MedicalResearch.com Interview with
Helen C. Kales MD
Professor of Psychiatry
Director, Section of Geriatric Psychiatry and The Program for Positive Aging, University of Michigan
Research Scientist, VA Center for Clinical Management Research
and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System
Please note that this paper is the result of the deliberations of a multi-disciplinary national expert panel, not a specific study.
MedicalResearch.com: What were the main findings of the expert panel?
Dr. Kales: Often more than memory loss, behavioral symptoms of dementia are among the most difficult aspects of caring for people with dementia. These symptoms are experienced almost universally, across dementia stages and causes, and are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment. Doctors often prescribe these patients psychiatric medications like antipsychotics, despite little hard evidence that they work well in this population and despite the risks they pose including hastening death. Meanwhile, studies show promise for non-medication behavioral and environmental approaches (such as providing caregiver education/support, creating meaningful activities and simplifying/enhancing the environment), but too few health providers are trained in their use. The method created by the national multidisciplinary group of experts (DICE which stands for Describe, Investigate, Create and Evaluate) represents a comprehensive approach to assessment and management of behavioral symptoms in dementia. For example, a new report of “agitation” from a caregiver, should be fully understood and described (e.g. who/what/when/where/risk/safety); underlying causes should be investigated (e.g. pain, changes in medications, medical conditions, poor sleep, fear); a treatment plan should be created (e.g. responding to physical problems, working collaboratively with the caregiver and other team members to institute non-pharmacologic interventions); and evaluating whether the interventions tried were effective.
MedicalResearch.com Interview with:
Li-Ching Lee, PhD, ScM
Associate Scientist,
Departments of Epidemiology and Mental Health
Johns Hopkins Bloomberg School of Public Health
Baltimore MD 21205
MedicalResearch.com: What are the main findings of the study?
Dr. Li-Ching Lee: This population-based case-control study in young children provides evidence that prenatal selective serotonin reuptake inhibitor (SSRI) use may be a risk factor for autism and other developmental delays (DD). Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with autism spectrum disorder (ASD) relative to children with typical development; the strongest association occurred with first-trimester exposure. Exposure was also elevated among boys with DD and was strongest in the third trimester.
MedicalResearch.com Interview with:
Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger
Oberarzt der Klinik und Hochschulambulanz
für Neurologie am Campus Charité Mitte
Center for Stroke Research Berlin (CSB)
Charité - Universitätsmedizin Berlin | CCM
Charitéplatz 1 | 10117 Berlin | Germany
MedicalResearch.com: What are the main findings of the study?
Dr. Ebinger: The main findings of our study was a significant time reduction during randomized weeks with prehospital thrombolysis compared to control weeks with regular care.
MedicalResearch.com Interview with:
Rustam Al-Shahi Salman
Professor of clinical neurology and MRC senior clinical fellow
University of Edinburgh
Honorary consultant neurologist, NHS Lothian
MedicalResearch.com: What are the main findings of the study?
Prof. Al-Shahi Salman: Patients with arteriovenous malformations (abnormal connection between arteries and veins) in the brain that have not ruptured had a lower risk of stroke or death for up to 12 years if they received conservative management of the condition compared to an interventional treatment.
Interventional treatment for brain arteriovenous malformations (bAVMs)
with procedures such as neurosurgical excision, endovascular
embolization, or stereotactic radiosurgery can be used alone or in
combination to attempt to obliterate bAVMs. Because interventions may
have complications and the untreated clinical course of unruptured
bAVMs can be benign, some patients choose conservative management (no
intervention). Guidelines have endorsed both intervention and
conservative management for unruptured brain arteriovenous malformations. Whether conservative management is superior to interventional treatment for unruptured
bAVMs is uncertain because of the lack of long-term experience,
according to background information in the article.
MedicalResearch.com Interview with:
Daniel I. Sessler, M.D.
