Social Media Seen As Important Resource For LVAD Patients and Caregivers

Dr. Kristin Kostick PhD on behalf of the authors Research Associate - Decision Making and Ethics Research Program Center for Medical Ethics and Health Policy Baylor College of Medicine Houston, TXMedicalResearch.com Interview with:
Dr. Kristin Kostick PhD on behalf of the authors
Research Associate – Decision Making and Ethics Research Program
Center for Medical Ethics and Health Policy
Baylor College of Medicine
Houston, TX

Medical Research: What is the background for this study? What are the main findings?

Response: The idea of this study came from a larger research study we’re doing to develop and test a decision aid for patients and caregivers considering LVAD treatment. As part of that study, we interviewed LVAD patients, candidates, caregivers and decliners of LVAD treatment to explore their decisional needs. One of the things that kept coming up in these interviews was the need for “support,” which everyone, including clinicians, identified as a crucial aspect of post-implant recovery. There is an excellent clinical support team at our partnering hospital in Houston, as well as a community of LVAD recipients and caregivers where people can get together to share their stories and resources face-to-face. But for other people who find it difficult to get to the hospital, either because they have transportation barriers or they simply live too far away, we began to wonder whether support services might be available to them in virtual settings. So we decided to do this analysis to see what social media sites exist for the LVAD community. What is the content of these sites? Are there different kinds for different support needs? What are patients getting from them? How might they be used in the future for improving patient care and support?

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No Knee-Jerk Antibiotics Campaign Aims To Reduce Antibiotic Overusage

Barbara W. Trautner, MD, PhD Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center Section of Infectious Diseases, Department of Medicine Baylor College of Medicine, Houston, TexasMedicalResearch.com Interview with:
Barbara W. Trautner, MD, PhD
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
Section of Infectious Diseases
Department of Medicine
Baylor College of Medicine, Houston, Texas

Medical Research: What is the background for this study? What are the main findings?

Dr. Trautner: Reducing antimicrobial overuse, or antimicrobial stewardship, is a national imperative. If we fail to optimize and limit use of these precious resources, we may lose effective antimicrobial therapy in the future. CDC estimates that more than $1 billion is spent on unnecessary antibiotics annually, and that drug-resistant pathogens cause 2 million illnesses and 23,000 deaths in the U.S. each year. The use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized and nursing home patients, especially among patients with urinary catheters. In catheterized patients, ASB is very often misdiagnosed and treated as catheter-associated urinary tract infection (CAUTI). Therefore, we designed the “Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign intervention” to reduce overtreatment of ASB and to reduce the confusion about distinguishing CAUTI from asymptomatic bacteriuria.

This study evaluated the effectiveness of the Kicking CAUTI intervention in two VAMCs between July 2010 and June 2013. The primary outcomes were urine cultures ordered per 1,000 bed-days (inappropriate screening for ASB) and cases of ASB receiving antibiotics (overtreatment). The study included 289,754 total bed days, with 170,345 at the intervention site and 119,409 at the comparison site. Through this campaign, researchers were able to dramatically decrease the number of urine cultures ordered. At the intervention site, the total number of urine cultures ordered decreased by 71 percent over the course of the intervention. Antibiotic treatment of asymptomatic bacteriuria decreased by more than 75 percent during the study. No significant changes occurred at the comparison site over the same time period. Failure to treat catheter-associated urinary tract infection when indicated did not increase at either site. Continue reading

Tall Women More Susceptible To Colon Cancer

Dr. Aaron P. Thrift PhD Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle, WA.MedicalResearch.com Interview with:
Aaron P. Thrift, Ph.D.
Assistant Professor, Department of Medicine
Dan L. Duncan Cancer Center
Baylor College of Medicine
Houston, TX 77030-3498

Medical Research: What is the background for this study? What are the main findings?

