hepatocellular carcinoma surveillance was associated with improved early stage detection (OR 2.08, 95% CI 1.80–2.37) and curative treatment rates (OR 2.24, 95% CI 1.99–2.52). These associations were robust to several sensitivity analyses, including study design, study location, and study period. Hepatocellular carcinoma surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67–2.17), which remained significant in the subset of studies adjusting for lead-time bias. Three-year survival rates were 50.8% among patients who underwent surveillance, compared to only 28.2% among hepatocellular carcinoma patients with tumors detected outside of a surveillance program.
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MedicalResearch.com Interview with:Kejal Kantarci, M.D. M.S.
Professor of Radiology
Division of Neuroradiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch: What are the main findings of the study?Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.
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MedicalResearch.com Interview with: Dana Dabelea, MD, PhD
Professor and Associate Dean, Faculty Affairs
Colorado School of Public Health
University of Colorado Denver
Aurora, CO 80045
MedicalResearch.com: What are the main findings of the study?Dr. Dabelea: We found that the proportion of US youth living with Type 1 Diabetes has increased by at least 21% over a period of only 8 years. This increase was seen in both boys and girls, most age-groups and race/ethnic groups. While we do not completely understand the reasons for this increase, since the causes of Type 1 Diabetes are still unclear, it is likely that something has changed in our environment- both in the US and elsewhere in the world- causing more youth to develop the disease, maybe at increasingly younger ages.
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MedicalResearch.com Interview with:Jessica A. Grieger (BSc(hons), R Nutr, PhD)
Post-doctoral research fellow
Robinson Research Institute, University of Adelaide
MedicalResearch: What are the main findings of the study?
Dr. Grieger: The study aimed to identify associations between maternal dietary patterns in the 12 months before conception on fetal growth and preterm delivery. We report that a one standard deviation increase in the scores on the high-protein/fruit pattern was associated with decreased likelihood for preterm birth, whereas a one standard deviation increase on the high-fat/sugar/takeaway pattern was associated with increased likelihood for preterm birth as well as shorter gestation and birth length.
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MedicalResearch.com Interview with: Dr Andrea Schuessler
QIMR Berghofer Medical Research Institute
Herston, Queensland 4006
MedicalResearch.com: What are the main findings of the study?Dr . Schuessler: Recurrent glioblastoma is a very aggressive brain cancer and most patients do not survive much longer than 6 months. Our study has assessed a novel immunotherapy and treated 10 patients with late stage cancer. The treatment did not have any serious side effects and most of the patients have survived much longer than the expected 6 months. Importantly, four of the 10 patients have not shown signs of disease progression during the study period with one of them still being cancer free four years after the treatment.
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MedicalResearch.com Interview with:Stefan Zeuzem, M.D.
Professor of Medicine, Chief Department of Medicine
JW Goethe University Hospital
Frankfurt Germany
MedicalResearch.com: What are the main findings of the study?Dr. Zeuzem: Main finding is that also patients infected with HCV 3 can be cured with an IFN-free regimen. However, duration of therapy must be prolonged to 24 weeks.
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MedicalResearch.com Interview with:Dr. Frank B. Hu MD MPH PhD
Professor of Nutrition and Epidemiology
From the Departments of Nutrition and Epidemiology
Harvard School of Public Health, Boston, MA
MedicalResearch.com: What are the main findings of the study?Dr. Hu: We found that people who increased the amount of coffee they drank each day by more than one cup over a four-year period had a 11% lower risk for type 2 diabetes than those who made no changes to their coffee consumption, but those who decreased their coffee consumption by more than a cup per day increased their type 2 diabetes risk by 17%.