Michael Cudahy Professor and Chair, Department of Outcomes Research
Cleveland Clinic, Cleveland, OH
MedicalResearch.com: What are the main findings of the study?
Dr. Sessler: Free fatty acids, arachidonic acid and linoleic acid, and their metabolites hydroxyeicosatetraenoic acids (5-HETE, 11-HETE, 12-HETE, and 15-HETE) were 1.8 to 5.7-fold greater in 37 patients with adenocarcinoma versus 111 patients without cancer (all P<0.001). Areas under the receiver operating characteristics (ROC) curve were significantly greater than 0.50 discriminating lung cancer patients and controls for all biomarkers and phospholipids, and ranged between 0.69 and 0.82 (all P<0.001) for lung cancer patients versus controls. Arachidonic acid, linoleic acid, and 15-HETE showed sensitivity and specificity >0.70 at the best cutpoint. Concentrations of free fatty acids and their metabolites were similar in 18 squamous-cell carcinoma patients and 54 non-cancer controls.
Allison W. Kurian, M.D., M.Sc.
Assistant Professor of Medicine and of Health Research and Policy
Divisions of Oncology and Epidemiology
and
James M. Ford, MD
Associate Professor of Medicine
Pediatrics and Genetics, Division of Oncology,
Stanford University School of Medicine
MedicalResearch.com: What are the main findings of the study?
Answer: We found that 11% of women who met standard clinical criteria for BRCA1 and BRCA2 (BRCA1/2) mutation testing, yet had tested negative, actually carried an actionable mutation in another cancer-related gene. We found that patients were highly motivated to learn about their genetic test results and new recommendations for cancer risk reduction. Over a short follow-up period, colonoscopy screening resulted in early detection of a tubular adenoma in a patient found to have a high-risk MLH1 mutation, and thus the multiple-gene testing in our study has likely prevented at least one cancer to date. We conclude that multiple-gene sequencing can benefit appropriately selected patients.
MedicalResearch.com Interview with:
Dr. George Patton
Department of Paediatrics, University of Melbourne
Centre for Adolescent Health, Murdoch Children's Research Institute,
Royal Children's Hospital, Parkville, VIC, Australia
MedicalResearch.com: What are the main findings of the study?
Dr. Patton: Although there has been wide acceptance that the teens are a time when emotional problems are common, views have been polarized about their significance. Some have viewed these problems are usual for this phase of life with little significance for later life mental health; others have argued that early psychiatric intervention was essential given the risks of ongoing disorders.
In this sample almost two thirds of girls and a third of boys had an episode of emotional troubles (anxiety and depression) at a level that would concern a family physician. For those where the episode were brief lasting weeks to months, recovery without further later life episodes was common. In contrast those with persistent (longer than 6 months) or recurrent emotional problems during the teens had a high likelihood of similar problems with depression and anxiety in their twenties. In general these emotional problems persisted more in females than in males.
MedicalResearch.com Interview with:
John I. Nurnberger, Jr., M.D., Ph.D.
Professor of Psychiatry
Joyce and Iver Small Professor of Psychiatry
Indiana University School of Medicine
MedicalResearch.com: What are the main findings of this study?
Dr. Nurnberger: The main findings of the study are the biological pathways identified to be associated with bipolar disorder, including those involved in hormonal regulation, calcium channels, second messenger systems, and glutamate signaling. Gene expression studies implicated neuronal development pathways as well.
These findings highlight the role of certain neurobiological processes that have been considered in prior hypotheses of bipolar disorder. They underline a role for calcium signaling, which has only been clearly implicated in the genetics of bipolar disorder in recent years. They also feature hormonal processes such as the hypothalamic-pituitary-adrenal axis, which has been known to be involved in stress responses, but has not been prominent in many recent theories of the pathogenesis of bipolar disorder.
MedicalResearch.com Interview with:
Angelo M. De Marzo MD PhD
Professor of Pathology
Johns Hopkins School of Medicine
Baltimore, MD 21231
MedicalResearch.com: What are the main findings of the study?
Dr. De Marzo: Working as a team with Dr. Elizabeth Platz and a group of other investigators we found that men with chronic inflammation in their benign areas of their prostate biopsies had a higher chance of prostate cancer, and especially higher grade cancers, which are associated with disease aggressiveness. A key unique aspect of the study is that the samples were taken from man who were enrolled in the Prostate Cancer Prevention Trial (PCPT), a trial in which all men entering the study had a relatively low PSA, and, all men at the end of study who did not already have a diagnosis of prostate cancer were offered a prostate biopsy regardless of their PSA. This study design, unlike a standard association study, allowed us to minimize the potential bias whereby inflammation is associated itself with elevations in PSA. In this standard design approach, when cancer is detected it could artifactually appear that inflammation is associated with cancer because the inflammation was in part driving the PSA elevation, which prompted the biopsy in which cancer was detected.
MedicalResearch.com Interview with:
Dr. Lorraine R. Reitzel Ph.D
Associate Professor in the Health Program of the Department of Educational Psychology
College of Education, University of Houston in Houston, Texas.
MedicalResearch.com: Please tell us about your study.
Dr. Reitzel: The current study represented a secondary analysis of data that were collected by Dr. Lorna McNeill and colleagues at The University of Texas MD Anderson Cancer Center. The parent study was focused on better understanding factors associated with cancer risk among African American adults, and several faculty members including myself contributed ideas about the variables we thought might play a role. The current study represents one of several studies emerging from these data. The current study was led by Ms. Pragati S. Advani, a graduate student on my research team, who was interested in better understanding the associations between financial strain and modifiable behavioral risk factors for cancer among African American adults. Financial strain represents an unfavorable income to needs ratio and was assessed using a questionnaire that tapped into current difficulty affording things that represent pretty basic components of life, including suitable food, clothing, and housing for the respondent and their family. The modifiable behavioral risk factors for cancer examined included smoking cigarettes, at-risk alcohol use, being overweight/obese, getting insufficient physical activity, and having inadequate fruit and vegetable intake. We also included a tally of the total number of these factors (0 to 5) as an outcome variable of interest.
MedicalResearch.com Interview with: Tomás Ahern MB, BCh, BAO St Columcille's Hospital and St Vincent's University Hospital Dublin, Ireland MedicalResearch.com: What are the main findings of the study? Answer: More than 40% of severely obese people, who make up 6.5% of American adults, are at risk of vitamin D deficiency. Severely obese people with low vitamin D...
MedicalResearch.com Interview with:
Dr. Annette Dickinson PhD
Consultant to the Council for Responsible Nutrition.
MedicalResearch.com: What are the main findings of the study?
Dr. Dickinson: “A five-year series of consumer surveys (2007 to 2011) consistently found that about half of adult consumers use dietary supplements on a regular basis, and a higher percentage (about 2/3) report using dietary supplements when occasional as well as regular use is taken into account. Over the five years, there was a shift in the pattern of supplement use, with the percentage of respondents who said they regularly used mostly a multivitamin declining, and the percentage who said they regularly used a variety of products increasing. The top 7 products used were: multivitamins, omega-3 fatty acids, calcium, vitamin D, vitamin C, B vitamins, and vitamin E. The main reasons given for supplement use were for overall health and wellness (58% of users) and to fill nutrient gaps in the diet (42%). Supplement users were more likely than nonusers to say they try to eat a balanced diet, visit their doctor regularly, get a good night's sleep, exercise regularly, and maintain a healthy weight. This indicates that supplement use is part of an overall approach to seeking a healthy lifestyle.”
MedicalResearch.com Interview with:
Dr Hardeep Singh MD MPH
Chief of the health policy, quality & informatics program at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, based at the Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine in Houston
MedicalResearch.com: What are the main findings of the study?
Dr Singh: We built estimates of diagnostic error by compiling and analyzing data from three previous studies. These studies evaluated situations such as unexpected return visits and lack of timely follow up and provided researchers with an estimated frequency of diagnostic error. This frequency was then applied to the general adult population. Diagnostic errors, which we defined as missed opportunities to make a correct or timely diagnosis based on available evidence—occur in about 5 percent of adults in the United States.
Oliver Muensterer MD Ph.D
Division of Pediatric Surgery
New York Medical College
Maria Fareri Children's Hospital of Westchester Medical Center
Valhalla, NY 10595, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Muensterer: We looked at the functionality of Google Glass, a novel head-mounted mobile computer with integrated display, camera, microphone, and speaker, in the clinical environment. While the technology has a lot of promise to be useful for pediatric surgeons, in its current version, it also has significant limitations. The most obvious utilities are hands-free photo- and videodocumentation, looking up medical terminology on the internet, help with coding and billing activities, and hands-free telecommunication.
MedicalResearch.com Interview with:
Craig M. Lilly, M.D.
Professor of Medicine
Departments of Medicine, Anesthesiology, and Surgery, University of Massachusetts Medical School, and Clinical and Population Health Research Program,
Graduate School of Biomedical Sciences, Worcester, MA
MedicalResearch.com: What are the main findings of the study?
Dr. Lilly: Critically ill adults with clinicians that chose to manage them with prophylactic anticoagulation were more likely to survive their hospitalization than patients that received venous thrombosis prophylaxis with mechanical devices or were not treated with venous thrombosis prophylaxis.
MedicalResearch.com Interview with:
Jordan Feld MD MPH
Toronto Western Hospital Liver Center
University Health Network
Sandra Rotman Centre for Global Health
MedicalResearch.com: What are the main findings of the study?
Dr. Feld: The SAPPHIRE 1 study was an international, large (631 patients) Phase 3 study of 3 direct acting antivirals combined with ribavirin for 12 weeks for the treatment of patients with genotype 1 hepatitis C virus (HCV) infection without cirrhosis. The antivirals used were ABT-450, which is a protease inhibitor that is boosted with ritonovir to allow for once daily dosing along with ombitasvir (formally ABT 267), a potent NS5A inhibitor and dasabuvir (formerly known as ABT 333), a non-nucleoside polymerase inhibitor. The ABT-450, ritonovir and ombitasvir were all co-formulated into a single tablet and dasabuvir was taken twice daily, as was ribavirin. The results of the study showed that the treatment is highly effective with 96% of patients achieving a sustained virological response (SVR) at 12 weeks after completing treatment. SVR is a cure of HCV infection. Importantly, patients with genotypes 1a and 1b had similar results with a rate of SVR12 of 95% in genotype 1a and 98% in genotype 1b. These results were clearly superior to a historical control treatment with telaprevir combined with peginterferon and ribavirin. Baseline factors were not predictive of outcome, including factors associated with non-response to interferon such as the IL28B genotype, baseline HCV viral load and older age.
MedicalResearch.com Interview with:
Kai-Jen Tien, MD
Division of Endocrinology and Metabolism,
Department of Internal Medicine, Chi Mei Medical Center
Assistant Professor, Center of General Education
Chia Nan University of Pharmacy and Science
Tainan, Taiwan
MedicalResearch.com: What are the main findings of the study?
Answer: We conducted the first and largest population-based cohort study to evaluate the association of obstructive sleep apnea (OSA) and osteoporosis in a 6-year follow-up investigation of an Asian population. OSA is characterized by repetitive episodes of apnea/hypopnea and hypoxia in tissue, which might impact the bone metabolism. The results of the study showed that patients with obstructive sleep apnea had 2.74 times the risk of osteoporosis than patents without obstructive sleep apnea after adjustment for the patient`s characteristics and comorbidities. Across all age groups and sex groups, individuals with OSA had higher incidence rate of osteoporosis than individuals without obstructive sleep apnea. Subgroup analysis showed that older patients and female patients had a higher risk for osteoporosis than their younger and male counterparts.
MedicalResearch.com Interview with:
Renda Soylemez Wiener, MD, MPH
Assistant Professor of Medicine
The Pulmonary Center
Boston University School of Medicine
Center for Healthcare Organization & Implementation Research
Edith Nourse Rogers Memorial VA Hospital
MedicalResearch.com: What are the main findings of the study?
Dr. Soylemez Wiener: The main finding is that evaluation of pulmonary nodules to determine whether or not they are cancerous is inconsistent with clinical practice guideline recommendations in almost half of cases, suggesting there is room for improvement in clinical care of these patients. Patients with pulmonary nodules are sometimes evaluated more aggressively than they should be (18%), which can cause harms to patients from unnecessary invasive tests (biopsies or surgery) or unneeded radiation exposure from imaging studies. Still more patients (27%) are followed less aggressively than they should be, which in the worst case scenario could lead to delays in the diagnosis and treatment of cancer. It is particularly important to improve care of these patients now, because new guidelines from the US Preventive Services Task Force recommend CT screening for lung cancer screening, which often finds pulmonary nodules that require evaluation.
MedicalResearch.com Interview with:
Zhang, Xuan MD
Professor of Medicine
Dept. of Rheumatology
Peking Union Medical College Hospital
Beijing,China,100730 and
Dr. Peter E. Lipsky, MD
Formerly National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health, Bethesda, MD,
MedicalResearch.com: What are the main findings of the study?
Prof. Zhang & Lipsky--The results of this study indicate that TwHF is effective for the treatment of active rhematoid arthritis (RA). Importantly, these are the first data indicating that TwHF is effective in DMARD-naïve patients with active rheumatoid arthritis. At week 24, TwHF monotherapy resulted in significant improvement of disease activity, including pain assessment, the patient’s and physician’s global assessment, tender joint counts, swollen joint counts, ESR, CRP, and HAQ and SF-36 scores. MTX monotherapy and TwHF monotherapy had similar efficacy as shown by ACR20, ACR50 and ACR70 response criteria, EULAR and cDAI good response criteria, as well as DAS28 remission criteria and low disease activity(LDA) rate. The efficacy of TwHF was not inferior to that of MTX, and MTX +TwHF combination therapy was more effective than monotherapy in treating active rhematoid arthritis. A safety evaluation of the study demonstrated that the frequency of total adverse events and severe adverse events of TwHF monotherapy was not significantly higher than that of MTX monotherapy, except for a slightly increased frequency of irregular menstruation.
MedicalResearch.com Interview with:
Dr. Feng He
Wolfson Institute of Preventive Medicine
Barts and The London School of Medicine and Dentistry
Queen Mary University of London, London, UKMedicalResearch.com: What are the main findings of the study?
Dr. He:
MedicalResearch.com Interview with:
Dr. Jeffery C. Huffman, M.D.
Harvard Medical School
Department of Psychiatry
Massachusetts General Hospital, Boston
MedicalResearch.com: What are the main findings of the study?
Dr. Huffman: Depression and anxiety in cardiac patients are associated with adverse cardiac outcomes. We completed a very low-intensity care management intervention to identify depression and anxiety disorders during a cardiac admission and then to assist in the monitoring and management of the condition over the next 24 weeks. There have been other care management trials in cardiac patients, but ours was the first to co-manage depression and anxiety, the first to initiate treatment in the hospital, the first to take a broad population of cardiac patients rather than a single diagnosis, and the first to use such a low-resource strategy with only a single part-time social worker to coordinate care.
We found that the care management intervention was associated with significant improvements in mental health treatment, mental health related quality of life, depression, and function at 24 weeks compared to enhanced treatment as usual. We did not find differences in anxiety, adherence, or cardiac readmissions.