Author Interviews, JAMA, Nutrition / 08.10.2014

Daniel (Dong) Wang MD, MSc Department of Nutrition, Harvard School of Public Health Boston, MA 02115MedicalResearch.com Interview with: Daniel (Dong) Wang MD, MSc Department of Nutrition, Harvard School of Public Health Boston, MA 02115   Medical Research: What are the main findings of the study? Dr. Wang:
  • The overall dietary quality in US adults improved modestly from 1999 to 2010, but the quality of US diet remains far from optimal and huge room exists for further improvements.
  • The improvement in dietary quality was greater among adults with higher socioeconomic status and healthier body weight, thus disparities that existed in 1999 increased over the next decade.
  • More than half of the improvement in diet quality was due to a large reduction in consumption of trans fat.
(more…)
Author Interviews, JAMA, Surgical Research, University of Pittsburgh, Weight Research / 03.10.2014

Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical Center MedicalResearch.com Interview with:  Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical Center Medical Research: What are the main findings of the study? Dr. Courcoulas: This paper was not a study but a summary of findings from a multidisciplinary workshop (and not a consensus panel) convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The goal of the workshop was to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research. (more…)
Author Interviews, Heart Disease, JAMA / 01.10.2014

MedicalResearch.com Interview with: Joanna Chikwe MD Associate Professor Department of Cardiovascular Surgery Mount Sinai Medical Center and Natalia N. Egorova, PhD Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai New York, New York Medical Research: What are the main findings of the study? Answer: This is one of the largest studies to date on the long-term outcomes of patients after aortic valve replacement. We found that bioprosthetic valves are as safe as mechanical valves in younger patients (age 50-69) - specifically, long-term death rates and stroke risk were very similar in patients who had either valve type. The main differences lay in the risk of other long-term complications: patients who had bioprosthetic valves were more likely to need repeat surgery in the long-term, whereas patients who had mechanical valves were more likely to experience a major bleeding event. (more…)
Author Interviews, JAMA, Vitamin D / 01.10.2014

Karin Amrein, MD, MSc Assistant Professor Department of Internal Medicine Division of Endocrinology and Metabolism Medical University of Graz 8036 Graz, AustriaMedicalResearch.com Interview with: Karin Amrein, MD, MSc Assistant Professor Department of Internal Medicine Division of Endocrinology and Metabolism Medical University of Graz 8036 Graz, Austria Medical Research: What are the main findings of the study? Dr. Amrein: This is the first large clinical trial on vitamin D in critical care. In a double-blind, randomized, placebo-controlled clinical trial, a population of mixed adult ICU patients with vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] level ≤ 20ng/ml) was assigned to receive either vitamin D3 or placebo. We used a high loading dose of vitamin D3 followed by monthly maintenance doses of 90,000 IU for a total of 5 months. Because of a substantially increased risk for skeletal complications below 12ng/ml of 25-hydroxyvitamin D, we used this threshold for a predefined subgroup analysis. Overall, high-dose vitamin D3 compared with placebo did not reduce hospital length of stay (primary endpoint), intensive care unit (ICU) length of stay, hospital mortality, or 6 month-mortality (more…)
Author Interviews, JAMA, Orthopedics, Pain Research / 01.10.2014

MedicalResearch.com Interview with: Ben Metcalf BsC (co-author) on behalf or A/Prof Rana Hinman PhD Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Metcalf: This study investigated whether acupuncture is an effective treatment for people aged more than 50 years with chronic knee pain. Participants in our study were randomly assigned to one of four groups; needle acupuncture, laser acupuncture, sham laser acupuncture or no treatment. The people in the treatment groups received acupuncture treatment from a family physician for 12 weeks. Participants were assessed after treatment and again after one year. There were no significant differences in knee pain or physical function between active and sham laser acupuncture at 12 weeks or at one year. Both needle and laser acupuncture resulted in modest improvements in pain compared with no treatment at 12 weeks that were not maintained at one year. Needle acupuncture improved physical function at 12 weeks compared with no treatment but was not different from sham acupuncture and was not maintained at one year. (more…)
Author Interviews, Esophageal, JAMA, University of Michigan / 01.10.2014