Dr. Thrift: Greater attained adult height is associated with increased risk of all cancers combined; however, the association may differ by cancer site and between women and men. For colorectal cancer, epidemiological studies suggest that the association with height may be stronger for women than for men. We used data from over 10,000 patients with colorectal cancer and over 10,000 population-based controls and conducted multiple analyses, including using Mendelian randomization (which incorporates genomic data with traditional approaches) to overcome potential issues of confounding and bias in observational studies, to further examine the association between height and risk of colorectal cancer. Overall, we found that taller height was associated with increased risk of colorectal cancer (8% increased risk per 10cm increase in height). When we examined women and men separately, our results strongly suggest that height is causally associated with colorectal cancer risk for women, whereas there was weaker evidence for a causal association between height and colorectal cancer risk for men.

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Poor Sleep May Contribute To Lower Urinary Tract Symptoms in Men

MedicalResearch.com Interview with:
Alexander W. Pastuszak, MD, PhD
Male Reproductive Medicine and Surgery
Scott Department of Urology
Jason Malcolm Scovell
Medical Student, Ofc SA-BCM Students
Baylor College of Medicine
Houston, TX

Medical Research: What is the background for this study? What are the main findings?

Response: Sleep quality is an important component of overall health, and can both exacerbate health issues and be impaired by health problems. Shift workers, primarily those who do not work standard daylight shifts, are prone to sleep problems, a significant concern in light of the fact that up to 25% of the U.S. workforce is comprised of shift workers. As men age, the prevalence of Lower Urinary Tract Symptoms (LUTS), which include urgency, frequency, waking up at night to urinate, and difficulties with urination, increases.  Unsurprisingly, men with LUTS report poor sleep in part due to awakening repeatedly during the night. We studied a group of male shift workers, who we believe to be an ‘at-risk’ population, and found that not only do the men who report worse sleep quality have worse Lower Urinary Tract Symptoms, but also men who report difficulty falling asleep have more severe LUTS than those who do not. This latter point is significant, given that most men with LUTS can fall asleep without difficulty, but then awaken repeatedly throughout the night, and suggests that sleep difficulties in this population may be resulting in Lower Urinary Tract Symptoms rather than LUTS exclusively resulting in sleep difficulties.

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Screening Men with ED For Heart Disease May Be Cost Effective

Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX MedicalResearch.com Interview with:
Alexander W. Pastuszak, MD, PhD
Male Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine Houston, TX

 

Medical Research: What is the background for this study?

Dr. Pastuszak: The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been growing stronger in recent years, and recommendations have recently been made to screen men with ED for CVD risk factors.  The arteries in the penis are much smaller than those in the heart, and if vascular disease contributes to ED, which we know it does, then ED should be detected before CVD in affected men.  We also know that treating men with CVD risk factors results in improvement in their risk of having acute cardiovascular events (i.e. heart attack, stroke, etc.).  Because of these relationships, we wanted to assess the economic impact of screening men with erectile dysfunction for CVD, identifying men with CVD risk factors, and treating these men on the incidence of cardiovascular events and new cases of ED.  Specifically, we wanted to look at the costs associated with screening and treatment of CVD and erectile dysfunction, and the cost savings resulting from screening and treating men with CVD risk factors and ED when preventing acute cardiovascular events.

Medical Research: What are the main findings?

Dr. Pastuszak: We modeled the reduction in acute cardiovascular events and the associated cost savings over 20 years.  We predicted that approximately 5.8 million men with both CVD and ED would be identified over 20 years if we screened men with ED for CVD risk factors, and the cost of this screening would be $2.7 billion.  We assumed that if we treated these at-risk men, there would be an approximately 20% decrease in cardiovascular events, which would prevent 1.1 million cardiovascular events over 20 years, saving $21.3 billion that would otherwise be put to treatment of these acute events.  Since ED and CVD arise from the same pathology, we predicted that in treating the CVD risk factors, a similar decrease in ED cases would be seen as well, which would save $9.7 billion that would otherwise be put to ED treatment.  In screening these men, a combined $28.5 billion would be saved over 20 years.