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MedicalResearch.com Interview with: Professor Gary Frost PhD RD
Head of the Nutrition and Dietetic Research Group
NIHR Senior Investigator
Division of Diabetes, Endocrinology and Metabolism
Faculty of Medicine Imperial College Hammersmith Campus
London W12 ONN
MedicalResearch.com: What are the main findings of the study? Prof. Frost: That acetate that is derived from the fermentation of dietary fiber in the colon by the microbiota is taken up by the hypothalamus in the brain. In the hypothalamus the way the cells metabolize acetate creates a signal that suppresses appetite
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MedicalResearch.com Interview with: Dr. Richard Body
Emergency Department
Manchester Royal Infirmary
Manchester UK
MedicalResearch.com: What are the main findings of the study?Dr. Body: This paper actually reports the findings of two consecutive, separate studies. We aimed to derive and then externally validate a clinical decision rule to risk stratify patients with suspected acute coronary syndromes in the Emergency Department (ED). This rule could then be used to reduce unnecessary hospital admissions while also making judicious use of specialist high dependency resources.
In the first study we derived a clinical decision rule that incorporates 8 variables: high sensitivity troponin T, heart-type fatty acid binding protein; ECG ischaemia; worsening angina; hypotension (systolic blood pressure <100mmHg on arrival); sweating observed in the ED; pain associated with vomiting; and pain radiating to the right arm or shoulder. When we validated the rule at a different centre, we found that its use could have avoided hospital admission for over a quarter of patients while effectively risk stratifying others. Of the 10% of patients who were identified as 'high risk', approximately 95% had a major adverse cardiac event within 30 days. The findings suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule could be used to 'rule in' and 'rule out' acute coronary syndromes immediately, using information gathered at the time of initial presentation to the ED. Before clinical implementation, we recommend that effect of using the MACS rule in practice should first be evaluated in a trial setting. This will enable us to determine:
(a) whether physicians and patients are likely to comply with (and be satisfied with) the MACS rule;
(b) the safety of the MACS rule when used in practice; and
(c) whether use of the MACS rule leads to cost savings for the health service.
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MedicalResearch.com Interview with:Arturo Araujo, PhD IMO
Moffitt Cancer Center
Tampa, FL 33612
MedicalResearch: What are the main findings of the study?Dr. Araujo: Using in vivo approaches it is often challenging to study the multiple simultaneous interactions occurring at various time points in the setting of bone metastasis. However, integrating biological data with a powerful computational model allowed us to build a tool that could not only mimic the in vivo growth of cancer in bone but also to determine how the disease was behaving at any given time point. The key finding for us was that the computational model demonstrated the phasic or cyclical nature of how the prostate cancers grow in bone. For example, a wave of osteoclast mediated bone resorption would be followed by sustained bone formation by osteoblasts, followed again by bone reposition. We think these findings could provide novel insights into when the best time to apply therapies might be in order to obtain maximum efficiency.
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MedicalResearch.com Interview with: Marianna VirtanenPhD
Finnish Institute of Occupational Health
Helsinki, Finland
MedicalResearch: What are the main findings of the study?Dr. Virtanen: We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. We used a clinical type 2 diabetes risk score to assess future diabetes risk and in addition, participants’ prediabetes status. We found that psychological distress did not predict future type 2 diabetes among participants who were normoglycemic and among those with prediabetes combined with a low diabetes risk score. However, psychological distress doubled the risk of type 2 diabetes among participants with prediabetes and a high diabetes risk score.
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MedicalResearch.com Interview with:Rajeev Desai
SpR Gastroenterology, City Hospital Birmingham
Honorary Clinical Research Fellow
University Hospital Birmingham / NHS Blood and Transplant, Bristol
MedicalResearch: What are the main findings of the study?Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non-transplantation.
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MedicalResearch.com Interview with:Michael H. Hall, MD
North Shore-LIJ Health System
MedicalResearch: What are the key points of your research?
Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary.
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MedicalResearch.com Interview with: Tina Hieken, M.D.
Associate Professor of Surgery
Mayo Clinic,Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation.