Megan A. Adams, MD Gastroenterology Fellow University of MichiganMedicalResearch.com Interview with Megan A. Adams, MD Gastroenterology Fellow University of Michigan   Medical Research: What are the main findings of the study? Dr. Adams: Surveys of doctors indicate that their fear of a malpractice lawsuit for missing a diagnosis of esophageal cancer might drive the overuse of tests called upper endoscopies in patients who are at low risk for the cancer. To examine whether this perception of medical liability risk accurately reflects the real likelihood of a malpractice claim, we looked at a national database of malpractice claims, and compared the rate of claims for delay in diagnosis of esophageal cancer in patients without alarm symptoms (weight loss, dysphagia, iron deficiency anemia), with the rate of claims alleging performance of an upper endoscopy without a good reason for performing the procedure. The database contained 278,220 claims filed against physicians in 1985-2012. The incidence of reported medical liability claims for failure to screen for esophageal cancer in patients without alarm features was quite low (19 claims in 11 years, 4 paid). In contrast, there were 17 claims in 28 years for complications of upper endoscopies with questionable indication (8 paid). (more…)
Author Interviews, Heart Disease, JAMA / 30.09.2014

MedicalResearch.com Interview with: Marwan Badri MBChB, MRCP Cardiovascular disease fellow Lankenau Medical Center Wynnewood Pa Medical Research : What is the background for this study? Dr. Badri: Recent years witnessed increased emphasis of the role of clinical guidelines in cardiovascular care. Physicians are encouraged to practice within the framework of major society guidelines to deliver better, more cost-effective patient care. It is therefore vital that the recommendations in these guidelines are applicable to most of the patient population. Since some clinical trials have been shown in the past to unfavorably exclude women, racial minorities and elderly patients, we conducted this study to see if the clinical trials used to form the American College of Cardiology/American Heart Association adequately represent these patient groups. (more…)
Author Interviews, JAMA, Mental Health Research, Weight Research / 27.09.2014

Stewart Agras, M.D. Professor of Psychiatry Emeritus Stanford University School of MedicineMedicalResearch.com Interview with: Stewart Agras, M.D. Professor of Psychiatry Emeritus Stanford University School of Medicine MedicalResearch: What was the study about? Dr. Agras: Family-based treatment (FBT) has been shown to be more effective than individual psychotherapy for the treatment of adolescent anorexia nervosa. This treatment focuses on helping the family to re-feed their child. The question posed in this study was whether Family-based treatment would have any advantages over Systemic family therapy (SyFT) focusing on family interactions that may affect the maintenance of the disorder. The participants were 164 adolescents with anorexia nervosa and their families – one of the largest studies of its type. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology / 27.09.2014

Dr. Song Hee Hong PhD Associate Professor, Health Outcomes and Policy Research Dept. Clinical Pharmacy University of Tennessee Health Science Center Memphis, TN 38163MedicalResearch.com Interview with: Dr. Song Hee Hong PhD Associate Professor, Health Outcomes and Policy Research Dept. Clinical Pharmacy University of Tennessee Health Science Center Memphis, TN 38163 Medical Research: What are the main findings of the study? Dr. Hong: Use of GDDP (generic drug discount programs) increased to 23.1% in 2010 from 3.6% of patients receiving any prescription drugs in 2007. Generic drug discount programs were more valued among the elderly, sicker and uninsured populations. The lower use of Generic drug discount programs among racial/ethnic minorities observed when the program was deployed no longer existed when the program matured. (more…)
Author Interviews, JAMA, Lancet / 25.09.2014

