Author Interviews
29 Aug Kaiser’s Hypertension Program Dramatically Improves Blood Pressure Control in Large Population
Posted at 11:27h
in Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF
MedicalResearch.com Interview with:
Dr. Marc Jaffe, MD
Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program
Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group
Associate Clinical Professor of Medicine, UCSF
Endocrinology and Internal Medicine
Kaiser South San Francisco Medical Center
1200 El Camino Real
South San Francisco, California 94080
MedicalResearch.com: What are the main findings of the study?
Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates.
If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.
29 Aug Cancer Patients: Coping, Medication Adherence if under Financial Distress
MedicalResearch.com Interview with:
S. Yousuf Zafar, MD, MHS
Assistant Professor of Medicine
Duke Cancer Institute
twitter: @yzafar
MedicalResearch.com: What are the main findings of the study?
Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan.
28 Aug Observation Status: Effect of “Two Midnights” Rule on LOS, Skilled Nursing Placement
MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Answer: The Centers for Medicare and Medicaid Services (CMS) has changed their definition for observation status. Previously, observation status was determined by Interqual clinical criteria. The new...
28 Aug Diabetes with CAD: Genetic Link Related to Glutamic Acid Metabolism
MedicalResearch.com Interview with:
Lu Qi, MD, PhD, FAHA
Assistant Professor of Medicine
Harvard Medical School
Assistant Professor of Nutrition
Harvard School of Public Health
MedicalResearch.com: What are the main findings of the study?
Answer: The main findings include, we for the first time identified a genetic variant predisposing to high risk of coronary heart disease in patients with type 2 diabetes, using genome-wide association (GWA) approach. More interesting, we demonstrated that the variant may affect expression of a gene involved in metabolism of amino acid glutamic acid, which has been related to insulin secretion and heart health in previous studies.
28 Aug Obesity: Inflammatory Markers May Detect Risk of Diabetes, Heart Disease
MedialResearch.com Interview with: Dr Catherine M. Phillips Health Research Board Centre for Diet and Health Research Room 4.033, Department of Epidemiology and Public Health Western Gateway Building, University College Cork, Cork, Ireland MedialResearch.com: What are the main findings of the study? Answer: Obesity is associated with increased risk of diabetes and heart disease leading to reduced life expectancy. However in recent years it has been recognized that not all obese individuals are at increased risk – these individuals have been described as being metabolically healthy obese (MHO) in that despite carrying excess weight they do not have the typical abnormal metabolic features associated with obesity such as hypertension, insulin resistance and alterations to their lipid profile. It is not clear what factors determine whether an obese person becomes metabolically healthy or unhealthy. In this study conducted at the Dept. of Epidemiology and Public Health at University College Cork, Ireland, we examined levels of a range of inflammatory markers in 2047 middle-aged Irish adults to investigate to what extent differences between metabolically healthy and unhealthy obese and non-obese male and female adults are explained by inflammatory status. Participants, who were between the ages of 50 and 69, completed lifestyle questionnaires, physical and clinical assessments, and underwent blood testing so their body mass index (BMI), metabolic profiles and inflammatory markers could be determined. We found that, regardless of a person’s BMI, having a favorable inflammatory profile was associated with being metabolically healthy. Specifically metabolically healthy individuals presented with lower levels of complement component 3, C reactive protein, tumour necrosis factor alpha, interleukin 6, plasminogen activator inhibitor-1, reduced white blood cell count and higher adiponectin levels compared to their metabolically unhealthy counterparts.28 Aug Prostate Cancer: Coffee and Tea Association
MedicalResearch.com Interview with:
Janet L. Stanford, MPH, PhD
Full Member, Research Professor
Co-Head, Program in Prostate Cancer Research
Fred Hutchinson Cancer Research Center
1100 Fairview Ave. N. M4-B874
Seattle, WA 98109-1024
MedicalResearch.com: What are the main findings of the study?
Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease. In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day. The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients.
27 Aug Leaving Hospital Against Medical Advice Raises Readmission, Death Risk
MedicalResearch.com Interview with:
Allan Garland, MD, MA
Co-Head, Section of Critical Care Medicine
Associate Professor of Medicine and Community Health Sciences
University of Maniitoba
820 Sherbrook St / GF-222
Winnipeg, Manitoba R3A 1R9
MedicalResearch.com: What are the main findings of the study?