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MedicalResearch.com Interview with: Elizabeth Devore, ScD
Associate Epidemiologist
Brigham and Women’s Hospital
Instructor in Medicine, Harvard Medical School
MedicalResearch.com: What are the main findings of the study?Dr. Devore: In this study, we examined sleep duration and memory performance in a group of ~15,000 women participating in the Nurses’ Health Study. We found that women with sleep durations of 5 or fewer hours/day or 9 or more hours/day, either in midlife or later life, had worse memory at older ages than those sleeping 7 hours/day. In addition, women with sleep durations that changed by two or more hours/day from midlife to later life performed worse on memory tests compared to those whose sleep duration did not change during that time period.The magnitude of these memory differences was approximately equivalent to being 1-2 years older in age.
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MedicalResearch.com Interview with: Shanshan Li, Doctoral candidate
Department of Epidemiology
Harvard School of Public Health, 655 Huntington Avenue
Boston, MA 02115, USA
MedicalResearch.com: What are the main findings of the study?Answer: This is the first study to show that greater intake of dietary fiber,
especially cereal fiber, was inversely associated with all-cause
mortality. Participants increased their average dietary fiber intake
after myocardial infarction (MI), and the greater the increase, the lower was the risk of
subsequent all-cause and cardiovascular mortality. Overall, the
benefits for increased fiber intake were strongest for fiber from
cereal and grain sources.
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MedicalResearch.com Interview with: Yoshikazu Goto, MD, PhD
Kanazawa University Hospital, Section of Emergency Medicine
Takaramachi 13-1, Kanazawa 920-8640, Japan
MedicalResearch.com: What are the main findings of the study?Dr. Goto: The main findings were as follows. Dispatcher-assisted bystander
cardiopulmonary resuscitation for children with out-of-hospital cardiac
arrest, increased bystander CPR provision rate, and was associated with
improved favorable neurological outcomes compared to no bystander CPR.
Conventional bystander CPR (chest compression plus rescue breathing) was
associated with greater likelihood of neurologically intact survival,
compared to chest-compression-only CPR irrespective of cardiac arrest
etiology.
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MedicalResearch.com Interview with: Hui Wang, M.D., Ph.D., Professor
Principal Investigator
Director, Food Safety Research Center
Institute for Nutritional Sciences, SIBS, CAS
MedicalResearch.com: What are the main findings of the study? Dr. Wang: This meta-analysis has systematically reviewed 25 relevant studies composed of 17,332 cancer cases to give a comprehensive perspective on the relationship between vitamin D and cancer patient outcomes. Our result demonstrated that vitamin D levels are linked to better outcomes in several types of cancer patients. The strongest link was found in breast cancer, lymphoma and colorectal cancer. There was less evidence of a connection in people with lung cancer, gastric cancer, prostate cancer, leukemia, melanoma or Merkel cell carcinoma, but the available data were positive. We also found that a 10 nmol/L increase in vitamin D levels was tied to a 4 percent increase in survival among people with cancer.
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MedicalResearch.com Interview with:Lara McKenzie, Ph.D. MA
Associate Professor of Pediatrics
Center for Injury Research and Policy
The Research Institute at Nationwide Children's Hospital
Columbus, Ohio
MedicalResearch.com: What are the main findings of the study?Dr. McKenzie: Our study was the first to compare and describe epidemiological patterns of basketball-related injuries presenting for treatment to emergency departments and to the high school athletic training setting using surveillance data captured from large, nationally representative samples. Specifically, we compared estimated national incidence, rates of injury and body sites injured, and diagnoses. Nationally, an estimated 1,514,957 athletes with basketball-related injuries reported to the emergency department and 1,064,551 presented to the athletic training setting. Patterns of basketball-related injuries presenting to the emergency department differ from those presenting to the high school athletic training setting for treatment, with those presenting to the emergency department being more severe. In general, injuries that could be relatively quickly assessed and more easily diagnosed and treated, such as strains and/or sprains, presented more commonly to the athletic training setting, while injuries that required more extensive diagnostic or treatment procedures, such as fractures, were treated more commonly in the emergency department.