Prof Mika Kivimäki PhD Department of Epidemiology and Public Health, University College London, London, UK Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, FinlandMedicalResearch.com Interview with: Prof Mika Kivimäki PhD Department of Epidemiology and Public Health, University College London, London, UK Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland Medical Research: What are the main findings of the study? Prof. Kivimäki: In our study, we pooled published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia. Of them, 4963 individuals developed type 2 diabetes during the mean follow-up of 7.6 years. This is the largest study to date on this topic. In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group, but was null in the high socioeconomic status group. The association in the low socioeconomic status group did not change after taking into account age, sex, obesity, physical activity, and shift working. So, the association was very robust. In brief, the main finding of our meta-analysis is that the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups. (more…)
Author Interviews, Depression, JAMA / 23.09.2014

A001_C001_03160QMedicalResearch.com Interview with: Dr. Philippe Courtet MD PhD Centre Hospitalier Régional Universitaire de Montpellier, Institut National de la Santé et de la Récherche Médicale , Université Montpellier, Montpellier, France Fondation Fondamental, Créteil, France Medical Research: What are the main findings of the study? Dr. Courtet: Depressed outpatients who are beginning the treatment with a SSRI at higher dose than recommended present an increased risk (x2) of worsening of suicidal ideation during the first 6 weeks of treatment. This is consistent with the study by Miller et al published in the same journal few weeks ago, reporting a double risk of suicide attempt in young subjects (<24 yrs) who are begun an SSRI at higher dose than recommended. Our results showed that the increased suicide risk with the high dose of SSRI is not restricted to youngsters and is independent of the severity of the depression. (more…)
Author Interviews, JAMA / 23.09.2014

MedicalResearch.com Interview with: Todd C. Lee, MD, MPH Division of General Internal Medicine and Infectious Diseases Department of Medicine, McGill University Health Centre McGill Centre for Quality Improvement, Montreal, Quebec, Canada Medical Research: What are the main findings of the study? Dr. Lee: We found that in our cross-sectional study of six inpatient units in five hospitals that, in general, only 11% of patients were wearing lower body garments despite the fact that probably 55% of them could have been doing so.  The remainder were wearing open backed gowns.  When specifically asked, the majority of these patients would like to have been afforded the opportunity to wear more dignified attire and the patients were surprised that they were allowed to do so. (more…)
Author Interviews, Blood Pressure - Hypertension, General Medicine, JAMA, Kidney Disease / 22.09.2014

Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical CentMedicalResearch.com: Interview Invitation Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical Center Medical Research: What are the main findings of the study? Dr. Kovesdy: We applied the structure of a clinical trial of hypertension management to our cohort of >600,000 patients with prevalent Chronic Kidney Disease (CKD). We first identified patients with baseline uncontrolled hypertension (using the definition applied by the SPRINT trial), then isolated the ones who had a decline in their baseline systolic blood pressure to two different levels (<120 and 120-139 mmHg) in response to a concomitant increase in prescribed antihypertensives, similar to what would happen in a trial examining two different systolic blood pressure targets. We then matched patients in the two groups to end up with identical baseline characteristics, similar to a randomized trial. When we examined the all-cause mortality of these two groups, we found that the group with follow-up systolic blood pressure of <120 had a 70% higher mortality. (more…)
Author Interviews, JAMA, Pulmonary Disease / 20.09.2014

Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, OntarioMedicalResearch.com Interview with: Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, Ontario Medical Research: What are the main findings of the study? Dr. Gershon: Within a large real world population of people with COPD, those who initiated combination long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) were less likely to die or be hospitalized for COPD than those who initiated LABA alone. Further those who initiated LABA/ICS combination therapy did not appear to have more pneumonia or osteoporotic fractures – side effects that have been associated with ICS use—than those initiating LABA alone. A second interesting finding was that people with a co-diagnosis of asthma experienced a greater incremental benefit of LABA/ICS over LABA than people without a co-diagnosis of asthma. Finally, we found that people who were not also taking an inhaled long-acting anticholinergic medication experienced a greater incremental benefit of LABA/ICS over LABA than people who were. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA / 20.09.2014