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Pathways to Breast Cancer Bone Metastases Identified

Dr. Xiang (Shawn) Zhang PhD Assistant Professor Department of Molecular and Cellular Biology Lester and Sue Smith Breast Center Baylor College of Medicine Houston, TexasMedicalResearch.com Interview with:
Dr. Xiang (Shawn) Zhang PhD

Assistant Professor
Department of Molecular and Cellular Biology
Lester and Sue Smith Breast Center
Baylor College of Medicine Houston, Texas

 

Medical Research: What is the background for this study? What are the main findings?

Response: Bone metastases present a major clinical problem for oncologists. They are very painful and unpleasant due to the ability of metastatic cells to dissolve bones, and if they spread to the spine or vertebrate bone they  the spinal cord compression could cause paralysis. There is a gap in our knowledge about bone metastasis in breast cancer. We know a lot about when they are fully established and already dissolving the bone, but little about what happens early on, right after the cancer cells get there but before they start the bone-dissolving process.

In the study, we revealed that in the early stages, when there are only a few cancer cells, these cells tend to locate themselves in a microenvironment that is enriched in bone making cells called osteoblasts whose normal job is to help make new bones. The cancer cells appear to be surrounded by these bone-making cells before they acquire the ability to dissolve bones.

We also uncovered the pathway that gets activated when the cancer cells lodge into the bone-making cells, and helps them progress to more malignant metastases. The action is mediated by a class of proteins that helps bind the cancer cells to the bone tissue called heterotypic adherens junctions (hAJs) involving the adherens proteins E-cadherin (cancer-derived) and N-cadherin (bone-promoting). This then activates the mTOR pathway in cancer cells, which drives the progression from single cells to metastases.

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Sleep in Young Adults Important For Later Life Cognitive Function

Michael K. Scullin, Ph.D. Principal Investigator of the Sleep Neuroscience & Cognition (SNaC) Laboratory and an Assistant Professor of Psychology & Neuroscience Director Sleep Neuroscience and Cognition Laboratory Baylor UniversityMedicalResearch.com Interview with:
Michael K. Scullin, Ph.D.
Principal Investigator of the Sleep Neuroscience & Cognition (SNaC) Laboratory and an Assistant Professor of Psychology & Neuroscience Director Sleep Neuroscience and Cognition Laboratory Baylor University

Medical Research: What is the background for this study? What are the main findings?

Dr. Scullin: One of the purposes of sleep in healthy adults is to optimize cognitive functioning. When we lose out on a few hours of sleep we tend not to be able to focus or think as well as when we get enough sleep (typically 8 hours). Even more interesting is that particular aspects of sleep physiology—our deepest levels of sleep known as slow wave sleep and rapid eye movement sleep—are essential to our brain’s ability to take the information that we learn during the day and stabilize those memories so that we can use them in the future.

Sleep quantity and quality change markedly across the lifespan, though there are individual differences in how much one’s sleep changes. Our work was concerned with the possible long-term repercussions of cutting back on sleep and getting lower quality sleep (less slow wave sleep and rapid eye movement sleep).  We reviewed approximately 200 scientific articles on this topic and we found that the amount of total sleep and the quality of that sleep is important to cognitive and memory functioning in young adults and middle-aged adults and can even predict how well someone’s cognitive functioning will be decades later. Thus, if you’re sleeping well when you are 40 then you are investing in preserving your mental functioning at age 50.

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Mental Health Services Linked To Lower Suicide Rate in Large HMO

M. Justin Coffey MD Associate Professor Menninger Department of Psychiatry & Behavioral Sciences Baylor College of MedicineMedicalResearch.com Interview with:
M. Justin Coffey MD
Associate Professor
Menninger Department of Psychiatry & Behavioral Sciences
Baylor College of Medicine

MedicalResearch: What is the background for this study? What are the main findings?


Dr. Coffey:
Although both the US Surgeon General and the Institute of Medicine have called on health care systems to reduce suicide, the few assessments of suicide in such systems have examined only specific patient groups and not the entire population of health plan members. Our study reports the first information on suicide for the entire membership of a large health maintenance organization (HMO). The findings provide a previously unavailable baseline data for health care systems who are engaged in important efforts to measure and prevent suicide.

