MedicalResearch.com Interview with:
Samuel Pannick, MA, MBBS, MRCP
Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London
West Middlesex University Hospital National Health Service Trust Middlesex, England
Medical Research: What is the background for this study? What are the main findings?
Response: Improving the quality of general medical ward care is a recognized healthcare priority internationally. Ward teams have been encouraged to structure their work more formally, with regular interdisciplinary team meetings and closer daily collaboration with their colleagues. Some early studies suggested that these changes might benefit patients, and help ward teams work more efficiently. However, team interventions on medical wards have been reported with numerous different outcome measures, and prior to this study, it was unclear what their objective benefits were.
We showed that there is little agreement on the objective outcomes that best reflect the quality of interdisciplinary team care on general medical wards. Changes to interdisciplinary care aren’t reflected in the outcome measures that researchers choose most often, like early readmission rates or length of stay. Complications of care - although harder to record - might have more promise as a measure of the quality of inpatient team care in these specific medical areas.
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MedicalResearch.com Interview with:
Jeffrey C. Schneider, M.D.
Medical Director, Trauma, Burn & Orthopedic Program
Assistant Professor, Dept. of Physical Medicine and Rehabilitation
Harvard Medical School
Spaulding Rehabilitation Hospital
Boston, MA 02129
Medical Research: What is the background for this study? What are the main findings?
Response: Hospitalizations account for the largest share of healthcare costs in the U.S., comprising nearly one-third of all healthcare expenditures. In 2011, readmissions within 30 days of hospital discharge represented more than $41 billion in hospital costs. Financial penalties for excess 30-day hospital readmissions were instituted by the Centers for Medicare and Medicaid Services in 20124; more than 2,200 hospitals were fined a total of $280 million in reduced Medicare payments in fiscal year 2013.
Most readmission risk prediction models have targeted specific medical diagnoses and have utilized comorbidities and demographic data as the central risk factors for hospital readmission. Yet, large U.S. administrative datasets have demonstrated poor discriminative ability (c-statistics: 0.55-0.65) in predicting readmissions. However, few studies have considered functional status as potential readmission risk factors.
There is increasing evidence that functional status is a good predictor of other health outcomes. To date, acute care hospital administrative databases do not routinely include functional status measures. Therefore, inpatient rehabilitation setting is an ideal population in which to examine the impact of functional status on readmission risk, because:
(1) inpatient rehabilitation patients often have complex care transitions after acute care discharge, and represent a significant proportion of total readmissions;
2) inpatient rehabilitation facilities routinely document functional status using a valid instrument—the FIM®; and
(3) a majority of U.S. IRFs participate in one of the only national datasets that contain standardized functional data—the Uniform Data System for Medical Rehabilitation.
Limitations of prior work include small and single-center study designs, narrowly defined patient populations, and defining readmissions beyond the 30-day period. Overall, there is a lack of literature on the utility of function as a readmission predictor in a large population of medical patients. Moreover, function is a modifiable risk factor with potential to impact readmission outcomes if function-based interventions are instituted early. Therefore, the objective of this study was to compare functional status with medical comorbidities as predictors of acute care readmissions in the medically complex rehabilitation population. We hypothesized that acute care readmission prediction models based on functional status would outperform models based on comorbidities,and that the addition of comorbidity variables to function-based models would not significantly enhance predictive performance.
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MedicalResearch.com Interview with:
Ishak Mansi, MD
Staff Internist, VA North Texas Health System.
Professor in Department of Medicine &
Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TX
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Mansi: Statin use is associated with increased incidence of diabetes, and possibly increased body weight, and less exercise capacity. Data on the long-term effects of these associations in healthy adults are very limited. Additionally, the effects of these associations on diabetic complications have not been adequately studied.
Dr. Mansi at VA North Texas Health System, Dallas and Professor of Medicine and Clinical Sciences at the University of Texas Southwestern, Dallas, TX and his colleagues found that among generally healthy individuals, statin-users in comparison to non-users had a higher odds of being diagnosed with new onset diabetes, diabetes with complications, and overweight/obesity.
The researchers examined the records of tens of thousands of Tricare beneficiaries, during the period from 10/1/2003 to 3/1/2012. After excluding patients who had at baseline a preexisting cardiovascular diseases or severe chronic diseases that may be life-limiting (including diabetes mellitus), they identified a cohort of 25,970 patients as “healthy cohort”. They, further, matched 3,351 statins-users and 3,351 nonusers on several baseline characteristics to ensure comparability.