Answer: Our study evaluated consequences of leaving the hospital against medical advice (AMA). It is a large, population-based analysis, that evaluated all hospitalizations from which patients were discharged alive, among all adults in the Canadian province of Manitoba over a 19 year period; this was over 1.9 million hospitalizations. Outcomes assessed were hospital readmission and death over 6 months after the event. Specifically, we compared these outcomes for those who left the hospital against medical advice, compared to those who remained in the hospital until their doctors felt it was safe to be discharged -- and these comparisons adjusted for a variety of patient and illness characteristics.
Among the 1.9 million hospitalizations, there were 21,417 that ended with the patients leaving against medical advice, this is 1.1% of the total. Without adjustment for other variables, leaving against medical advice was associated with double the rate of unscheduled hospital readmission within 30 days (24.0 vs. 12.1%); after adjustment, the odds of unscheduled hospital readmission within 30 days was 3-fold higher for someone who left against medical advice compared to one who did not. After adjustment, the odds of death at 90 days were 2.51-fold higher for those who left against medical advice.
27 Aug Lupus Nephritis Susceptibility Genes Identified
Hemodialysis.com Interview with: Dr. David W. Powell PhD Associate Director of Clinical Proteomics Assistant Professor of Medicine Assistant Professor of Biochemistry and Molecular Biology Department of Medicine/Nephrology 570 South Preston Street Baxter Research Building I, Room 102 South Louisville, Kentucky Hemodialysis.com: What are the main findings of the study? Dr. Powell: We found a strong association for variants...
27 Aug Depression: Effectiveness of Collaborative Care
MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School Sir Henry Wellcome Building University of Exeter Washington Singer Building The Queen’s Drive Exeter EX4 4QQ United Kingdom MedicalResearch.com: What are the main findings of the study? Answer: We found that collaborative care improves depression immediately after treatment compared to usual care, has effects that persist to 12 month follow-up and is preferred bypatients over usual care. This difference in effect equated to a standardized effect size of 0.26 (95% CI 0.07 to 0.46). More participants receiving collaborative care than those receiving usual care met criteria for recovery (odds ratio 1.67 (95% confidence interval 1.22 to 2.29); number needed to treat=8.4) and response (1.77 (1.22 to 2.58); 7.8 at 4 months. At 12 months follow up more participants in collaborative care than those in usual care met criteria for recovery (odds ratio 1.88 (95% confidence interval 1.28 to 2.75); number needed to treat=6.5) and response (1.73 (1.22 to 2.44); 7.3. Collaborative care is as effective in the UK healthcare system—an example of an integrated health system with a well developed primary care sector—as in the US.27 Aug Vertebral Fractures: Inflammation, hsCRP association in Men
MedicalResearch.com Interview with: Anna Eriksson MD, PhD Centre for Bone and Arthritis Research Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden MedicalResearch.com: What are the main findings of the study? Answer: The main findings of the study are that low-grade inflammation as measured by high sensitive CRP (hsCRP) is a risk factor for fractures in men, and that this is mainly driven by an increased risk for vertebral fractures. Previous epidemiological research has shown that higher levels of hsCRP is associated with an increased risk for fractures in women but until now it has not been known whether this applies also to men. The associations between hsCRP and fracture risk remained also after controlling for a wide range of known risk factors for fractures. There were no associations between hsCRP and BMD in our study. This implies that low-grade inflammation is an independent risk factor for fractures.26 Aug Pediatric Magnet Ingestions Continue to Rise
MedicalResearch.com Interview with:
Dr. Jonathan Silverman, MD
Department of Pediatrics
University of Washington in Seattle, Washington
MedicalResearch.com: What are the main findings of the study?
