Financial Distress Common Among Cancer Patients, Especially Underinsured

MedicalResearch.com Interview with:

Dr. Fumiko Chino, MD Duke Radiation Oncology Duke School of Medicine

Dr. Chino

Dr. Fumiko Chino, MD
Duke Radiation Oncology
Duke School of Medicine

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

Response: The financial burden of cancer treatment is a growing concern. Out-of-pocket expenses are higher for patients with cancer than for those who have other chronic illnesses. Fifty percent of elderly cancer patients spend at least 10% of their income on treatment-related out-of-pocket expenses. Additionally, high financial burden is associated with both increased risk of poor psychological well-being and worse health-related quality of life. A cancer diagnosis has been shown to be an independent risk factor for declaring personal bankruptcy, and cancer patients who declare personal bankruptcy are at greater risk for mortality. These potentially harmful outcomes resulting from financial burden have been recognized as the financial toxicity of cancer therapy, analogous to the more commonly considered physical toxicity.

We conducted an IRB approved study of financial distress and cost expectations among patients with cancer presenting for anti-cancer therapy. In this cross-sectional, survey based study of 300 patients, over one third of patients reported higher than expected financial burden. Cancer patients with highest financial distress are underinsured, paying nearly 1/3 of income in cancer-related costs. In adjusted analysis, experiencing higher than expected financial burden was associated with high/overwhelming financial distress (OR 4.78; 95% CI 2.02-11.32; p<0.01) and with decreased willingness to pay for cancer care (OR 0.48, 95% CI 0.25-0.95, p=0.03).

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Survival Benefit from Primary Prevention Implantable Cardioverter Defibrillators

MedicalResearch.com Interview with:

Daniel J. Friedman, MD Duke University Hospital Duke Clinical Research Institute Durham, NC

Dr. Friedman

Daniel J. Friedman, MD
Duke University Hospital
Duke Clinical Research Institute
Durham, NC

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

Response: Although primary prevention ICDs have saved countless lives among patients with heart failure and a reduced ejection fraction, the use of primary prevention ICDs in patients with more advanced heart failure [defined by New York Heart Association Class (NYHA)] is controversial.

Specifically, there are conflicting data from the pivotal primary prevention ICD trials regarding whether primary prevention ICDs reduce all-cause mortality among patients with a severely reduced ejection fraction (≤35%) and NYHA III heart failure.

We performed a patient level meta-analysis using data from 4 pivotal primary prevention ICD trials (MADIT-I, MADIT-II, SCD-HeFT, and DEFINITE) to assess whether primary prevention ICD efficacy varied by NYHA class (II vs. III). Overall, the ICD reduced all-cause mortality among the overall population of patients (NYHA II and III). We subsequently assessed ICD efficacy after stratification by NYHA class.

Among NYHA II patients, the ICD significantly reduced all-cause mortality by reducing sudden cardiac death. Although NYHA III patients randomized to an ICD experienced a significantly lower rate of sudden cardiac death, this did not translate into a reduction in all-cause mortality, due to competing causes of non-sudden death (which an ICD cannot treat). Based on relatively wide confidence intervals associated with the estimate for ICD effect in NYHA III patients, there appears to be substantial heterogeneity in outcomes among these patients. This suggests that many NYHA III patients can benefit from a primary prevention ICD, but further study is necessary to determine which NYHA III patients are poised to benefit.

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Metformin Associated With Lower Mortality in CKD, CHF and Chronic Liver Disease

MedicalResearch.com Interview with:

Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center

Dr. Matthew Crowley

Matthew J. Crowley, MD, MHS
Assistant Professor of Medicine
Member in the Duke Clinical Research Institute
Duke University Medical Center

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

Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?”

The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease.

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Marital History Linked to Survival After Stroke

MedicalResearch.com Interview with:

Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University

Dr. Mathew Dupre

Matthew E. Dupre, Ph.D.
Associate Professor
Department of Community and Family Medicine &
Duke Clinical Research Institute (DCRI)
Duke University

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

Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke.

We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses.

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Hearing Loss Linked To Increased Depression and Dementia Risk

MedicalResearch.com Interview with:

Dr-Frank-Lin.jpg

Dr. Lin

Frank Robert Lin, M.D., Ph.D.
Associate Professor of Geriatric Medicine, Head and Neck Surgery
Johns Hopkins Medicine

MedicalResearch.com Editor’s note: Dr. Lin discussed his research during Cochlear’s Global Research Symposium, which brought together international experts from the audiology community.

MedicalResearch.com: Is there a link between hearing loss and the risk of developing dementia?

Response: In the last few years, we have investigated the link between hearing loss and dementia in large studies of older adults who have been followed for many years. In these studies, we and others have found that those with greater hearing loss have a higher risk of developing dementia even after we account for factors like age, education, medical comorbidities, etc. We think this is because there are some pathways through which hearing loss can directly affect our thinking and memory abilities

MedicalResearch.com: Is there an association between hearing loss and cognitive decline or premature death?