There are 3 main important findings for our study:
MedicalResearch.com Interview with: Dennis Tsilimingras, M.D., M.P.H. Assistant Professor, Co-Director of Michigan AHEC (Area Health Education Center), Director of Patient Safety, Department of Family Medicine...
MedicalResearch.com Interview with:
Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC
Professor of Cardiovascular Medicine,
Adjunct Professor of Cardiovascular Sciences,
Thrombosis Research Unit, Aalborg University, Denmark;
Aston Centre for Cardiovascular Sciences City Hospital Birmingham
England UK
Medical Research: What is the background for this study? What are the main findings?
Prof. Lip: Women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation.
The reasons for this elevated risk remain unclear.
The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention.
Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.
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MedicalResearch Interview with:
Prof Dr Isabelle Mansuy
Lab of Neuroepigenetics University/ETH Zürich
Brain Research Institute Zürich, Switzerland
MedicalResearch: What is the background for this study? What are the main findings?
Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms.
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MedicalResearch.com Interview with:
Giovanni Landoni, M.D.
Head of Research,Department of Anesthesiology and Intensive Care
Associate Professor at Università Vita-Salute San Raffaele, Milan
Medical Research: What is the background for this study?
Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective.
Medical Research: What are the main findings?
Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension.
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MedicalResearch.com Interview with:
Dr. Norman Putzki, MD PhD
Global Program Medical Director
Neuroscience Development Franchise
Novartis Pharma AG Basel, Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Putzki: Herpes zoster (HZ) infections are increasingly reported in patients taking multiple sclerosis (MS) disease modifying treatments (DMTs). This has been a particular concern ever since more potent MS DMTs have become available.
We have assessed the experience with oral fingolimod, a first in class S1P receptor modulator licensed for multiple sclerosis treatment in 2010, which has today more than 140,000 patient years of exposure in MS clinical trials and the post-marketing setting. Key findings include the fact that Herpes Zoster (HZ) infections occurred at a low rate in clinical trials but were more frequent than with placebo.
In the post-marketing setting, Herpes zoster reporting rates have not increased over time versus clinical trials, and rates have remained stable over time (so there is no risk accumulation).
Our article, which is the result of a consensus meeting with experts in the field of MS and infectious diseases, provides general guidance on risk mitigation; this includes vigilance and appropriate HZ infection management, relevant to physicians when prescribing MS DMTs.
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MedicalResearch.com Interview with:
Longjian Liu, MD, PhD, MSc(LSHTM), FAHA
Interim Chair, Department of Environmental and Occupational Health Associate Professor, Department of Epidemiology and Biostatistics, Senior Investigator, Center for Health Equality
Drexel University School of Public Health, and
Adjunct Associate Professor of Medicine, Drexel U. College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Liu: The prevalence of diabetes is increasing rapidly in the United States and worldwide. In 2010, 25.8 million Americans, or 8.3% of the population had diabetes in the United States. In 2012, these figures were 29.1 million, or 9.3% in the nation. Philadelphia, the largest city in PA, ranks as the 5th largest city in the nation. However, the city also had the highest prevalence of diabetes according to the national surveys in 2009. We face a great challenge to stop the epidemic of diabetes locally and nationally. It is well-known personal risk factors at individual level, including lifestyles, play a role in the prevention and control of diabetes. However very limited studies addressed the importance that physical and socioeconomic environmental factors at community level may also play a pivotal role in the prevention and control of the disease. This study aimed to quantitatively examine (1) the trend of diabetes from 2002 to 2010 in the city of Philadelphia, and (2) the impact of physical and socioeconomic environmental factors at community level (assessed using zip-codes based neighborhoods) on the risk of the prevalence of diabetes.
The main findings support our hypotheses that
MedicalResearch.com Interview with:
Michelle M. Mello, JD, PhD
Professor of Law, Stanford Law School
Professor of Health Research and Policy
Stanford University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Mello: In this report, we examined trends in the volume and cost of medical liability claims in the US, as well as liability insurance costs, and reviewed current initiatives to reform the liability system.