MedicalResearch.com Interview  Dongyi (Tony) Du, MD, PhD Division of Epidemiology FDA/CDRH/OSB Medical Research: What are the main findings of the study? Dr. Du: The risk for death on the date of surgery was 60% higher for recipients of mechanical aortic valves than recipients of bioprosthetic aortic valves (OR, 1.61 [95%CI, 1.27-2.04; P < .001]; risk ratio [RR], 1.60). The risk difference decreased to 16% during the 30 days after the date of surgery (OR, 1.18 [95%CI, 1.09-1.28; P < .001]; RR, 1.16). The risk for operative mortality was 19% higher for recipients of mechanical compared with bioprosthetic valves (OR, 1.21 [95%CI, 1.13-1.30; P < .001]; RR, 1.19). The number needed to treat with mechanical valves to observe 1 additional death on the surgery date was 290; to observe 1 additional death within 30 days of surgery, 121. (more…)
JAMA, Ophthalmology / 20.09.2014

Szilárd Kiss, MD Director of Clinical Research Director of Compliance Associate Professor of Ophthalmology Weill Cornell Medical College NewYork-Presbyterian Hospital New York, New York 10021MedicalResearch.com Interview with: Szilárd Kiss, MD Director of Clinical Research Director of Compliance  Associate Professor of Ophthalmology Weill Cornell Medical College NewYork-Presbyterian Hospital New York, New York 10021 Medical Research: What is the background for your study? Dr. Kiss: There has been a good deal of publicity about bevacizumab (Avastin; a Genetech/Roche antibody originally developed for treatment of cancer but now used widely to treat macular degeneration and diabetic retinopathy) being prepared by (mostly unregulated) compounding pharmacies for injection into the eye, and being associated with pathogen contamination. (more…)
Author Interviews, Dermatology, JAMA, Metabolic Syndrome / 19.09.2014

MedicalResearch.com Interview : Iben Marie Miller, MD Department of Dermatology Roskilde Hospital, Roskilde Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Medical Research: What are the main findings of the study? Dr. Miller: Using a cross-sectional design based on data from a Hidradenitis Suppurativa (HS) group recruited from the hospital (32 individuals), an HS group recruited from the general population (326 individuals) and 14,851 individuals without Hidradenitis Suppurativa, we investigated a possible association of Hidradenitis Suppurativa and the metabolic syndrome. We found that the HS groups had 2 to 4 times odds of having the metabolic syndrome when compared to individuals without HS leaving Hidradenitis Suppurativa patients at a high cardiovascular risk. Furthermore, we found that the odds were higher for the HS group from the hospital in comparison to the Hidradenitis Suppurativa group from the general population. (more…)
Addiction, Author Interviews, JAMA, PTSD / 17.09.2014

Susan Mason, PhD, MPH Assistant Professor Division of Epidemiology and Community Health Minneapolis, MN 55454MedicalResearch.com Interview with: Susan Mason, PhD, MPH Assistant Professor Division of Epidemiology and Community Health Minneapolis, MN  55454   Medical Research: What are the main findings of the study? Dr. Mason: We examined 49,408 women enrolled in the Nurses' Health Study II to see if those who had experienced PTSD symptoms at some point in their lives were more likely than those without PTSD symptoms to meet the criteria for food addiction, a measure of perceived dependence on food. We found that the 8% of women with the most lifetime PTSD symptoms were about 2.7 times as likely to meet the criteria for food addiction as women with no lifetime PTSD symptoms. This translates to an elevation in food addiction prevalence from about 6% among women with no PTSD symptoms to about 16% in women with the most PTSD symptoms. (more…)
Author Interviews, JAMA, Surgical Research, Transplantation / 17.09.2014