Response: There is a link between hearing loss and accelerated cognitive decline. There is also external research that links hearing loss and premature death (Friburg 2014, Contrera 2015). Hearing loss can also increase a person’s chance of using medical and social services

MedicalResearch.com: How is hearing loss linked to increased social isolation and depression in the elderly?

Response: Older people with hearing loss are at a greater risk of social isolation due to their difficulty communicating with people. These individuals may be less likely to go out, particularly to settings where listening can be difficult (e.g., restaurants), and even if they do go out, they may feel isolated from the conversation and not able to engage with others.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that we’re increasingly understanding that hearing loss can detrimentally impact our thinking and memory abilities, risk of dementia, and our ability to remain engaged with others. Ongoing research is now studying to what extent our current hearing loss therapies can reduce and mitigate these risks and promote healthy aging.

MedicalResearch.com: Is there anything else you would like to add?

Response: Readers should know that hearing loss is a growing public health issue. It has been estimated that by 2050 1.2 billion people will suffer from hearing loss, underscoring the need for us to address it and recognize the burden of hearing loss on wider health. To learn more visit,www.linresearch.org and www.nas.edu/hearing

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Cochlear’s Global Research Symposium October 2016

Disclosure:  Symposium supported by Cochlear Limited (ASX: COH), together with Macquarie University and the Australian Hearing Hub

www.cochlear.com

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Do People Wearing Activity Trackers Really Exercise More?

MedicalResearch.com Interview with:
Aarti Sahasranaman, PhD
Duke-NUS Gradaute Medical School
Singapore

MedicalResearch.com: What is the background for this study?

Response: More than half of adults in developed countries do not achieve recommended levels of physical activity. Despite the popularity of activity trackers as a tool for motivating and monitoring activity levels, little research exists on whether they can help people lead healthier lives, or if financial incentives could encourage people to wear them for longer and achieve higher fitness levels. One in ten US adults owns an activity tracker but research suggests that about a third of people abandon them within 6 months of purchase.

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Brain Scans Can Predict Specific Spontaneous Emotions

MedicalResearch.com Interview with:

Kevin S. LaBar, Ph.D. Professor and Head, Cognition & Cognitive Neuroscience Program Co-Director of Undergraduate Studies in Neuroscience Center for Cognitive Neuroscience Duke University Durham, NC

Dr. Kevin LaBar

Kevin S. LaBar, Ph.D.
Professor and Head, Cognition & Cognitive Neuroscience Program
Co-Director of Undergraduate Studies in Neuroscience
Center for Cognitive Neuroscience
Duke University
Durham, NC

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

Response: Emotion research is limited by a lack of objective markers of emotional states. Most human research relies on self-report, but individuals may not have good insight into their own emotions. We have developed a new way to identify emotional states using brain imaging and machine learning tools. First, we induced emotional states using film and music clips while individuals were in an MRI scanner. We trained a computer algorithm to identify the brain areas that distinguished 7 emotions from each other (fear, anger, surprise, sadness, amusement, contentment, and a neutral state). This procedure created a brain map for each of the 7 emotions. Then, a new group of participants self-reported their emotional state every 30 seconds in an MRI scanner while no stimuli were presented. We could predict which emotion was spontaneously reported by the subjects by comparing their brain scans to each of the 7 emotion maps. Finally, in a large group of 499 subjects, we found that the presence of the fear map during rest predicted state and trait anxiety while the presence of the sadness map predicted state and trait depression.

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Most Gastric Bypass Patients Keep Weight Off After Surgery

MedicalResearch.com Interview with:

Matthew Leonard Maciejewski, PhD Professor in the Division of General Internal Medicine Department of Medicine Duke University School of Medicine Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care Durham VA Medical Center

Dr. Matt Maciejewski

Matthew Leonard Maciejewski, PhD
Professor in the Division of General Internal Medicine
Department of Medicine
Duke University School of Medicine
Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care
Durham VA Medical Center

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

Response: No study based on a US cohort undergoing current procedures has examined weight change comparing surgical patients and nonsurgical patients for as long as we have. This is the first study to report 10-year outcomes on gastric bypass patients and compare them to matched patients who did not get surgery. At 1 year, gastric bypass patients lost 31% of their baseline weight compared controls who only lost 1.1% of their baseline weight. At 10 years, gastric bypass had lost 28% of their baseline weight.

We also compared weight loss at 4 years for Veterans who received the 3 most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric banding). At 4 years, patients undergoing gastric bypass lost more weight than patients undergoing sleeve gastrectomy or gastric banding. Given that few high quality studies have examined sleeve gastrectomy to 4 years, the 4-year sleeve outcomes contribute to filling this important evidence gap as the sleeve gastrectomy is now the most commonly performed bariatric procedure worldwide.

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Persistent Postpartum Pain Linked To Higher Risk of Depression

MedicalResearch.com Interview with:
MS WEI DU, First author
Third Year Medical Student
DUKE-NUS Medical School and
DR BAN LEONG SNG, Senior Author
Senior Consultant Department of Women’s Anesthesia KK
Women’s and Children’s Hospital

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

MS WEI DU: We performed a cohort study involving 200 healthy women who received epidural pain relief during the deliveries of their firstborns to investigate the relationship between persistent childbirth pain, psychological and pain vulnerability with postnatal depression. Postnatal depression was evaluated using the Edinburgh Postnatal Depression Score (EPDS).

Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

DR BAN LEONG SNG: Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

MedicalResearch.com: What should readers take away from your report?

MS WEI DU: We concluded that greater pain vulnerability and stress during intrapartum period, and presence of persistent pain or higher anxiety during postpartum period are positively associated with higher scores on postnatal depression tests.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

DR BAN LEONG SNG: The research findings support the need to address pain comprehensively to lessen the risk of developing postnatal depression. We are currently conducting a larger study to evaluate the impact of pain and postnatal depression in pregnant women.

MedicalResearch.com: Is there anything else you would like to add?

DR BAN LEONG SNG: Postnatal evaluation and management of childbirth pain and postnatal depression is important in our care of mothers and their newborns.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

World Congress of Anaesthesiologists abstract discussing:

Persistent childbirth pain increases risk of postnatal depression

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Same Genes Predict Educational Attainment and Socioeconomic Success

MedicalResearch.com Interview with:

Daniel Belsky, PhD Assistant Professor of Medicine Duke University School of Medicine Durham, NC 27708

Dr. Daniel Belsky

Daniel Belsky, PhD
Assistant Professor of Medicine
Duke University School of Medicine
Durham, NC 27708

MedicalResearch.com: What is the background for this study?

Dr. Belsky: The genome-wide association study
(GWAS) of educational attainment by the Social Science Genetic Association Consortium was the first large-scale genetic investigation of a human social/behavioral trait. Follow-up studies, including studies some of us were involved in, established that the genetic signature uncovered by this GWAS was highly reproducible; people who carried more education-associated alleles completed more schooling—and this was true even when studies compared siblings in the same family. Because getting a good education requires many of the same skills and abilities needed to get ahead in life more generally, we hypothesized that the same genetics that predicted success in schooling would predict success in life.

To ask this question, we designed a study to do three things.
• First, we wanted to test if the genetics of success in schooling would predict social and economic success through midlife (better jobs, salaries, and credit scores, fewer financial problems, etc.).
• Second, if the genetics of educational success did predict broader economic outcomes, we wanted to test how this came about:
o When and how did differences develop between children whose genomes predicted more educational success and children whose genomes predicted less success?
o The goal of this analysis was to try and learn something about pathways to success – pathways that any child could take advantage of, regardless of their genetics.
• Third, we wanted to know what kinds of psychological characteristics linked genetics with behavior. The goal of this analysis was to begin building a bridge between statistical models of the genome and the biological mechanisms that connect DNA sequence with behavior.

MedicalResearch.com: What are the main findings?

Dr. Belsky: There are four major take home points:
(1) Genetic discoveries for educational attainment are not discoveries for education only. The same genetics predict socioeconomic success well beyond the completion of schooling.
(2) Genetic discoveries were associated with social mobility — children with higher polygenic scores tended to achieve more socioeconomic success even if they were born poor.
(3) The psychological characteristics that mediated genetic associations with life outcomes included intelligence, but also self-control and interpersonal skills, for example being friendly.
(4) The pattern of characteristics and behaviors that connects DNA sequence with life outcomes begins early in life and extends through adulthood. Kids with higher polygenic scores started talking and reading earlier, and they had higher IQ scores, more self-control, and were more skilled interpersonally. As they grew into adolescence and adulthood, they were more ambitious, more willing to move away from home in search of opportunity, more successful in attracting better educated and higher earning spouses, and better at managing their money.

MedicalResearch.com: What should readers take away from your report?

Dr. Belsky: Our research speaks to three audiences. To scientists — behavioral/social and genetic — our results highlight the need for interdisciplinary collaborations to untangle genetic influences on human outcomes. We found that children’s genes shaped the environments they grew up in, suggesting that social and behavioral scientists may need to pay more attention to genetics. We also found that genes influenced life outcomes through patterns of behavior that are also affected by environmental circumstances, suggesting that geneticists may need to pay more attention to the social and behavioral sciences.
To policy makers, our research highlights the importance of developing regulations for the use of genetic information. “Precision education” or other tailoring of environments to children’s genomes is not possible with the data we have in hand today. But our findings suggest that such data may someday become available. It is vital to have the conversation about what that might mean and how we will deal with it BEFORE it happens.
Finally, to the general public, our research emphasizes the small effects of known-genetics on important human outcomes. Our findings provide a provocative window into how our genes may shape our lives. But we can make only very weak predictions about how far a child can go in life based on their genes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Belsky: Two big questions are “How do children’s environments affect the relationship between their genomes and their outcomes as adults?” and “How may genetics linked to educational success affect adult health and aging?”

MedicalResearch.com: Is there anything else you would like to add?

Dr. Belsky: I was most surprised to find the very same genetics that predicted better cognitive and social functioning in children were unrelated to their physical health. When we tested if the polygenic score predicted children’s physical health – measured from repeated clinical exams across childhood – we found no association whatsoever.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

D. W. Belsky, T. E. Moffitt, D. L. Corcoran, B. Domingue, H. Harrington, S. Hogan, R. Houts, S. Ramrakha, K. Sugden, B. S. Williams, R. Poulton, A. Caspi. The Genetics of Success: How Single-Nucleotide Polymorphisms Associated With Educational Attainment Relate to Life-Course Development. Psychological Science, 2016; DOI:10.1177/0956797616643070

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Epigenetic Changes Link Environmental Deprivation to Depression

MedicalResearch.com Interview with:
Dr. Johnna Swartz, PhD
Postdoctoral researcher in the lab of Ahmad Hariri
Duke postdoctoral researcher in the lab of Ahmad Hariri

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

Dr. Swartz: Prior research has shown that low socioeconomic status is a risk factor for the development of depression. In this study, we examined whether this risk factor was associated with changes in an epigenetic tag near the gene coding for the serotonin transporter, which has previously been linked to depression. We found that adolescents growing up in families with lower socioeconomic status accumulated more of these tags over time, which may lead to decreased gene expression. Moreover, we found that more of these tags were associated with increased activity in the amygdala, a brain region that plays an important role in the stress response.

Finally, we found that adolescents with increased activity in the amygdala were more likely to develop depression symptoms a year later, particularly if they had a close relative with a history of depression. This is some of the first research to draw a link from an environmental risk factor to changes in depression symptoms through changes in epigenetic markers and brain function.

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Medicare Patients May Have Better Outcomes with Carotid Endarterectomy Than Stenting

MedicalResearch.com Interview with:
Jessica J. Jalbert PhD
From the Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine, Brigham and Women’s Hospital
Harvard Medical School, Boston, MA
LASER Analytica
New York, NY

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

Dr. Jalbert: Landmark clinical trials have demonstrated that carotid artery stenting (CAS) is a safe and efficacious alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. Clinical trials, however, tend to enroll patients that are younger and healthier than the average Medicare patient. We therefore sought to compare outcomes following CAS and CEA among Medicare patients.

MedicalResearch.com: What are the main findings?

Dr. Jalbert: We found that outcomes among real-world Medicare patients undergoing CAS and CEA were similar. While our results were inconclusive due to small sample size, we also found some evidence suggesting that patients over the age of 80 and those with symptomatic carotid stenosis may have better outcomes following carotid endarterectomy than CAS.

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PCSK9 Antibody May Revolutionize Treatment of Atherosclerosis and Acute Coronary Syndrome

MedicalResearch.com Interview with:

Paul A. Gurbel, M.D. Director, Inova Center for Thrombosis Research and Drug Development Director, Cardiovascular Medicine Research Director, Interventional Cardiology Inova Heart and Vascular Institute Falls Church, VA Professor of Medicine, Johns Hopkins University School of Medicine Adjunct Professor of Medicine, Duke University School of Medicine

Dr. Paul Gurbel

Paul A. Gurbel, M.D.
Director, Inova Center for Thrombosis Research and Drug Development
Director, Cardiovascular Medicine Research
Director, Interventional Cardiology
Inova Heart and Vascular Institute
Falls Church, VA
Professor of Medicine,
Johns Hopkins University School of Medicine
Adjunct Professor of Medicine,
Duke University School of Medicine 

MedicalResearch.com: What is the background for this review? What are the main findings?

Dr. Gurbel: In current practice, treatment with statins and antiplatelet agents is the primary strategy to reduce death and ischemic cardiovascular events following ACS (acute coronary syndrome)/PCI. Immediately following ACS, many patients are incompletely responsive to potent current therapy and remain at high risk for recurrent thrombotic events. Treatment with monoclonal antibodies that target proprotein convertase subtilisin/kexin type 9 (PCSK9) is a new potent lipid lowering therapy. Recent studies have shown that PCSK9 antibodies combined with statins provided marked additional benefits in reducing atherogenic lipid fractions. In a recent meta-analysis, PCSK9 antibody therapy was also associated with a reduction in mortality and no increase in serious adverse events. In the current Narrative Review, we focused on novel pathways affected by PCSK9 antibodies that may make them appropriate for immediate treatment in patients with acute coronary syndrome.

MedicalResearch.com: What are the main findings?

Dr. Gurbel: PCSK9 antibodies, in addition to markedly reducing LDL levels, may also reduce pro-inflammatory oxidized LDL levels and platelet function. The latter properties, in addition to plaque stabilization, may provide antithrombotic properties favorably influencing clinical outcomes following acute administration at the time of  acute coronary syndrome.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Gurbel: In addition to a potent lipid lowering effect, PCSK9 antibody therapy when administered immediately at the time of acute coronary syndrome in addition to standard statin and antiplatelet therapy may provide additional antithrombotic effects. The latter novel properties of PCSK9 antibodies may be associated with improved patient outcomes. However, at this time there is no direct evidence for recommending PCSK9 antibody therapy in patients at the time of presentation with acute coronary syndrome .

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Gurbel: A large scale randomized study assessing the clinical effects of PCSK9 antibody therapy on top of current statin and antiplatelet therapy is needed. In addition, mechanistic studies to further delineate anti-inflammatory and antithrombotic effects of PCSK9 antibody therapy are also needed.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Gurbel: PCSK9 antibody therapy provides marked lowering of LDL. The latter property may revolutionize the treatment of patients with atherosclerosis. The potential antithrombotic effects of PCSK9 antibody therapy, in turn, may revolutionize acute therapy of ACS. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Navarese EP, Kołodziejczak M, Kereiakes DJ, Tantry US, O’Connor C, Gurbel PA. Proprotein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies for Acute Coronary Syndrome: A Narrative Review. Ann Intern Med. [Epub ahead of print 22 March 2016] doi:10.7326/M15-2994

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Dr. Paul Gurbel (2016). PCSK9 Antibody May Revolutionize Treatment of Atherosclerosis and Acute Coronary Syndrome MedicalResearch.com

Risk/Benefits of Sildenafil For Swimming-Induced Pulmonary Edema

MedicalResearch.com Interview with:

Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCC Medical Director, Hyperbaric Center Professor of Anesthesiology Department / Division Anesthesiology / GVTU Division Medicine / Pulmonary Duke University School of Medicine

Dr. Richard Moon

Richard Moon, MD, CM, MSc,
FRCP(C), FACP, FCCP

Medical Director, Hyperbaric Center
Professor of Anesthesiology
Department / Division
Anesthesiology / GVTU Division
Medicine / Pulmonary
Duke University School of Medicine

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

Dr. Moon: This study was performed to investigate the reason why young, fit individuals develop a condition usually associated with severe heart disease: pulmonary edema. Immersion pulmonary edema (also known as swimming-induced pulmonary edema, SIPE) develops in certain susceptible individuals while swimming or scuba diving, usually in cold water. Some SIPE-susceptible people include highly conditioned triathletes and Navy SEAL trainees. The prevalence of SIPE in triathletes is around 1.5%, and in open sea swimming trials in naval special forces trainees has been reported to be 1.8-60%. SIPE often requires hospitalization and has caused death.

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

Dr. Moon: We directly measured arterial pressure, pulmonary artery pressure (PAP) and PA wedge pressure (PAWP) during submersed exercise in cold water. We found that both PAP and PAWP were higher in swimming-induced pulmonary edema-susceptible individuals compared with a group of volunteers of similar age who had never experienced SIPE. This confirmed that SIPE is a form of hemodynamic pulmonary edema, which is curious since all of the people we studied had normal hearts. We hypothesized that the cause could be differences between the groups in venous tone or LV diastolic compliance. When we retested the SIPE-susceptibles under the same conditions after a dose of sildenafil, pulmonary artery pressures were decreased, with no adverse effects on hemodynamics. We concluded that by dilating pulmonary vessels and systemic venous sildenafil could be an effective prophylaxis against SIPE.  Continue reading

Meditation May Improve Experience with Imaging-Guided Needle Breast Biopsy

MedicalResearch.com Interview with:

Mary Scott Soo, M.D. FACR Associate professor of Radiology Duke Cancer Institute

Dr. Mary Scott Soo

Mary Scott Soo, M.D. FACR
Associate professor of Radiology
Duke Cancer Institute

Medical Research: What is the background for this study?

Dr. Soo: Imaging-guided needle breast biopsies for diagnosing suspicious breast lesions have been performed for many years and have definite advantages as a diagnostic tool over surgical biopsies. These biopsies are performed in outpatient settings, which decrease costs and reduce delays, and are highly accurate and less invasive than surgical procedures, requiring only local anesthesia. However, performing biopsies in this outpatient setting limits the use of intravenous sedation and pain medication that could address commonly experienced patient anxiety and occasional associated pain. Anxiety and pain can negatively impact the patient’s experience and could possibly affect the biopsy outcome due to patient movement, and could potentially even alter patients’ adherence to follow-up recommendations. Prior studies have explored methods to reduce anxiety, using interventions such as music, hypnosis and anxiolytics. Although hypnosis and anxiolytics are effective, these are a little more complicated to implement due to training costs for administering hypnotherapy, and costs, potential side effects, and need for an adult driver to take the patients home when anxiolytics are used. Other research has shown that meditation-based interventions can lead to positive psychological and physical outcomes, and may be helpful for decreasing anxiety, pain and fatigue.

Loving-kindness mediation is a type of mediation that focuses on relaxation and developing positive emotions, by silently repeating phrases encouraging compassion and goodwill towards oneself and others, while also reducing negative emotions. Previous studies have shown that even a 7-minute loving-kindness meditation can be effective for increasing positive emotions, so my co-authors Rebecca Shelby PhD, a clinical psychologist at Duke’s Pain Prevention and Treatment Research Program,clinical psychologist Anava Wrenn PhDwho has used loving-kindness meditation in a different practice setting, and breast imaging radiologist Jennifer Jarosz MD and I put together a team to study whether an audio-recorded, lovingkindness meditation could reduce anxiety, fatigue and pain during the imaging-guided breast biopsy time frame.  We consulted with Mary Brantley, MA, LMFT, who teaches loving-kindness meditation at Duke’s Integrative Medicine, to develop an audio-recorded loving-kindness mediation used specifically in the breast biopsy setting, and compared this to using music during biopsies or standard care (supportive dialogue) from the technologist and radiologist performing the biopsy.

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Genes Identified That May Predispose Some Individuals to Getting Sick

Dr. Ephraim Tsalik assesses Charles Watts for a respiratory infection in the ER at the Durham VA Medical Center on Wednesday, January 13, 2016.

Dr. Ephraim Tsalik
Duke Health

MedicalResearch.com Interview with:
Ephraim L. Tsalik, MD MHS PhD

Assistant Professor of Medicine
Division of Infectious Diseases
Center for Applied Genomics & Precision Medicine
Duke University Medical Center
Emergency Department Service Line
Durham VA Medical Center 

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

Dr. Tsalik: This study was motivated by the convergence of two research interests.  The first was spearheaded by Dr. Sack, leading our collaboration at Johns Hopkins.  Dr. Sack and his colleagues have a long history and expertise in studying enteric infections such as E. coli.  The second is our group here at Duke’s Center for Applied Genomics & Precision Medicine as well as the Durham VA Medical Center.  Specifically, we have an interest in studying the host response to infectious disease.  One of the ways we’ve done that historically is through challenge studies where healthy volunteers are exposed to a pathogen in a controlled setting.  Despite everyone getting the same exposure, not everyone gets sick.  That observation gives us a unique opportunity to study the host biology of symptomatic individuals, asymptomatic individuals, and what distinguishes the two from each other.  That is precisely what we did here.

Volunteers ingested Enterotoxigenic E. coli (ETEC), which is a common cause of traveler’s diarrhea.  Some subjects became ill with diarrhea while others remained well.  In this study, we focused on gene expression patterns, which is a snapshot of how genes in the body are being used in response to this infection.  Some genes are more active, some are less.  The pattern of those changes that occur in response to infection is what we call a “signature”.

This approach allowed us to generate some key findings.  First of all, we were able to define the genes involved in the body’s response to this type of E. coli infection.  Second, we discovered genes that were differentially expressed at baseline that could distinguish people who would go on to become ill from those that would remain healthy.  Although this study was not designed to identify the mechanism for that resilience to infection, it does focus our attention on where to look.  We suspect the genes we identified are likely to play a role in infectious disease resilience and susceptibility based on their known immune function roles.  We also have data, which wasn’t published in this study, that implicates some of these genes in the resilience to other infections such as influenza.

The last major finding was something called Drug Repositioning Analysis.  This is a tool that allowed us to identify drugs and drug classes that could be used to mitigate infections caused by ETEC.  That analysis highlighted some compounds already known to be effective such as Zinc.  But it also identified several other drug classes that have not previously been investigated and could be important tools to combat such infections especially as antibiotic resistance looms.

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STEMI Patients With Kidney Disease Have Worse Clinical and Angiographic PCI Outcomes

Renato D. Lopes MD, MHS, PhD Duke University Medical Center Duke Clinical Research Institute Durham, NC 27705

Dr. Renato Lopes

MedicalResearch.com Interview with:
Renato D. Lopes MD, MHS, PhD
Duke University Medical Center
Duke Clinical Research Institute
Durham, NC 27705

John P. Vavalle, MD, MHS Assistant Professor of Medicine Division of Cardiology UNC Center for Heart & Vascular Car

Dr. Vavalle

 

John P. Vavalle, MD, MHS
Assistant Professor of Medicine
Division of Cardiology
UNC Center for Heart & Vascular Care

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

 Dr. Lopes: Patients with varying degrees of underlying renal failure who presented for primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI) were studied as part of the APEX-AMI trial.
Baseline renal dysfunction portends a worse prognosis in patients undergoing PCI. However, the association between clinical outcomes and angiographic results with baseline renal function in this population of STEMI patients is not clearly defined.  We report the results of a trial population with a full spectrum of underlying renal function (normal to dialysis dependent) and developed a prediction model for the development of acute kidney injury following primary percutaneous coronary intervention.

In summary, patients with worse underlying renal function had worse angiographic outcomes, higher mortality, and were less likely to be treated with evidence-based medications.  The rate of acute kidney injury (AKI) after PCI appears to increase with worsening underlying renal function, except for those with Class IV chronic kidney disease where the rate of AKI was lowest.  Our novel prediction model for the development of AKI found that the strongest predictors of AKI were age and presenting in Killip Class III or IV.

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CRT-D Reduced Heart Failure Hospitalizations in CKD Patients

Dr. Daniel Friedman

Dr. Daniel Friedman

MedicalResearch.com Interview with:
Daniel Friedman, MD
Cardiology Fellow
Duke University Hospital
Durham, North Carolina

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

Dr. Friedman: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce heart failure hospitalizations, heart failure symptoms, and mortality in randomized clinical trials. However, these well-known trials either formally excluded or did not report enrollment of patients with more advanced chronic kidney disease (CKD), which we defined as a glomerular filtration rate of <45ml/minute. Since advanced CKD has been associated with an increased risk of adverse outcomes among patients with a variety of pacemakers and defibrillators, many have questioned whether the risks of CRT may outweigh the benefits in this population. Furthermore, many have hypothesized that the competing causes of morbidity and mortality among advanced CKD patients who meet criteria for CRT may mitigate clinical response and net benefit.

Our study assessed the comparative effectiveness of CRT with defibrillator (CRT-D) versus defibrillator alone in CRT eligible patients with a glomerular filtration rate of <60ml/minute (Stage III-V CKD, including those on dialysis). We demonstrated that CRT-D use was associated with a significant reduction in heart failure hospitalization or death in the overall population and across the spectrum of CKD. The lower rates of heart failure hospitalization or death was apparent in all subgroups we tested except for those without a left bundle branch block. Importantly, we also demonstrated that complication rates did not increase with increasing severity of CKD.

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Social Barriers Limit Benefits of Exercise in Heart Failure Patients

Lauren Cooper, MD Fellow in Cardiovascular Diseases Duke University Medical Center Duke Clinical Research Institute

Dr. Cooper

MedicalResearch.com Interview with:
Lauren Cooper, MD
Fellow in Cardiovascular Diseases
Duke University Medical Center
Duke Clinical Research Institute

Medical Research: What is the background for this study?

Dr. Cooper: The HF-ACTION study, published in 2009, showed that exercise training is associated with reduced risk of death or hospitalization, and is a safe and effective therapy for patients with heart failure and reduced ejection fraction. Subsequently, Medicare began to cover cardiac rehabilitation for patients with heart failure. However, many patients referred to an exercise training program are not fully adherent to the program. Our study looked at psychosocial reasons that may impact participation in an exercise program.

Medical Research: What are the main findings?

Dr. Cooper: We found that patients with higher levels of social support and fewer barriers to exercise exercised more than patients with lower levels of social support and more barriers to exercise. And patients who exercised less had a higher risk of cardiovascular death or heart failure hospitalization compared to patients who exercised more.

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Preventable Falls and Fights Cause Most Eye Injuries

MedicalResearch.com Interview with:
Christina R. Prescott, M.D., Ph.D
Assistant Professor of Ophthalmology
Johns Hopkins Wilmer Eye Institute

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

Dr. Prescott: I wanted to look at the most common causes of severe ocular injuries, with the hope of helping to focus injury prevention strategies.

From 2002 to 2011, the mean hospital charge for inpatient hospitalizations due to eye injuries increased from $12,430 to $20,116, when controlling for inflation.  This increase paralleled the increase of mean hospital charges for all inpatient stays during the same time period, even when controlling for length of stay, which actually decreased slightly.  Costs were highest at large hospitals and for older patients.  Race, insurance, and gender were less strongly correlated to cost.

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Repositioning Bazedoxifene For Use Against Pancreatic Cancer

Jiayuh Lin, Ph.D. Associate Professor, College of Medicine, The Ohio State University

Dr. Lin

MedicalResearch.com Interview with:
Jiayuh Lin, Ph.D.

Associate Professor,
College of Medicine,
The Ohio State University

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

Dr. Jiayuh Lin: Pancreatic cancer is one of the most serious forms of cancer.  Because of the poor response to chemotherapy as conventionally used, patients with any stage of pancreatic cancer may appropriately be considered candidates for clinical trials using novel agents.

IL-6 signaling plays an important role in oncogenesis and high serum IL-6 levels is a poor prognostic factor for overall survival in pancreatic cancer. Therefore, IL-6 is considered as a viable target for pancreatic cancer therapy.  We utilized a drug discovery method with Multiple Ligand Simultaneous Docking and drug repositioning to identify an existing FDA-approved drug Bazedoxifene with previously unknown biological function as an IL-6/GP130 inhibitor.  Bazedoxifene can inhibit cell viability of pancreatic cancer cells expressing IL-6 and suppressed pancreatic tumor growth in vivo.

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Relatively Few Women Physicians Choose Cardiology as Career

Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine

Dr. Douglas

MedicalResearch.com Interview with:
Pamela S. Douglas, MD, MACC, FASE, FAHA

Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine

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

Dr. Douglas: The impetus for our study was the concern that cardiology as a profession might be enhanced by greater diversity. By not attracting women in larger numbers (9% of FACCs are female), our fellowships have incomplete access to the talent pool of outstanding residents, and we do not have a diverse group of clinicians to care for our increasingly diverse patient population, or of researchers to explore potentially important health care disparities.

Our findings were twofold: first, job descriptions for men and women cardiologists are dramatically different. Men are much more likely to do invasive procedures while women are more likely to see patients and perform imaging/noninvasive tests.  While there were slightly more women working part time than men this was still rare, and the difference in number of days worked was just 6, across an entire year.