We identified all suicides among the entire membership of our HMO network between 1999 and 2010, determining the date and cause of death using official state mortality records. In our sample, the annual suicide rate among all HMO members (including non-patient members) did not change over time, whereas the annual suicide rate in the general population of the state of Michigan increased significantly. Importantly, suicides actually decreased among HMO members who received specialty mental health services, whereas suicides increased among HMO members who accessed general medical services but not specialty mental health services.  
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Study Examines Follow-up Of Abnormal Radiology Results

MedicalResearch.com Interview with:
Aymer Al-Mutairi, MD
Primary Care Research fellow
Dept. Family and Community Medicine
Baylor College of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Al-Mutairi: Previous studies indicate that 8% of abnormal imaging results did not receive follow-up actions by referring providers within 4 weeks. In addition, abnormal imaging results often state recommendations for further testing and radiology reports occasionally contain language that conveys doubt regarding the results.

We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up. We found that patients with abnormal imaging results where radiologists recommended further imaging were less likely to be followed-up by a treating clinician within 4 weeks compared with patients without such recommendations. Expression of “doubt” in the radiology reports did not affect follow-up actions.

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Running Does Not Lead To Knee Osteoarthritis

Dr. Grace Hsiao-Wei Lo Baylor College of Medicine Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine Faculty, Immunology, Allergy, and Rheumatology Section, Michael E. DeBakey VA Medical CenterMedicalResearch.com Interview with:
Dr. Grace Hsiao-Wei Lo
Baylor College of Medicine
Assistant Professor, Section of Immunology, Allergy and Rheumatology,  Department of Medicine, Baylor College of Medicine
Faculty, Immunology, Allergy, and Rheumatology Section,
Michael E. DeBakey VA Medical Center

Medical Research:What is the background for this study? What are the main findings?

Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee.  There is concern that chronic repetitive loading of the knee could physically damage structures within the knee.  Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis.  Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable.  Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality.

To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6.  Twenty-nine percent of the participants reported that they ran at some time in their lives.

Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older.

Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA.

After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded.  Continue reading

Traumatic Brain Injury: Maintaining Hemoglobin With Transfusions or EPO Found Not Helpful

Claudia Robertson, MD Professor, Department of Neurosurgery Baylor College of Medicine One Baylor Plaza Houston, Texas 77030MedicalResearch.com Interview with:
Claudia Robertson, MD
Professor, Department of Neurosurgery
Baylor College of Medicine
One Baylor Plaza
Houston, Texas 77030

Medical Research: What are the main findings of the study?

Dr. Robertson: We studied two issues related to treatment of anemia after severe traumatic brain injury.

One issue was the optimal hemoglobin transfusion threshold for this subgroup of critically ill patients, and the second issue was use of erythropoietin to increase hemoglobin concentration and reduce the need for transfusion.  For the transfusion threshold, we found that there was no difference in long-term neurological outcome when patients were transfused at a hemoglobin concentration of less than 7 g/dl compared to those transfused at less than 10 g/dl.  In addition, there was an increased risk of thromboembolic events in those transfused at less than 10 g/dl.  With administration of erythropoietin, we found no improvements in neurological outcome, and no increase in hemoglobin concentration or reduction in the need for transfusion.

Medical Research: Were any of the findings unexpected?

Dr. Robertson: It has been believed that maintaining hemoglobin concentration at least 10 g/dl is an important management practice to reduce secondary injury to the brain.  This study does not support that practice.

Medical Research: What should clinicians and patients take away from your report?

Dr. Robertson: The major message is that patients with traumatic brain injury should be managed the same as other critically ill patients with a restrictive transfusion practice.  There is no advantage to maintaining hemoglobin concentration at a higher level, and there is some risk of transfusion related complications.  There is also no support from this study for use of erythropoietin in patients with traumatic brain injury.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Robertson: The findings with erythropoietin were disappointing because there have been many studies in experimental models of brain injury showing neuroprotection.  It is possible that we are not able to give high enough doses of erythropoietin in patients because of potential side effects and that derivatives of erythropoietin which do not have these side effects may still be of interest for future clinical trials.

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Electronic Health Records Can Present Ongoing Patient Safety Concerns

Dr. Hardeep Singh MD, MPH Chief the Health Policy, Quality & Informatics Program Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center in Houston, Texas Associate professor at Baylor College of MedicineMedicalResearch.com Interview with:
Dr. Hardeep Singh MD, MPH
Chief the Health Policy, Quality & Informatics Program
Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine

MedicalResearch: What are the main findings of the study?

Dr. Singh: EHRs use can prompt new patient safety concerns, and many of these problems are complex and difficult to detect. We sought to better understand the nature of these patient safety concerns and reviewed 100 closed investigations involving 344 technology-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA).

We evaluated safety concerns related to technology itself as well as human and operational factors such as user behaviors, clinical workflow demands, and organizational policies and procedures involving technology. Three quarters of the investigations involved unsafe technology while the remainder involved unsafe use of technology. Most (70%) investigations identified a mix of 2 or more technical and/or non-technical underlying factors.

The most common types of safety concerns were related to the display of information in the EHR; software upgrades or modifications; and transmission of data between different components of the EHR system.

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Does Testosterone Lower Risk of Heart Attacks and Stroke?

Robert S. Tan MD, MBA, AGSFMedicalresearch.com Interview with:
Robert S. Tan MD, MBA, AGSF
Clinical Director & Chief Geriatrics, Michael DeBakey VAMC
Director, Opal Medical, LLC
Clinical Professor of Family & Community Medicine, UTHSC-Houston
Associate Professor of Medicine (Geriatrics), Baylor College Medicine

Medicalresearch: What are the main findings of the study?

Dr. Tan: Our findings¹ are similar to that of an early study by Shores et al ² and other studies on endogenous testosterone that found testosterone lowered mortality. In the analysis of 39,937 patients at the Low T Centers up to 5 years, the rate ratios of new MI and strokes on testosterone as compared to general community based data sets (3,4) was 0.12 (C.I. 0.08-0.18, p<0.0001) and 0.05 (C.I 0.02-0.13, p<0.0001) respectively. Thus, there appears to be a lower risk of heart attacks and strokes with patients on testosterone. While the compared population sets are not identical or real controls; our study does suggest that rates of MI and strokes in real life practice with testosterone treated patients are even lower than the general population registries (which may include older patients).
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Tdap Vaccine During Pregnancy: Safety and Efficacy

Flor M. Munoz, MD  Department of Pediatrics Department of Molecular Virology and Microbiology Baylor College of Medicine, Houston, Texas MedicalResearch.com Interview with:
Flor M. Munoz, MD
Department of Pediatrics
Department of Molecular Virology and Microbiology
Baylor College of Medicine, Houston, Texas


MedicalResearch.com: What are the main findings of the study?

Dr. Munoz:

1. Tdap vaccine was safe and well tolerated during pregnancy

2. Women who are pregnant have adequate responses to the Tdap vaccine, similar to those of women who are not pregnant.

3. Antibodies to pertussis are efficiently transferred to the fetus through the placenta so that babies of mothers who were vaccinated during pregnancy had significantly higher concentrations of antibody at birth and up to 2 months of age, when compared to infants of mothers who were vaccinated post-partum.

4. Higher antibody concentrations in the first two months of life are likely to provide protection against pertussis during this period of high vulnerability

5. Infants of mothers who were vaccinated during pregnancy had adequate responses to their routine pertussis vaccines at 2, 4, and 6 months of age, and had expected and adequate responses to their 4th dose of vaccine at 1 year of age. The absolute concentration of antibodies to some of the pertussis antigens might be modestly lower after the primary series of vaccines in some infants of mothers who were vaccinated during pregnancy, but this difference does not persist after the 4th dose.
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Medical Diagnostic Errors Occur In About 5% of US Adults

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 HoustonMedicalResearch.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.

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Alzheimer’s Disease: Solanezumab Trials for Mild to Moderate Disease

Rachelle S. Doody, M.D.,Ph.D. Effie Marie Cain Chair in Alzheimer's Disease Research Director, Alzheimer's Disease and Memory Disorders Center Baylor College of Medicine-Department of Neurology Houston, Texas 77030: MedicalResearch.com MedicalResearch.com Interview with:
Rachelle S. Doody, M.D.,Ph.D.
Effie Marie Cain Chair in Alzheimer’s Disease Research
Director, Alzheimer’s Disease and Memory Disorders Center
Baylor College of Medicine-Department of Neurology
Houston, Texas 77030: MedicalResearch.com

MedicalResearch.com: What are the main findings of the study? 

Dr. Doody: The study set out to see whether the antibody infusion treatment, Solanezumab, would improve the course of mild to moderate Alzheimer’s disease in the ways necessary to gain drug approval.  Unfortunately, the results did not support an approvable treatment for this purpose.
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High Volume Hospitals and Discharge to Home after Colon Surgery

MedicalResearch.com Interview with:
Daniel A. Anaya, MD, FACS
Associate Professor of Surgery – Surgical Oncology
Michael E. DeBakey Department of Surgery
Baylor College of Medicine
Chief, General Surgery & Surgical Oncology SectionDirector, Liver Tumor Program
Michael E. DeBakey VA Medical Center Houston, TX 77030

and
Dr. Courtney J. Balentine, MD
First author and surgical resident at Baylor College of Medicine

MedicalResearch.com: What are the main findings of the study?

Dr. Anaya:  That a good proportion of patients having colorectal operations will need additional assistance to recover during the postoperative period, resulting in being discharged to other facilities (nursing facilities, skilled care, etc) after surgery, and that hospitals where a higher-volume of colorectal operations are performed are more likely to discharge patients back to home after surgery.
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Coronary Artery Bypass Grafting: On-Pump vs Off-Pump Trends and Mortality

Faisal G. Bakaeen, MD FACS Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, TexasMedicalResearch.com Interview with:
Faisal G. Bakaeen, MD FACS
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas

 

MedicalResearch.com: What are the main findings of the study?

Dr. Bakaeen:  The relative use of off-pump CABG peaked at 24% in 2003, followed by a slow decline after that to about 19%. In addition, the conversion rate from off- to on-pump decreased with time and has stayed below 3.5% in recent years. Perioperative mortality rates decreased over time for both on- and off-pump CABG and have stayed below 2% since 2006. The mortality associated with converted cases was high regardless of the surgery year.
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Hypertension Control: Financial Incentives Effects

Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) 2002 Holcombe Blvd. Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine www.houston.hsrd.research.va.govAshley Motter HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical CenterMedicalResearch.com Interview with:
Laura A. Petersen, MD, MPH

MEDVAMC Associate Chief of Staff, Research
Director, VA HSR&D Center of Excellence (152)
Houston TX 77030
Professor of Medicine
Chief, Section of Health Services Research
Baylor College of Medicine
HSR&D Center of Excellence
Michael E. DeBakey Veterans Affairs Medical Center
Houston, Texas 77030

MedicalResearch.com: What are the main findings of the study?

Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension.  The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups.  Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year.  The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant.  None of the incentives resulted in increased incidence of hypotension compared with controls.  While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group.  The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000.
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Coronary Heart Disease : What Correlates with Repeat Lipid Testing?

 MedicalResearch.com Interview with Salim S. Virani, MD, PhD

Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine,
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas

MedicalResearch.com: What are the main findings of the study?

Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients.  Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up.

Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing.
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Blood Tests May Hold Clues to Pace of Alzheimer’s Disease Progression

Release Date: 10/03/2011

Johns Hopkins-led research suggests levels of certain fats in blood might predict rate of cognitive decline.

A team of scientists, led by Johns Hopkins researchers, say they may have found a way to predict how quickly patients with Alzheimer’s disease (AD) will lose cognitive function by looking at ratios of two fatty compounds in their blood. The finding, they say, could provide useful information to families and caregivers, and might also suggest treatment targets for this heartbreaking and incurable neurodegenerative disorder.

Past research has shown that cognitive function declines at different rates in AD patients, with roughly one-third not declining at all in five years, one-third declining at a moderate rate, and the other third declining quickly. Accurately predicting the pace of cognitive decline would help patients and caregivers better prepare and, if treatments are developed, help doctors aggressively target those whose descent into dementia is likely to be accelerated. Currently there are no predictably effective treatments that prevent, slow or stop AD, though the researchers caution that more studies need to be done before their blood fat test proves its value.

“We’re confident there’s a relationship between these lipids and AD progression, but this work is not yet ready to be used clinically,” according to Michelle Mielke, Ph.D., adjunct assistant professor of psychiatry at the Johns Hopkins University School of Medicine and lead author of an article about the work published in the Journal of Alzheimer’s Disease.

Mielke’s team analyzed data from 120 probable Alzheimer’s patients at the Alzheimer’s Disease and Memory Disorders Center at Baylor College of Medicine in Texas, measuring a variety of fats found in the patients’ blood, as well as conducting cognitive assessments during an average of 4.2 visits over 2.3 years. The researchers found that the higher the level of plasma sphingomyelins and the lower the level of ceramide — two types of fat found in cells throughout the body — the slower the progression of the dementia of Alzheimer’s disease.

Although the researchers emphasize that the link between the fats and AD is not well understood, ceramides are involved in inflammation and cell death. If there are fewer of these cell-killing ceramides circulating — which in turn may be killing off fewer important brain cells — the result may be slower disease progression, Mielke says. Meanwhile, a previous study by Mielke and her team showed that higher ceramide levels were associated with greater shrinkage of the brain’s memory center over one year in patients with mild cognitive impairment. Basic science data has also linked ceramide levels and levels of the protein amyloid beta, the accumulation of which has been tied to Alzheimer’s disease.

If the blood fat ratios do turn out to be important, Mielke says there may be ways to use this discovery to slow cognitive decline. For example, an enzyme known as sphingomyelinase metabolizes sphingomyelins into ceramides. It is possible, she says, that if a sphingomyelinase inhibitor were used to slow down the process of breaking down sphingomyelins into ceramides, the progression of the disease could be interrupted.

Though much research has been done to find ways to halt Alzheimer’s, so far the only approved therapy treats symptoms of cognitive decline in some patients for a short period of time. It does nothing to alter the course of the disease.

“And none of the other compounds in clinical trials to date are showing any benefits,” says Mielke, who is also an associate consultant in the division of epidemiology at the Mayo Clinic. “Perhaps we need to shift our focus. The answers could be in these lipids, which can be measured in the blood.”

Other Hopkins researchers contributing to this work include Norman J. Haughey, Ph.D.; Vera Venkata Ratnam Bandaru, Ph.D.; and Constantine G. Lyketsos, M.D.

Genomic analysis of superbug provides clues to antibiotic resistance

HOUSTON – (Sept. 7, 2011) – An analysis of the genome of a superbug has yielded crucial, novel information that could aid efforts to counteract the bacterium’s resistance to an antibiotic of last resort. The results of the research led by scientists from The University of Texas Health Science Center at Houston (UTHealth) are published in the Sept. 8 issue of the New England Journal of Medicine.

Superbugs are bacteria that are resistant to multiple antibiotics and represent one of the most challenging health problems of the 21st century. Infections caused by these bacteria can lead to longer illnesses, extended hospital stays and in some instances death. Antibiotic resistance is on the rise and alternative treatments are frequently suboptimal.

Researchers focused on a superbug called vancomycin-resistant enterococci (VRE), which is an intestinal bacterium that is resistant to multiple antibiotics, particularly vancomycin, a drug that has been used for treatment of potentially lethal hospital-associated infections.

“It is the second most common bacterium isolated from patients in U.S. hospitals after staphylococci,” said Cesar Arias, M.D., Ph.D., the study’s lead author and principal investigator. He is an associate professor of medicine at the UTHealth Medical School.

“The problem is that VRE has become so resistant that we don’t have reliable antibiotics to treat it anymore,” Arias said. “Daptomycin is one of the few antibiotics left with activity against VRE and is usually used as a drug of last resort. Additionally, this particular superbug is frequently seen in debilitated patients such as those in critical care units, receiving cancer treatment and patients receiving transplants, among others; therefore the emergence of resistance during therapy is a big issue.”

VRE itself can develop resistance to daptomycin during treatment. To find out why, researchers compared the genomes of bacterial samples drawn from the blood of a patient with VRE bloodstream infection receiving daptomycin. The bacterium developed daptomycin resistance and the patient subsequently died.

By comparing the genetic makeup of the bacterium before and after it developed resistance to daptomycin, the researchers were able to identify changes in genes directly tied to antibiotic resistance. “Our research provides direct substantiation that changes in two bacterial genes are sufficient for the development of daptomycin resistance in VRE during therapy,” Arias said.

Barbara Murray, M.D., coauthor  and director of the Division of Infectious Diseases at the UTHealth Medical School, said, “These results lay the foundation for understanding how bacteria may become resistant to daptomycin, which opens immense possibilities for targeting the functions encoded by these mutated genes. This would be a step toward the development of much needed new drugs.  That is, once we understand the exact mechanism for resistance, one can start to develop strategies that block or attack the resistance mechanism.”

Murray, holder of the J. Ralph Meadows Professorship in Internal Medicine, added, “This study identified genes never before linked to antibiotic resistance in enterococci. The genomic approach used in the study is very powerful and was able to pinpoint exactly the specific genes and mutations within them that resulted in the failure of daptomycin (CUBICIN®) therapy and contributed to the fatal outcome of the patient.”

Arias’ laboratory is doing additional research needed to determine the precise mechanisms by which the gene changes allow the bacterium to defeat the antibiotic. “There are mutations that appear to alter the bacterial cell envelope, which is the target of the antibiotic. The modifications brought about by the gene mutations may change the cell envelope to avoid the killing by these antibiotics. We believe these changes are a general mechanism by which bacteria protect themselves,” Arias said.

Herbert DuPont, M.D., holder of the Mary W. Kelsey Distinguished Professorship in the Medical Sciences and director of the Center for Infectious Diseases at The University of Texas School of Public Health, said,  “Twenty years ago antibiotic-resistant bacteria more often caused hospital-acquired infections in people with underlying illness or advanced age. Now, resistant bacteria are often seen in the community in otherwise healthy people, making treatment very complicated.”

The study titled “Genetic Basis for In Vivo Daptomycin Resistance in Enterococci” received support from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Additional UTHealth Medical School researchers in the study include Diana Panesso, Ph.D.;  Lorena Diaz, Truc T. Tran, Pharm. D.; and Jung H. Roh, Ph.D. Coauthors from The University of Texas MD Anderson Cancer Center include Danielle M. McGrath, Ph.D.; E. Magda Barbu, Ph.D.; Renata Pasqualini, Ph.D.; and Wadih Arap, M.D., Ph.D. Others Houston-area contributors include: Xiang Qin, Ph.D., of Baylor College of Medicine; and Corwin Miller and Yousif Shamoo, Ph.D. of Rice University.

Other research contributors include Elizabeth Lobos, Ph.D., Erica Sodergren, Ph.D.  and George Weinstock, Ph.D., all from Washington University in St. Louis;  John P. Quinn, M.D., of the Chicago Infectious Disease Institute; Maria F. Mojica of the Center for Medical Research and Training (CIDEIM) in Cali, Colombia; and Sandra Rincon and Jinnethe Reyes of Universidad El Bosque, Bogota, Colombia.

Arap, DuPont, Murray and Pasqualini are on the faculty of The University of Texas Graduate School of Biomedical Sciences, which is overseen by UTHealth and the UT MD Anderson Cancer Center.

Arias leads the UTHealth Medical School Laboratory for Antimicrobial Research and the Universidad El Bosque, Molecular Genetics and Antimicrobial Resistance Unit in Colombia. Arias’ laboratories have collaborations with several Latin American countries to study specific types of antibiotic-resistant bacteria.

Press Release from University of Texas Health Science Center at Houston