Dr. Silverman: We looked at the incidence of magnet foreign body injuries in children between 2002-2011, using a Consumer Products Safety Division surveillance database. We found an estimated 22, 581 cases over that period. Most strikingly, we found a rise in the incidence of magnet ingestions (in cases per 100,000 children/yr) from 0.57 (95% CI 0.22-0.92) in 2002-2003 to 3.06 (95% CI 2.16-3.96) in 2010-2011. The mean age for ingested magnets was 5, but for nasal magnets was 10. Multiple magnet ingestions and magnet injuries requiring hospital admission were much more common in the second half of the study period, corresponding with the rising popularity of small, high-powered, desktop magnet sets. However, due to limited detail from the database, we were unable to say with any certainty whether injuries were specifically due to these magnet sets.
26 Aug Stroke: Ultra-Early Thrombolysis Therapy
MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Associate Professor Department of Neurology Helsinki University Central Hospital PL 340, 00290 HUS MedicalResearch.com: What are the main findings of the study? Dr. Strbian: That providing early treatment is not enough, we have to be ultra-early.26 Aug CRT-D: Cardiac Resynchronization plus Defibrillator – Predicting Who Does Best
MedicalResearch.com Interview with:
Dr Pamela N Peterson MD
Denver Health Medical Center, CO
MedicalResearch.com: What are the main findings of the study?
Answer: We assessed the outcomes of mortality, rehospitalization, and procedural complications among 24,169 patients in the NCDR-ICD Registry with left ventricular systolic dysfunction receiving a cardiac resynchronization device in addition to an implantable defibrillator for the primary prevention of sudden cardiac death between 2006 and 2009. After stratification by the QRS complex morphology and duration on the ECG and adjustment for measured differences in other characteristics, patients with left bundle branch block (LBBB) and QRS durations of at least 150 msec had significantly lower rates of mortality and rehospitalization at 3 years compared with patients with non-LBBB QRS morphology and/or QRS duration of 120-149 msec. Rates of mortality and readmission were generally highest in patients with non-LBBB and QRS duration of 120-149 msec. Rates of procedural complications at 30- and 90-days were similar across strata of QRS morphology and duration.
24 Aug Diabetes: Exercise Improves Glycemic Control if Pancreatic Beta-Cell Function Remains
MedicalResearch.com Interview with:
Thomas P. J. Solomon, Ph.D.
Associate Professor of Biomedical Sciences
Department of Biomedical Sciences | Cellular & Metabolic Research Section
Panum Institute 4.5 | University of Copenhagen | Blegdamsvej 3B | 2200 Copenhagen N | Denmark
MedicalResearch.com: What are the main findings of the study?
Dr. Solomon: The main findings were that when impaired glucose tolerant and type 2 diabetic subjects underwent 3-4 months of regular aerobic exercise training, although the majority of subjects (86-90%) increased increased VO2max, lost weight, and increased insulin sensitivity, only around two-thirds of subjects improved glycemic control (HbA1c, fasting glucose, and 2-hour OGTT glucose). The novel finding was that the changes in glycemic control were congruent with changes in oral glucose-stimulated insulin secretion (GSIS). We also found that exercise training-induced changes in glycemic control were related to changes in GSIS (P0.05), but not insulin sensitivity. Furthermore, we found that training-induced improvements in glycemic control were largest in subjects with greater pre-training GSIS, i.e. in subjects with greatest beta-cell function. And, we noted that high pre-training hyperglycemia blunted exercise-induced improvements in beta-cell compensation for insulin resistance.
23 Aug Breast Cancer Screening: Risk of False-Positive Results
MedicalResearch.com Interview with:
Solveig Hofvind, PhD
Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Majorstua 0403, Oslo, Norway
MedicalResearch.com: What are the main findings of the study?
Dr. Hofvind: We find that if 100 women aged 50 years attend the Norwegian Breast Cancer Screening Program as recommended, every two years until they are 69 years, four women will undergo a needle biopsy with benign outcome (a false positive needle biopsy).
In the same group of women, twenty women will be recalled for further examination and have additional imaging, ultrasound, and/or a biopsy with negative outcome (a false positive screening result).
23 Aug Breast Cancer: Surgical Oophoretomy + Tamoxifen – Impact on Bone Loss
MedicalResearch.com: Interview with:
Richard R. Love, MD MS
International Breast Cancer Research Foundation
Professor of Medicine and Public Health The Ohio State University
Columbus, OH
MedicalResearch.com: What are the main findings of the study?
Answer: Surgical oophorectomy and tamoxifen treatment was associated with no loss of bone mineral density (BMD) in the femoral neck, and loss of BMD in the first year, followed by stabilization in the lumbar spine.
23 Aug Stretch Marks: Four Genetic Markers Near Elastin Gene Identified
MedicalResearch.com Interview with:
Joyce Y Tung Ph.D.
Research Team
23andMe Inc.
Mountain View, California, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Tung: 23andMe researchers identified four genetic markers that were significantly associated with the development of stretch marks, including one near the elastin (ELN) gene. This finding may further explain why some individuals are more susceptible to the skin condition. Given that loose skin is a symptom of syndromes caused by deletion or loss-of-function mutations in ELN, these results also support the hypothesis that variations in the elastic fiber component of the skin extracellular matrix contribute to the development of stretch marks.
23 Aug Delirium Prediction Rule: the AWOL Tool
MedicalResearch.com Interview with:
Vanja Douglas, MD
Sara & Evan Williams Foundation
Endowed Neurohospitalist Chair
Assistant Professor of Clinical Neurology
UCSF Department of Neurology
Neurology Clerkship Director
Editor in Chief, The Neurohospitalist
MedicalResearch.com: What are the main findings of the study?
Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient's risk of developing delirium during that hospitalization.
23 Aug Electronic Health Record Utilization as a Measure of Hospital Care Intensity
MedicalResearch.com Interview with:
Saul Blecker, MD, MHS
Assistant Professor
Department of Population Health
NYU School of Medicine
227 East 30th St., #648
New York, NY 10016
MedicalResearch.com: What are the main findings of the study?
Dr. Blecker: We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends.
23 Aug Strategy Video Game Training and Improved Cognitive Flexibility
MedicalResearch.com Interview with: Brian D. Glass Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary, University of London, London, United Kingdom Bradley C. Love Department of Cognitive, Perceptual and Brain Sciences, University College London, London, United Kingdom MedicalResearch.com: What are the main findings of the study? Answer: We had 72 non-gaming participants play 40 hours of video games over 6 to 8 weeks. We tested them on psychological tests before and after. The participants either played The Sims (a life simulator game), or one of two versions of StarCraft (a real-time strategy game) -- one which had a higher level of complexity. We found that the StarCraft players (especially on the higher complexity version) performed better on specifically the psychological tasks which tested cognitive flexibility. Cognitive flexibility is the ability to adapt to a changing environment by keeping multiple things in mind and switch between tasks effectively. This sort of ability is considered a higher level psychological ability because it requires strategic thinking and creativity.23 Aug Type 2 Diabetes: Lifetime Medical Costs
MedicalResearch.com Interview with: Xiaohui Zhuo PhD Health economist Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention MedicalResearch.com: What are the main findings of the study? First, someone diagnosed with type 2 diabetes may pay an average of about $85,500 treating the disease over his or her lifetime. Lifetime cost is higher for women, and for patients who developed the disease earlier in life. Second, treating diabetic complications account for more than half of lifetime costs, and a majority of which is attributed by damage to large blood vessels, which can lead to coronary heart disease and stroke.23 Aug Renal Sympathetic Denervation: Using Baroreflex To Predict Who Might Benefit
MedicalResearch.com Interview with: Dr. Axel Bauer, MD, FESC, F-ISHNE Prof. Dr. med. Axel Bauer is head of the coronary care and chest pain unit and primary investigator in the research group of biosignal analysis and sudden death of the cardiology department of the Eberhard-Karls-Universität Tübingen, Germany. MedicalResearch.com: What are the main findings of the study? Dr. Bauer: Catheter-based renal sympathetic denervation is a promising treatment option in patients with resistant arterial hypertension. However, it is invasive and might have presently unknown adverse side effects in the long-term. Therefore, identification of patients who benefit from RDN and, equally importantly, those who do not is of great importance. With assessment of baroreflex sensitivity (BRS) we found a way to do that. Patients with resistant hypertension and impaired BRS at baseline benefited the most from RDN in terms of reduction of mean systolic BP on (ABPM) while RDN had no effect in patients with preserved BRS.23 Aug Infantile Pyloric Stenosis: Associated with Low Plasma Lipids
MedicalResearch.com Interview with:
Bjarke Feenstra, Ph.D.
Senior Research Scientist
Statens Serum Institut
Artillerivej 5, 2300 Copenhagen S
Denmark
MedicalResearch.com: What are the main findings of the study?
Dr. Feenstra: We discovered a new genome-wide significant locus for infantile hypertrophic pyloric stenosis (IHPS) in a region on chromosome 11 harboring the apolipoprotein (APOA1/C3/A4/A5) gene cluster and also confirmed three previously reported loci. Characteristics of the new locus led us to propose the hypothesis that low levels of circulating lipids in infants are associated with increased risk of IHPS. We addressed this hypothesis by measuring plasma lipid levels in prospectively collected umbilical cord blood from a set of 46 IHPS cases and 189 matched controls. We found that levels were on average somewhat lower in the children who went on to develop the condition.
22 Aug Coffee Intake: Risk Factor for Higher Mortality in Men, Not Women
MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD Assistant Professor Department of Exercise Science Arnold School of Public Health University of South Carolina 921 Assembly Street Room 226 Columbia, SC 29208 MedicalResearch.com: What are the main findings of the study? Answer: Coffee intake was a risk factor with higher mortality in men, but not in women. Men who drank more than 28 cups of coffee weekly had a 21% higher risk of dying when comparing with their non-coffee-consuming peers. In addition, younger men (age<55 years) who drank more than 28 cups of coffee weekly had a 56% increase in mortality from all-cause and younger women had a greater than 2-fold higher risk of all-cause mortality than those who did not drink coffee.22 Aug Biological Clock: Removing Protein Repressor Boosts Clock Function
MedicalResearch.com Interview with: Ruifeng Cao, MD,PhD Postdoctoral Fellow Laboratory of Nahum Sonenberg McGill University Department of Biochemistry Montreal, QC H3A 1A3, Canada MedicalResearch.com: What are the main findings of the study? Answer: Circadian (~24h) timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria. In mammals, including humans, a circadian clock in the brain drives daily rhythms in sleep and wakefulness, feeding and metabolism, and many other essential processes. We studied how protein synthesis, which is a fundamental process underlying many biological activities, is controlled in the brain clock in mice and identified a protein that functions as a clock repressor. By removing the repressor protein, the clock function is improved.22 Aug Medial Knee Osteoarthritis: Lateral Wedge Insoles
MedicalResearch.com Interview with: Matthew Parkes Research Statistician Research in Osteoarthritis Manchester (ROAM) Arthritis Research UK Epidemiology Unit Centre for Musculoskeletal Research Institute of Inflammation and Repair The University of Manchester Manchester Academic Health Science Centre Manchester M13 9PT MedicalResearch.com: What are the main findings of the study? Answer: Looking at all trials of lateral wedge insoles, they seem to reduce pain slightly. However, looking at trials which compare lateral wedges to flat wedges, they don’t appear to differ in terms of pain reduction.22 Aug Gestational Diabetes Mellitus and Sleep Apnea
Posted at 01:59h
in Author Interviews, Diabetes, JCEM, OBGYNE, Obstructive Sleep Apnea, Sleep Disorders
MedicalResearch.com: Interview with
Sirimon Reutrakul MD
Section of Endocrinology Department of Medicine
Rush University Medical Center
Chicago, Illinois 60612
MedicalResearch.com: What are the main findings of the study?
Answer: We found a strong association between obstructive sleep apnea and gestational diabetes mellitus. In pregnant women diagnosed with gestational diabetes, the risk of obstructive sleep apnea is increased nearly 7-fold compared to those without gestational diabetes. In addition, we found that in non-diabetic women, pregnancy is associated with more disrupted sleep.
20 Aug Coronary Artery Disease: Hypertension and Prognostic Score
MedicalResearch.com Interview with
Dr. Anthony Bavry, MD MPH
Interventional Cardiology
Assistant Professor of Medicine
University of Florida
1600 SW Archer Road
Gainesville, FL 32610
MedicalResearch.com: What are the main findings of the study?
Dr. Bavry: Among individuals with chronic stable coronary artery disease, it is possible to define a group who are at relatively low risk for adverse cardiovascular events.
MedicalResearch.com:Were any of the findings unexpected?