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MedicalResearch.com Interview with:Professor Stuart Allan
Faculty of Life Sciences, AV Hill Building
The University of Manchester
Manchester, M13 9PT
MedicalResearch.com: What are the main findings of the study?Dr. Allan: Using an experimental model of stroke it was found that animals with preceding Streptococcus pneumoniae infection had a worse outcome than uninfected animals. This confirms and extends previous data, both clinical and preclinical, that systemic inflammation is a key contributor to stroke outcome. Importantly, effects of infection were also demonstrated in animals with co-morbidities associated with stroke (atherosclerosis and age), with outcomes worse than observed in healthy young subjects. Exacerbating effects of infection on stroke are mediated via the pro-inflammatory cytokine, interleukin-1 (IL-1), shown by reversal of the increased ischaemic brain damage and functional impairments by treatment with the IL-1 receptor antagonist (IL-1Ra). Infection also leads to increased platelet activation and microvascular coagulation after stroke, which contributes to the increased injury. Collectively, these data are the first to show, how systemic inflammatory mechanisms induced by one of the most common non-invasive, human S.pneumoniae isolates, lead to critical illness after stroke in different rodent species and strains, and how common stroke comorbidities interact with infection to worsen outcome after stroke. (more…)
MedicalResearch.com Interview with: Prof. Paul E O'Brien
Centre for Obesity Research and Education
Monash University
Melbourne, Australia
MedicalResearch.com: What are the main findings of the study?Prof. O'Brien: Using a randomised trial format we compared the diabetes status at two years after a program of multidisciplinary diabetes care (MDC) alone or with the addition of a Lap-Band procedure in 50 people who were overweight (BMI 25-30) and with diabetes. 52% of the Lap-Band group had remission of their diabetes as measured by glucose tolerance testing compared to 8% in the multidisciplinary diabetes care group. The Lap-Band procedures were performed as outpatients with a 2-3 hr length of stay. There were no perioperative adverse events. The surgical group had lost a mean of 11.5kg in weight. The incremental cost effectiveness ratio (ICER) for remission of diabetes was AUD $20,700.
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MedicalResearch.com Interview with:Mr. David Bowrey, MD FRCS (Gen Surg) MMedEd FHEA
Consultant General / Oesophagogastric Surgeon & Honorary Senior Lecturer, Dept Cancer Studies,
Training Programme Director for Core Surgery, East Midlands South
University Hospitals of Leicester NHS Trust,
Leicester Royal Infirmary
MedicalResearch.com: What are the main findings of this study?Dr. Bowrey: Of 103 patients who had undergone Roux en Y gastric bypass surgery, changes in appetite, taste and smell were noted in 97%, 73% and 42% respectively. Seventy-three percent of patients developed aversions to certain types of foods, most frequently meat, starch and dairy produce. The change in taste sensation for the three common modalities of "sweet", "salt" and "sour" was decreased in some patients and increased in other patients. Patients who experienced food aversions typically experienced more weight loss than patients not developing aversions.
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MedicalResearch.com Interview with: Dr Kate Bramham
Division of Women's Health
King's College London
Women's Health Academic Centre KHP
London, SE1 7ER
MedicalResearch.com: What are the main findings of the study?Dr. Bramham:This meta-analysis of nearly 800,000 pregnancies from 55 studies has shown that women with chronic hypertension have a significantly increased incidence of pregnancy complications including superimposed pre-eclampsia, preterm delivery, low birth weight infants, perinatal loss and neonatal unit admission.
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MedicalResearch.com Interview with:Mr. Thamara Perera FRCS
Consultant Surgeon - Multi Organ Retrieval and Liver Transplant
Liver Transplant - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre,
Birmingham, UK
MedicalResearch.com: What are the main findings of the study?Answer: In this study we compared the basic energy metabolism of liver grafts obtained from conventional and widely practiced form of organ donation, the donation after brain death (DBD) donors, and recently revived form of organ donation called donation after circulatory death (DCD) donors. To introduce a background to this study - DCD liver grafts are perceived as marginal liver grafts, owing to the basic differences surrounding the organ donation. DCD organs suffer a period of warm ischemia from the time of treatment withdrawal in a potential donor up until the organs are actually recovered and preservation is initiated. Although the DCD liver grafts have supplemented the donor organ pool, the initial and short-term results following liver transplantation are comparatively poor and these differences are attributable to the donor warm ischemia. However there were no studies in the literature examining the energy status of DCD liver grafts and our study is the first such study.