Examining publicly available data from the National Practitioner Data Bank, we found that the frequency and average cost of paid malpractice claims have been declining. The rate of paid claims against physicians decreased from 18.6 to 9.9 paid claims per 1,000 physicians between 2002 and 2013, about a 6.3% annual average decrease for MDs. Among claims that resulted in a payment, the median payment increased from $133,799 in 1994 to $218,400 in 2007, but has been declining--by 1.1% annually, on average--since 2007. In 2013 the median payment was $195,000.
When we looked a trends in insurance premiums in several markets, using data from the Medical Liability Monitor’s Annual Rate Survey, we found greater variation from place to place. However, the overall picture was favorable. None of the locations we examined showed large increases over the last 10 years, and most showed flat or declining premiums. (more…)
MedicalResearch.com Interview with:
Thomas M. Maddox MD MSc
Cardiology, VA Eastern Colorado Health Care System
Associate Director, VA CART Program
Associate Professor, Department of Medicine
University of Colorado School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices. Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines.
We used the PINNACLE registry to conduct our investigation. Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S. We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients. We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren't currently prescribed them. We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren't currently recommended for cholesterol treatment. Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines.
(more…)MedicalResearch.com Interview with Dr. Peter Mazzone MD, FCCP Regarding CHEST lung cancer experts recent policy statement to CMS Committee on Coverage for Lung Cancer...
MedicalResearch.com Interview with:
Dr. Mike Miedema MD, MPH
Minneapolis Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Miedema: " Released in November 2013, the ACC/AHA guidelines for the treatment of blood cholesterol attempt to target individuals that are most likely to benefit from cholesterol-lowering statin therapy. These guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat. Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits. In addition to recommending statin therapy for individuals with known cardiovascular disease, diabetes, or markedly elevated cholesterol levels, they also recommend statin therapy for individuals without these conditions but with an elevated estimated risk of a heart attack or stroke in the next 10-year based on a risk calculator that factors in an individual’s age, gender, race, and risk factors. Patients with an estimated 10-year risk > 7.5% are recommended to consider statin therapy. While I believe the scientific evidence supports this “risk-based” approach, one potential concern is that the risk-calculator relies heavily on age to determine an individual’s risk, so we wanted to examine the implications for these guidelines in an older sample of adults."
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MedicalResearch.com Interview with:
Manesh Patel, MD
Associate Professor of Medicine
Director Interventional Cardiology and Catheterization Labs
Duke University Health System
Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Patel: In clinical practice, patients with acute myocardial infarction are found to have non-IRA disease of varying significant and location. The current recommendations are to have patients recover from the acute myocardial infarction and get non-invasive testing to determine revascualrization after 4-6 six weeks in uncomplicated patients. These data demonstrate that non-IRA disease is common (>50% of STEMI patients) and that these patients have an elevated 30-day mortality.
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MedicalResearch.com Interview with:
Christopher J. Ferguson PhD.
Associate Professor and Chair of Psychology
Department of Psychology
Stetson University DeLand, FL
Medical Research: What is the background for this study? What are the main findings?
Dr. Ferguson: People have debated whether media violence contributes to societal violence for centuries. A lot of individual laboratory experiments have tried to answer this question, but results have always tended to be inconsistent. Not too much data had yet looked at concordance between media violence and societal violence. In the current study I examined levels of movie violence across the 20th century, and video game violence in the latter part of the 20th, into the 21st century. Results generally indicted that it was not possible to demonstrate that media violence consumption correlated with increased crime in society.
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MedicalResearch.com Interview with:
John E. Wagner, M.D.
Principal Investigator
Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455
Medical Research: What is the background for this study? What are the main findings?
Dr. Wagner: Earlier studies of umbilical cord blood transplantation (UCB) in children with hematological malignancies demonstrated a survival rate of approximately 50%. While single UCB transplant was very effective despite HLA mismatch, few adults had access to umbilical cord blood as a treatment option due to the cell dose requirement of 2. 5 x 10^6 nucleated cells per kilogram recipient body weight. For this reason, at the University of Minnesota we explored the co-transplantation of two partially HLA matched umbilical cord blood units in adults as a straightforward strategy to achieving the cell dose requirement. Early results were remarkable with survival rates higher than that observed in children. This in turn led to the design of the BMT CTN 0501 study, a randomized trial comparing single versus double umbilical cord blood transplantation in children aged 2-21 years with hematological malignancies. All patients received a uniform conditioning regimen of fludarabine, cyclophosphamide and total body irradiation and GVHD prophylaxis of cyclosporine A and mycophenylate mofetil. 224 patients were randomized.
There were four major findings: