MedicalResearch.com Interview with: Adela Hruby PhD Adjunct Instructor, Friedman School of Nutrition Science and Policy Research Fellow, Harvard School of Public Health Fellow, Oak...
MedicalResearch.com Interview with:
Anthony V. D'Amico, MD, PhD
Chief, Division of Genitourinary Radiation Oncology
Professor of Radiation Oncology, Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. D'Amico: Controversy exists as to whether androgen deprivation therapy (ADT) used to treat prostate cancer can cause fatal cardiac events.
We found that in men with moderate to severe comorbidity based most often on a history of a heart attack that the use of 6 months of androgen deprivation therapy to treat non metastatic but clinically significant prostate cancer was associated with both an increased risk of a fatal heart attack and shortened survival.
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MedicalResearch.com Interview with:
Aaron L. Schwartz, PhD
Department of Health Care Policy
Harvard Medical School
Boston, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Schwartz: It is widely believed that much health care spending is devoted to services that provide little or no health benefit to patients. In previous work, we demonstrated that low-value services were commonly delivered to the Medicare population. In this study, we examined whether a new form of paying physicians and hospitals was effective in discouraging the use of low-value services.
The payment reform we studied was the Medicare Pioneer Accountable Care Organization (ACO) Program, a feature of the Affordable Care Act. This program financially rewards health care provider groups who keep spending under a specified budget and achieve high performance on measures of quality of care. This voluntary program employs a similar ACO payment model that some private insurers have adopted. The hope is that such models can encourage providers to be more efficient by allowing them to share in the savings generated by lower health care spending. In previous work, we demonstrated that the Pioneer ACO Program was associated with lower overall health care spending and steady or improved performance on health care quality measures. However, it was unclear whether providers were focusing on low-value services in their attempts to reduce spending.
We examined 2009-2012 Medicare claims data and measured the use of, and spending on, 31 services often provided to patients that are known to provide minimal clinical benefit. We found that patients cared for in the ACO model experienced a greater reduction in the use of low-value services when compared to patients who were not served by ACOs. We attributed a 4.5 percent reduction in low-value service spending to the ACO program. Interestingly, this was a greater reduction than the 1.2 percent reduction in overall spending attributed to the program, which suggests that providers were targeting low-value services in their efforts to reduce spending.
In addition, we found that providers with the greatest rate of low-value services prior to the ACO program showed the greatest reduction in these services. We also found similar reductions in service use between services that are more likely to be requested by patients (i.e. early imaging for lower-back pain) and other services.
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MedicalResearch.com Interview with:
Avik Chatterjee, MD, MPH
Physician, Boston Health Care for the Homeless Program
Instructor, Harvard Medical School
Associate Epidemiologist, Division of Global Health Equity, Brigham and Women's Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Chatterjee: Substance use, sexual activity and violent behaviors are common during adolescence. Understanding risk factors for these behaviors will improve our ability to prevent them and their sequelae. The Chaos, Hubbub and Order Scale (CHAOS) is a measure of household physical and social disorder, and higher CHAOS score, as reported by parents, has been shown to be correlated with less self-regulatory behavior in children. Thus, CHAOS could be a risk factor for the above behaviors in adolescents. We used data from the RISE study, in which 929 adolescents completed face-to-face and computer-assisted (for sensitive questions) interviews about their health behaviors to analyze the relationship between CHAOS score and risky health behaviors. We found that students with highest CHAOS score, compared to those with zero CHAOS score, had elevated odds for tobacco use (3x), alcohol use (2.5x), any substance use at school (6x) and fighting in the past 12 months (2x).
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MedicalResearch.com Interview with:
Aditya Bardia MBBS, MPH
Attending Physician, Massachusetts General Hospital Cancer Center,
Assistant Professor, Harvard Medical School
Boston, MA 02114
Medical Research: What is the background for this study? What are the main findings?
Response: Multiple studies have consistently shown that African American women with cancer, including breast cancer, have worse outcomes than Caucasian counterparts. While socioeconomic issues, including access to care plays an important role, the contribution of tumor biology has been less clear.
In this study, utilizing exome sequencing data, we linked the racial distribution of primary breast cancer with tumor genotypic traits, including somatic mutations, gene-expression profiles and intra-tumor heterogeneity. We observed that in addition to having a higher prevalence of triple negative breast cancer than Caucasian women (something that has been documented in the literature), African American women had a significantly higher prevalence of TP53 mutations, TNBC basal-like 1 and mesenchymal stem-like tumors, and intratumor genetic heterogeneity, and all of which suggest more aggressive tumor biology, suggesting that differences in tumor genomic profile contribute, at least partly, to the known racial disparity in survival between African Americans and Caucasians breast cancer patients.
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MedicalResearch.com Interview with:
Peter Caravan, PhD
Co-Director, Institute for Innovation in Imaging (I3)
Martinos Center for Biomedical Imaging
Massachusetts General Hospital
Associate Professor of Radiology
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Caravan: The motivation for this work was to develop a technique that would allow the detection of thrombus (clot) anywhere in the body after injection of a molecular probe called 64Cu-FBP8. Current techniques for thrombus detection are limited to specific vascular territories. In instances where the location of the thrombus is unknown or if there is suspicion of multiple thrombi, then multiple imaging tests must be performed. We sought to develop a test that could be used to find clots anywhere: brain, thorax, abdomen, legs and in arteries, veins, or the cardiac chambers. In addition to whole body thrombus detection, we sought a technique that could address some of the limitations with current thrombus imaging techniques. For example computed tomography (CT), which is used to detect pulmonary emboli, requires a contrast agent that cannot be used in patients with poor kidney function. Transesophageal echocardiography used to identify thrombus in the chambers of the heart requires that the patient be sedated.
Our approach is to use a small peptide that recognizes the protein fibrin, which is a key component of blood clots. We tagged the peptide with an isotope of copper, Cu-64, that allows the peptide to be detected by positron emission tomography (PET). 64Cu-FBP8 binds specifically to fibrin but not to other proteins in the blood and this means that the uptake in the clot is high while background signal is very low. We combined PET imaging which finds the clot with CT imaging or magnetic resonance imaging (MRI). By overlaying the PET image with the CT or MRI image, we could precisely localize the clot within the We were interested to see if the age of the clot impacted our ability to detect it. We imaged animals with a total of 42 arterial or venous clots and then the images were analyzed by two reviewers who had no prior knowledge of the location of the clot. Overall the accuracy was 98% for detection.
Another key finding was that the uptake of 64Cu-FBP8 strongly correlated with the amount of fibrin in the clot and that younger, fresher clots had more fibrin than older clots. This could be very useful in distinguishing newer clots which may be the source of cardiovascular events from older, clots that may pose less risk.
We also showed using combined PET-MRI that we could detect multiple blood clots in the animal in a single whole body scan. The procedure involves a single intravenous administration of 64Cu-FBP8 and clots in the deep veins of the legs or in the carotid arteries were readily detected.
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MedicalResearch.com Interview with:
J. Michael McWilliams MD, PhD
Associate Professor and
Dr. Michael Barnett MD
Researcher and General Medicine Fellow
Dept. of Health Care Policy
Harvard Medical School
Boston MA
Medical Research: What is the background for this study?
Response: The financial impact of Medicare’s Hospital Readmissions Reduction Program on hospitals is growing. In this year’s round of penalties, nearly 2,600 hospitals were collectively fined $420 million for excess readmissions. There has been concern that the risk-adjustment methods used by Medicare to calculate a hospital’s expected readmission rate is inadequate, meaning that hospitals disproportionately serving sicker and more disadvantaged patients are being penalized because of the populations they serve rather than their quality of care. Specifically, Medicare accounts only for some diagnoses, age and sex but no other clinical or social characteristics of patients admitted to the hospital.
No study to date has examined the impact adjusting for a comprehensive set of clinical and social factors on differences in readmission rates between hospitals. We did this by using detailed survey data from the Health and Retirement Study linked to information on admissions and readmissions in survey participants’ Medicare claims data. We then compared differences in readmission rates between patients admitted to hospitals in the highest vs. lowest quintile of publicly reported readmission rates, before vs. after adjusting for a rich set of patient characteristics. These included self-reported health, functional status, cognition, depressive symptoms, household income and assets, race and ethnicity, educational attainment, and social supports.
Medical Research: What are the main findings?
Response: Our two most important findings were:
1) Patients admitted to hospitals with higher readmission rates are sicker and more socially disadvantaged in a variety of ways than patients admitted to hospitals with lower readmission rates.
2) After adjusting for all measurable patient factors that are not accounted for in standard Medicare adjustments, the difference in readmission rates between hospitals with high vs. low readmission rates fell by nearly 50%.
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MedicalResearch.com Interview with:
Dr. Rachel A Freedman MD MPH
Dana-Farber Cancer Institute
Assistant Professor of Medicine
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Freedman: Despite a lack of medical benefit for most patients, the rates for bilateral mastectomy (double mastectomy) are on the rise in the U.S. Many factors have been cited as potential reasons for this increase, such as one’s race/ethnicity, education level, family history, and use of MRI. Cancer stage has not consistently been a factor in past studies. In this study, we surveyed 487 women who were treated for breast cancer in Northern California within the California Cancer Registry, we examined factors associated with the type of surgery a woman received. In our study, we found strong associations for stage III cancer with receipt of unilateral and bilateral mastectomy. In addition, higher (vs. lower) income and older age were associated with lower odds of having bilateral surgery.
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MedicalResearch.com Interview with:
Dr. Yin Cao MPH, ScD
Postdoctoral Fellow, Department of Nutrition
Harvard T. H. Chan School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Cao: Light-to-moderate drinking, defined as up to 1 drink (roughly corresponds to a 355ml bottle of beer, or a small [118-148 ml] glass of wine or 44ml of liquor) for women and up to 2 drinks for men, is prevalent in many western countries. It is believed that light-to-moderate drinking may be healthy for the heart. However, the influence of light-to-moderate drinking on risk of overall cancer is less clear, although it is well known that heavy alcohol intake increases risk of several cancers, including cancers of colorectum, female breast, oral cavity, pharynx, larynx, liver, and esophagus.
Also because drinkers are more likely to be smokers, and smoking is the major risk factor for all of the alcohol-related cancers (mentioned above) except breast cancer, it is thus difficult to tease out the influence of alcohol on cancer in studies among a mixed population of ever and never smokers. In particular, it is important to know how light and moderate drinking would affect cancer risk particularly among never smokers, who now make up the majority of the population in many western countries.
Our main findings are that, light-to-moderate drinking minimally increases risk of overall cancer. For men, the association with alcohol related cancers was primarily observed among smokers, and light to moderate drinking did not appreciably increase risk in never smokers. Among women, even consumption of up to one drink per day was associated with increased risk of alcohol-related cancers (mainly breast cancer) for both never and ever smokers.
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MedicalResearch.com Interview with:
Susan A. Slaugenhaupt PhD
Professor of Neurology,
Harvard Medical School
Associate Geneticist, Department of Neurology,
Molecular Neurogenetics Unit
Center for Human Genetic Research
Massachusetts General Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Slaugenhaupt: Mitral valve prolapse (MVP) is one of the most common human diseases affecting 1 out of every 40 people worldwide. The mitral valve is found between two chambers of the heart, and mitral valve prolapse results when the valve does not close properly. By studying families in which multiple members have mitral valve prolapse, we have identified a biological explanation for the disease. Mutations in the DCHS1 gene cause mitral valve prolapse in three families, and suggest that early defects in heart valve formation during development contribute to the progressive deterioration of the valve.
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Dr. Jeff Karp Ph.D
Associate Professor of Medicine
Brigham and Women's Hospital
Harvard Medical School
Cambridge, MA 02139 and
Giovanni Traverso M.B., B.Ch., Ph.D
The David H. Koch Institute for Integrative Cancer Research
Massachusetts Institute of Technology, Cambridge, MA
Medical Research: What is the background for this study? What are the main findings
Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment. Enema therapy has 3 major issues.
MedicalResearch.com Interview with:
Dr. Audrey J Gaskins
Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Gaskins: Previous studies have linked shift work, long working hours, and physical factors to an increased risk of menstrual cycle disturbances, spontaneous abortion, preterm birth, and low birth weight; however the association with fecundity is inconsistent. Several papers have also reviewed the occupational exposures of health care workers and concluded that reproductive health issues are a concern. Therefore we sought to determine the extent to which work schedules and physical factors were associated with fecundity in a large cohort of nurses. Women who work in an industry that requires them to work from a height or even lift heavy objects requires them to undertake training which guides them though the effective stages on how to work safely at heights. Without the right training, this sort of work can become very dangerous.
Our main findings were that that working >40 hours per week and moving or lifting a heavy load >15 times per day (including repositioning or transferring patients) were associated with reduced fecundity in our cohort of female nurses planning pregnancy. However, all other factors such as frequency of night work, duration of rotating and non-rotating night shifts, and time spent walking or standing at work were not significantly associated with fecundity in this cohort.
(more…)MedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Associate Professor of Medicine Harvard Medical School Associate Professor of Nutrition and Epidemiology Harvard T.H. Chan School...
MedicalResearch.com Interview with:
Alexander C. Tsai, MD, PhD
Center for Global Health
Massachusetts General Hospital, Boston
Harvard Center for Population and Development Studies
Cambridge, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Tsai: Suicide is one of the leading causes of death among middle aged women, and the rates have been climbing over the past decade. At the same time, we know that Americans are becoming more and more isolated. As one example, over the past two decades, there has been a tripling in the number of people who say they don't have anyone to confide in about important matters. In our study, we tracked more than 70,000 American women over two decades and found that the most socially isolated women had a threefold increased risk of suicide.
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MedicalResearch.com Interview with:
Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Response: The Affordable Care Act (ACA) expanded insurance options for millions of adults, via an expansion of Medicaid and the new health insurance Marketplaces, which had their first open enrollment period beginning in October 2013. We used a large national survey to assess the changes in health insurance, access to care, and self-reported health since these expansions began. What we found is that the beginning of the ACA’s open enrollment period in 2013 was associated with significant improvements in the trends of insurance coverage, access to primary care and medications, affordability of care, and self-reported health. Among low-income adults in Medicaid expansion states, the ACA was associated with improvements in coverage and access to care, compared to non-expansion states. Gains in coverage and access to medicines were largest among racial and ethnic minorities.
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MedicalResearch.com Interview with:
Lu Qi, MD, PhD, FAHA
Associate Professor of Medicine
Harvard Medical School
Assistant Professor of Nutrition
HarvardSchool of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Lu Qi: Most previous studies focus on the effects of either lifestyle or prenatal malnutrition on diabetes risk; no study has assess these two types of risk factors in combination.
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MedicalResearch.com Interview with:
Dr. Ankur Pandya Ph.D.
Assistant Professor of Health Decision Science
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Pandya: The American College of Cardiology and the American Heart Association (ACC-AHA) cholesterol treatment guidelines were controversial when first released in November 2013, with some concerns that healthy adults would be over-treated with statins.
We found that the current 10-year ASCVD risk threshold (≥7.5%) used in the ACC-AHA cholesterol treatment guidelines has an acceptable cost-effectiveness profile (incremental cost-effectiveness ratio of $37,000/QALY), but more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100,000/QALY (≥4.0%) or $150,000/QALY (≥3.0%). (more…)
MedicalResearch.com Interview with:
Liana C. Del Gobbo, PhD
Postdoctoral Research Fellow
Friedman School of Nutrition Science & Policy
Tufts University Boston MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Del Gobbo: Heart failure most commonly develops in adults over 65 years old- the most rapidly growing portion of the US population. The condition greatly reduces the quality of life of older adults. Heart failure is the leading cause of hospitalizations in the US among those on Medicare, and is associated with large health care costs. Prevention is key for reducing the burden of this disease.
A detailed analysis of factors that might help prevent heart failure, such as a person's pattern of eating (as well as individual foods), in addition to other lifestyle factors (eg. smoking, physical activity, etc), had not been previously examined all together, in the same study.
To get a fuller picture of how to prevent this condition, this study examined the relative importance of dietary habits and other lifestyle factors for development of heart failure.
Our paper shows that older adults can cut their risk in half by adhering to a few healthy lifestyle factors, including moderate physical activity, modest alcohol consumption (eg. more than one drink/week, but not more than 1-2 drinks/day), not smoking, and maintaining a healthy weight.
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MedicalResearch.com Interview with:
Timothy P. Padera, PhD
Edwin L. Steele Laboratories
Department of Radiation Oncology
MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School
Boston, Massachusetts 02114
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Padera: Systemic therapy benefits cancer patients with lymph node metastases; however all phase III clinical trials to date of antiangiogenic therapy have failed in the adjuvant setting. We have previously reported the lack of efficacy of antiangiogenic therapies in pre-clinical models of spontaneous lymphatic metastasis, however there were no mechanistic data to explain these observations. Here, we developed a novel chronic lymph node window model to facilitate new discoveries in the mechanisms of growth and spread of lymph node metastases. Our new data provide pre-clinical evidence along with supporting clinical evidence that angiogenesis does not occur in the growth of metastatic lesions in the lymph node. These results reveal a mechanism of treatment resistance to antiangiogenic therapy in adjuvant setting, particularly those involving lymph node metastases.
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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:
Paula Chatterjee, MD, MPH
Department of Medicine, Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Chatterjee: Thousands of patients die every year due to organ shortages. Finding ways to address this public health issue is critical. States have designed a variety of strategies to promote organ donation and transplantation, however we don’t know if any of these strategies have been successful. The goal of our study was to try to figure out which strategies have been most successful in terms of increasing organ donation and transplantation.
We found that states have implemented a wide and creative set of strategies, but unfortunately, it seems that these strategies have had almost no effect on increasing organ donation and transplantation. In states that adopted these strategies compared to those that did not, the rates of donation and transplantation increased at nearly the same rate over the past two decades. The only strategy that seemed to have a small effect was when states created revenue pools dedicated toward organ donation activities.
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MedicalResearch.com Interview with:
Jennifer R. Rider, ScD, MPH
Assistant Professor of Medicine
Channing Division of Network Medicine
Brigham and Women's Hospital and Harvard Medical School
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Rider: Numerous studies have investigated the potential role of sexual activity on the development of prostate cancer. However, most of these studies have been small and retrospective, making them more prone to bias. In addition, previous studies often relied on proxies of exposure for sexual activity (number of sexual partners, age at first marriage, etc.), which may not adequately measure the aspects of sexual activity that are most important for prostate health. The current study is the largest prospective study to date on ejaculation frequency and prostate cancer. It includes 18 years of follow up of almost 32,000 healthy men, 3839 of whom later were diagnosed with prostate cancer. We asked men about their average monthly frequency of ejaculation between the ages of 20-29, 40-49, and in the year prior to the questionnaire (1991). We find that frequency of ejaculation throughout life course is inversely associated with risk of prostate cancer at all three of these time points. For instance, men who have an average monthly ejaculation frequency of 21 or more times/moth at ages 40-49 have a statistically significant 22% reduction in risk of developing prostate cancer compared to men with a frequency of 4-7 times/month, adjusting for multiple dietary and lifestyle factors, and prostate cancer screening history.
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MedicalResearch.com Interview with:
Manoj Duraisingh Ph.D.
John LaPorte Given Professor of Immunology and Infectious Diseases
Harvard T.H. Chan School of Public Health
Department of Immunology and Infectious Diseases
Boston, Massachusetts
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Duraisingh: The malaria parasite P. falciparum is one of the most important pathogens of humans, with enormous mortality resulting from blood-stage infections, when parasites replicate exponentially in red blood cells. Although anti-Plasmodial drugs are in clinical use, widespread and increasing parasite drug-resistance has contributed to an ongoing public health crisis, and we urgently need to find novel approaches to prevent and treat disease.
Targeting host red blood cell molecules presents an unexploited alternative. However, the highly differentiated and enucleated red blood cell poses a significant technical hurdle for genetic experimentation, due to the lack of a nucleus.
Here we have developed a novel, forward genetic screen to identify critical factors of malaria infection of red blood cells in an unbiased fashion. Our screen takes advantage of recent advances in human stem cell biology that enable the ex vivo culture of red blood cells from nucleated hematopoietic precursors which are amenable to in vitro genetics.
We have now identified a surface molecule CD55 (alias Decay-Accelerating Factor, DAF) as an essential host factor required for the invasion of red blood cells by P. falciparum. We demonstrate that this protein is required by all P. falciparum strains tested (laboratory and field) for invasion. Furthermore, we demonstrate that CD55 acts at the initial stage of invasion when the P. falciparum parasite attaches to the surface of the red blood cell.
Collectively, our findings indicate that CD55 is an ideal target for the development of new host-directed and vaccine therapeutics for malaria.
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MedicalResearch.com Interview with:
Karen E. Joynt, MD MPH
Cardiovascular Division,
Brigham and Women's Hospital and VA Boston Healthcare System
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Joynt: While there is a great deal of optimism about the potential of Electronic Health Records (EHRs) to improve health care, there is little national data examining whether hospitals that have implemented EHRs have higher-quality care or better patient outcomes. We used national data on 626,473 patients with ischemic stroke to compare quality and outcomes between hospitals with versus without EHRs. We found no difference in quality of care, discharge home (a marker of good functional status), or in-hospital mortality between hospital with versus without EHRs. We did find that the chances of having a long length of stay were slightly lower in hospitals with EHRs than those without them.
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MedicalResearch.com Interview with:
Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia, Harvard Medical School
Director of Research, Critical Care Division
Massachusetts General Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Eikermann: Obstructive sleep apnea occurs in about 5% of pregnant women, worsens as pregnancy progresses and is likely to persist into the early postpartum period. A main cause of anesthesia-related maternal death is postpartum airway obstruction. We observed among early postpartum women, that 45° upper body elevation increased upper airway diameter and mitigated sleep apnea, without adverse effects on quality of sleep after delivery.
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MedicalResearch.com Interview with:
Elissa Hope Wilker, Sc.D.
Beth Israel Deaconess Medical Center
Cardiovascular Epidemiology Research
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Wilke: Long-term exposure to ambient air pollution is associated with cerebrovascular disease and cognitive impairment, but the impact on structural changes in the brain is not well understood. We studied older adults living in the greater Boston area and throughout New England and New York and we looked at the air pollution levels and how far they lived from major roads. We then linked this information to findings from MRI studies of structural brain images. Although air pollution levels in this area are fairly low compared to levels observed in other parts of the world, we found that people who lived in areas with higher levels of air pollution had smaller brain volumes, and higher risk of silent strokes. The magnitude of association that we observed for a 2 µg/m3 increase in fine particulate matter (PM2.5) (a range commonly observed across urban areas) was approximately equivalent to one year of brain aging. The association with silent strokes is of concern, because these are associated with increased risk of overt strokes, walking problems, and depression.
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