Darren J. Malinoski, MD, FACS Assistant Chief of Surgery – Research and Education Chief, Section of Surgical Critical Care Portland VA Medical Center Associate Professor of Surgery Oregon Health & Science University Portland, OR 97207MedicalResearch.com Interview with: Darren J. Malinoski, MD, FACS Assistant Chief of Surgery – Research and Education Chief, Section of Surgical Critical Care Portland VA Medical Center Associate Professor of Surgery Oregon Health & Science University Portland, OR 97207 Medical Research: What are the main findings of the study?  Dr. Malinoski: Our two main findings are that the status of the DMG Bundle prior to organ recovery, at the end of the OPO donor management process, is the most predictive of the number of organs that will be transplanted per expanded criteria donor (ECD) and that the absolute increase in the number of individual DMG elements achieved over time also appears to be relevant.  Taken together, these two findings suggest that the number of organs that will be transplantable from each donor is not necessarily predetermined by their age, comorbidities, and pre-neurologic death condition, but that active critical care management has the ability to affect outcomes and reassessing each donor’s condition over time is necessary. (more…)
Author Interviews, JAMA, Weight Research / 17.09.2014

Aner Tal, PhD Food and Brand Lab Department of Applied Economics and Management Cornell University, Ithaca, New YorkMedicalResearch.com Interview with: Aner Tal, PhD Food and Brand Lab Department of Applied Economics and Management Cornell University, Ithaca, New York Medical Research: What are the main findings of the study? Dr. Tal: Some TV programs might lead people to eat twice as much as other programs. “We find that if you’re watching an action movie while snacking your mouth will see more action too!” says Aner Tal, Ph.D. lead author on the new article just published in the Journal of the American Medical Association: Internal Medicine. “In other words, the more distracting the program is the more you will eat.” In the study 94 undergraduates snacked on M&Ms, cookies, carrots and grapes while watching 20 minutes of television programming. A third of the participants watched a segment of the action movie The Island, a third watched a segment from the talk show, the Charlie Rose Show, and a third watched the same segment from The Island without sound. “People who were watching The Island ate almost twice as many snacks – 98% more than those watching the talk show!” says co-author Brian Wansink, author of Slim by Design (forthcoming) and Professor and Director of the Cornell Food and Brand Lab. “Even those watching “The Island” without sound ate 36% more.” People watching the more distracting content also consumed more calories, with 354 calories consumed by those watching The Island (314 calories with no sound) compared to 215 calories consumed by those watching the Charlie Rose Show. “More stimulating programs that are fast paced, include many camera cuts, really draw you in and distract you from what you are eating. They can make you eat more because you're paying less attention to how much you are putting in your mouth,” explains Tal. Because of this, programs that engage viewers more might wind up being worse for their diets. (more…)
Author Interviews, JAMA, Thromboembolism / 17.09.2014

Dr. Marc Carrier, MD MSc Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute Physician, Hematology (Thrombosis), The Ottawa Hospital Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of OttawaMedicalResearch.com Interview with: Dr. Marc Carrier, MD MSc Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute Physician, Hematology, The Ottawa Hospital Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of Ottawa MedicalResearch.com: What are the main findings of this study? Dr. Carrier: Venous thromboembolism (VTE), comprised of deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular death. There are many anticoagulant treatments available but there is little guidance about which treatment is most effective and safe. This systematic review and network meta-analysis evaluated eight different treatment options for acute Venous thromboembolism.  Forty-five trials were included in the analysis and there were no significant differences in clinical or safety outcomes associated with most treatment options when compared to the combination of LMWH-VKA.. (more…)
Author Interviews, General Medicine, JAMA, Pediatrics / 17.09.2014

Lex W Doyle MD BS MSc FRACP Professor of Neonatal Paediatrics Department of Obstetrics and Gynaecology The Royal Women’s Hospital Parkville, Victoria, AustraliaMedicalResearch.com Interview with: Lex W Doyle MD BS MSc FRACP Professor of Neonatal Paediatrics Department of Obstetrics and Gynaecology The Royal Women’s Hospital Parkville, Victoria, Australia Medical Research: What are the main findings of the study? Dr. Doyle: From collectively pooling data from five large trials carried out around the world over the past 20 years, we know that magnesium sulfate given under strict medical protocols in hospital to women threatening to deliver preterm reduces the risk of cerebral  palsy in their children in early childhood.  Following  from this knowledge, magnesium sulfate is now given routinely to women, under strict medical conditions, who are threatening to deliver very early in Australia, and in other parts of the world, to try to prevent cerebral palsy in their child.  What we do not know is if magnesium sulfate used this way has any longer-term effects on the brain or on other important outcomes. One of the initial studies that contributed to the overall evidence about cerebral palsy was carried out in Australia and New Zealand and completed more than 10 years ago.  Over 1000 women and their babies were enrolled in that study and although the rate of cerebral palsy was not substantially reduced by magnesium sulfate in our study, we showed that there were fewer children at 2 years of age who were not walking in the group whose mothers were given magnesium compared with those whose mothers were given placebo.  With this knowledge, and given the unknown longer-term benefits or risks, we re-evaluated the children from our study at school-age, between 6-11 years of age.  We thoroughly evaluated their brain function, including movement and co-ordination, thinking ability, behaviour, and school progress, as well as general health and well-being.  The basic message from our longer-term study is that magnesium sulfate, as used in our trial, does not have any substantial benefits or harms on brain or cognitive function, or any other outcome at school age. (more…)
Author Interviews, JAMA, Stroke / 16.09.2014

Silvia Koton, PhD, MOccH, RN Chair, Department of Nursing The Stanley Steyer School of Health Professions Tel Aviv University Tel Aviv, IsraelMedicalResearch.com Interview with: Silvia Koton, PhD, MOccH, RN Chair, Department of Nursing The Stanley Steyer School of Health Professions Tel Aviv University Tel Aviv, Israel Medical Research: What are the main findings of the study? Dr. Koton: Based on data on 14,357 participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of stroke when the study began in 1987 and followed until the end of 2011, we found a 24 percent overall decline in first-time strokes in each of the last two decades and a 20 percent overall drop per decade in deaths after stroke. The results were similar across race and gender, but varied by age: the decline in stroke risk was concentrated mainly in the over-65 set, while the decrease in stroke-related deaths was primarily found among those under age 65. (more…)
Author Interviews, CDC, Gender Differences, JAMA, Weight Research / 16.09.2014

MedicalResearch.com Interview with:  Earl S. Ford, MD, MPH Medical officer, U.S Public Health Service Centers for Disease Control and Prevention Atlanta, GA 30341 Medical Research: What are the main findings of the study? Dr. Ford:  The main finding of the study is that mean waist circumference and the prevalence of abdominal obesity in US adults have increased since 1999-2000 and that these increases are being driven primarily by trends in women. Mean waist circumference and the percentage of abdominal obesity in men has been relatively stable since 2003-2004. (more…)
Author Interviews, JAMA, Ophthalmology, Telemedicine / 11.09.2014

Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GeorgiaMedicalResearch.com Interview with: Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine,  Atlanta, Georgia Medical Research: What are the main findings of the study? Dr. Lynch:
  • Since 2006, the VA has been systematically using teleretinal screening of patients with diabetes to screen for retinopathy in the Primary Care Clinics. Under this program, 90% of veterans with diabetes are evaluated on a regular basis. A number of patients who are screened have findings that warrant a face-to-face ophthalmic exam. No information exists on the effect of such a program on medical center resources.
  • 1,935 patients  underwent teleretinal screening through the Atlanta VA over a 6 month period.  We reviewed the charts of the 465 (24%) of the patients who were referred for a face to face exam in the Eye Clinic.
  • Data was collected for these patients to determine the reasons for referral, the accuracy of the teleretinal interpretation, the resources needed in the Eye Clinic of the Medical Center to evaluate and care for the referred patients over a two year period and possible barriers to patient care.
  • Of the 465 patients referred for an exam, 260 (55.9%) actually came in for an exam. Community notes were available for an additional 66 patients. Information was available for 326 (70.1%) of the referred patients.
  • The most common referring diagnoses were nonmacular diabetic retinopathy (43.2% of referrals), nerve related issues (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%) and diabetic macular edema (5.6%).
  • 16.9% of the referred patients had 2 or more concurrent problems that put them at high risk for visual loss.
  • The percentage agreement between teleretinal screening and the ophthalmic exam was high: 90.4%. Overall sensitivity was 73.6%. The detection of diabetic macular edema had the lowest sensitivity.
  • A visually significant condition was detected for the first time through teleretinal screening for 142 of the patients examined (43.6%).
  • The resource burden to care for referred patients was substantial.
  • 36% of patients required 3 or more visits over the ensuing 2 year period.
  • The treatment of diabetic macular edema had the highest resource use involving on average 5 clinic visits, 6 diagnostic procedures and 2 surgical procedures
  • The most common non-refractive diagnostic procedures were visual fields and optical coherence tomography.
  • The average cost to care for the referred patients (in Medicare dollars) in work RVUs alone was approximately $1,000 per patient. The cost to care for a patient with diabetic macular edema was $2673.36.
(more…)
Author Interviews, Dermatology, JAMA, NIH, Transplantation / 11.09.2014

MedicalResearch.com Interview with: Rena Zuo, BA MD Candidate at Duke University School of Medicine and Edward W. Cowen, MD, MHSc Senior Clinician Head, Dermatology Consultation Service Dermatology Branch Center for Cancer Research National Cancer Institute National Institutes of Health MedicalResearch: What are the main findings of the study?
 Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood. Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed. Several particularly interesting results were found:
  1. Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
  2. Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
  3. Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.
(more…)
Author Interviews, Dermatology, Gastrointestinal Disease, JAMA, Mayo Clinic / 11.09.2014

Shadi Rashtak, MD Department of Dermatology Mayo Clinic College of Medicine Rochester, MinnesotaMedicalResearch.com Interview with: Shadi Rashtak, MD Department of Dermatology Mayo Clinic College of Medicine Rochester, Minnesota Medical Research:  What are the main findings of the study? Dr. Rashtak: We found that among a population of mainly acne patients those who received isotretinoin had a lower risk of inflammatory bowel disease as compared to those who did not take this medication. We carefully reviewed the medical records of patients to ensure that this finding was not simply because the drug was avoided in patients with a previous personal or family history of IBD. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 10.09.2014

Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461MedicalResearch.com Interview with: Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461 Medical Research:  What are the main findings of the study? Dr. Gershengorn: Using a large national database, we found there to be no association between the use of arterial catheters and mortality in mechanically ventilated medical intensive care unit patients. Similarly, we found no beneficial association between arterial catheters and mortality in any of the eight other critically ill subgroups evaluated. (more…)
Author Interviews, Cost of Health Care, JAMA / 09.09.2014

Michael Johansen, MD MS Assistant Professor Dept of Family Medicine Ohio State UniversityMedicalResearch.com Interview with: Michael Johansen, MD MS Assistant Professor Dept of Family Medicine Ohio State University Medical Research: What are the main findings of the study? Dr. Johansen: Between 2007-2011, the United States spent $63.4 billion on high-cost proton pump inhibitors of which $47.1 billion was in excess of using generic omeprazole. (more…)
Author Interviews, JAMA, Ophthalmology / 06.09.2014

Louis R. Pasquale, MD Channing Division of Network Medicine Department of Ophthalmology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MassachusettsMedicalResearch.com Interview with: Louis R. Pasquale, MD Channing Division of Network Medicine Department of Ophthalmology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, Massachusetts Medical Research: What are the main findings of the study? Dr. Pasquale: We found that more time spent outdoors in summer was associated with increased risk of exfoliation syndrome. (more…)