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MedicalResearch.com Interview with:Dr. Yvonne Bombard, PhD
Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital
Assistant Professor, Institute of Health Policy, Management and Evaluation,
Faculty of Medicine, University of Toronto
MedicalResearch.com: What are the main findings of the study?Dr. Bombard: The main finding of the study is that gene expression profiling tests play a critical role when women with early-stage breast cancer decide whether to have chemotherapy, but many of them do not fully understand what some of the test results mean. For many the gene expression profiling test was the main factor in their treatment decision.
The women we interviewed understood the test would indicate whether chemotherapy would be beneficial to them. But many thought the test reflected their unique circumstances and did not understand that their test result was based on larger population statistics. Patients often viewed their gene expression profiling results as providing information that was more scientifically valid, uniquely personalized and emotionally significant than any other information they had received. For many, the test was a transformational element that empowered them, allowed them to feel confident in their decisions and may even have rescued them from unnecessary chemotherapy.
Patients described emotionally and socially complex reasons why they valued gene expression profiling testing in making their treatment decisions. Patients valued the test because it provided them with certainty amidst confusion, with options and a sense of empowerment, and with personalized, authoritative information.
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MedicalResearch.com Interview with:Takehiro Sugiyama, MD, MSHS, PhD
Project Director, Diabetes Policy Planning Office
Management and Planning Bureau
Fellow, Department of Diabetes, Endocrinology and Metabolism
National Center for Global Health and Medicine
Shinjuku-ku, Tokyo Japan
MedicalResearch.com: What are the main findings of the study?Dr. Sugiyama:In the US nationally representative sample from the National Health and Nutrition Examination Survey 1999-2010, we found that statin users in 2009-2010 eat 9.6% more calories and 14.4% more fat than statin users in 1999-2000. These increases were not observed in statin non-users; the trends of caloric and fat intake were statistically different between statin users and non-users. In 1999-2000, caloric and fat intake was significantly less for statin users compared with non-users, but the difference between the groups because smaller as time went by and there was no statistical difference in 2009-2010. Body mass index increased more rapidly for statin users compared to non-users.
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MedicalResearch.com Interview with:Tara Lagu MD PhD
Assistant Professor of Medicine
Tufts University School of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Lagu:We found that use of mechanical ventilation in patients 65 and older is increasing rapidly. If current rates of increase continue, we expect that by 2020 there will be more than 600,000 hospitalizations per year that involve mechanical ventilation. This is a doubling in 20 years (2001-2020), and represents demand that could easily exceed the capacity of the US critical care system. We also found that increase in use among patients with dementia is 4 times faster than those without dementia. This is important because dementia is a terminal illness, and use of mechanical ventilation in patients with end-stage dementia is associated with poor 30-day and 1-year outcomes.
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MedicalResearch.com Interview with:Juliana C. N. Chan, MBChB MD FHKAM FRCP
Professor Juliana Chan is Professor of Medicine and Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity and International Diabetes Federation Centre of Education at the Chinese University of Hong Kong, Prince of Wales Hospital and Chief Executive Officer of Asia Diabetes Foundation Hong Kong.
MedicalResearch.com: What are the main findings of the study?Dr. Chan: In this 1-year randomized study, we asked the question whether type 2 diabetic patients receiving team-based integrated care augmented by information technology would further improve in their glycemic control if given additional peer support through the telephone. All patients underwent comprehensive risk assessment guided by the web-based JADE portal which generated personalized risk report with attained treatment targets and decision support. After 1 year, all patients improved significantly in all risk factors including A1c with improved treatment adherence, self efficacy and psychological wellbeing. Although the peer support group did not further improve in A1c, short-stay hospitalization rates were substantially reduced by 50% , especially amongst those with emotional distress. These patients accounted for 20% of the intervention group, in whom peer support further reduced psychological distress and treatment non-adherence.
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