The second finding was that there was a significant difference in compensation. Unadjusted, this was over $110, 000 per year; after very robust adjustment using over 100  personal, practice, job description and productivity measures, the difference was $37, 000 per year, or over a million dollars across a career. A separate independent economic analysis of wage differentials yield a similar difference of $32,000 per year.

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Benefits of tPS Outweigh Risks in Ischemia Stroke, Even in Patients on Antiplatelet Medications

Ying Xian, PhD Assistant Professor of Medicine. Member in the Duke Clinical Research Institute

Dr. Ying Xian

MedicalResearch.com Interview with:
Ying Xian, PhD

Assistant Professor of Medicine.
Member in the Duke Clinical Research Institute

Medical Research: What is the background for this study? What are the main findings?
Dr. Xian: Intravenous tissue plasminogen activator (tPA) is the only FDA approved medical therapy to reduce disability and improve outcomes for patients with acute ischemic stroke. But treatment with tPA also carries the risk of symptomatic intracranial hemorrhage (sICH), which is often fatal. Nearly half of ischemic stroke patients are taking antiplatelet drugs such as aspirin and/or clopidogrel prior to stroke. We found these patients had higher risk for sICH when treated with tPA. But the risk is relatively small. For every 147 patients on aspirin treated with tPA, only 1 more symptomatic intracranial hemorrhage as compared with those treated with tPA without prior antiplatelet therapy. The risk is slightly higher among those on dual antiplatelet therapy of aspirin and clopidogrel (number needed to harm 60). Despite the higher bleeding risk, patients treated with tPA on prior antiplatelet therapy appeared to have better functional outcomes in terms of ambulatory status and modified Rankin scale than those not on prior antiplatelet therapy. Therefore, overall the benefits of thrombolytic therapy may outweigh the risks.

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Most Heart Failure Patients on Mineralocorticoid Receptor Antagonist Don’t Receive Recommended Laboratory Tests

Lauren Cooper, MD Fellow in Cardiovascular Diseases Duke University Medical Center Duke Clinical Research Institute

Dr. Cooper

MedicalResearch.com Interview with:
Lauren Cooper, MD

Fellow in Cardiovascular Diseases
Duke University Medical Center
Duke Clinical Research Institute

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

Dr. Cooper: Heart failure guidelines recommend routine monitoring of serum potassium and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). Specific monitoring recommendations include: within 2-3 days of initiation of the drug, again at 7 days, monthly for at least 3 months, then every 3 months thereafter. However, no large studies had evaluated compliance with these safety recommendations in routine clinical practice. Using Medicare claims data from 2011, we evaluated monitoring of serum creatinine and potassium levels among patients with heart failure initiated on an MRA.

After MRA initiation, rates of guideline-recommended laboratory monitoring of creatinine and potassium were low. Of 10,443 Medicare beneficiaries included in this study, 91.6% received pre-initiation testing; however, only 13.3% received appropriate testing in the first 10 days after drug initiation and 29.9% received appropriate testing in the first 3 months. Only 7.2% of patients received guideline-recommended laboratory monitoring both before and after MRA initiation. Chronic kidney disease was associated with a greater likelihood of appropriate testing (relative risk, 1.83; 95% CI, 1.58-2.13), as was concomitant diuretic use (relative risk, 1.78; 95% CI, 1.44-2.21).

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Studies Evaluates Outcomes of Carotid Artery Stenting in Real World Settings

MedicalResearch.com Interview with:
Soko Setoguchi-Iwata, M.D
MPH
Adjunct Associate Professor
Department of Medicine
Duke Clinical Research Institute

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

Dr. Setoguchi: Medicare made a decision to cover Carotid Artery Stenting (CAS) in 2005 after publication of SAPPHIRE, which demonstrated the efficacy of Carotid Artery Stenting vs Carotid Endarterectomy in high risk patients for CEA. Despite the data showing increased carotid artery stenting dissemination following the 2005 National Coverage Determination, peri-procedural and long-term outcomes have not been described among Medicare beneficiaries, who are quite different from trial patients, older and with more comorbidities in general population.

Understanding the outcomes in these population is particularly important in the light of more recent study, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which established CAS as a safe and efficacious alternative to CEA among non-high-surgical risk patients that also expanded the clinical indication of carotid artery stenting.

Another motivation to study ‘real world outcomes in the general population is expected differences in the proficiency of physicians performing stenting in trial setting vs. real world practice setting. SAPPHIRE and CREST physicians were enrolled only after having demonstrated  Carotid Artery Stenting proficiency with low complication rates whereas hands-on experience and patient outcomes among real-world physicians and hospitals is likely to be more diverse.

We found that unadjusted mortality risks over study period of 5 years with an mean of 2 years of follow-up in our population was 32%.  Much higher mortality risks observed among certain subgroups with older age, symptomatic patients and non-elective hospitalizations.  
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Oncotype DX Assay Can Help Guide Adjuvant Breast Cancer Chemotherapy

Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of MedicinMedicalResearch.com Interview with:
Michaela Ann Dinan Ph.D.

Assistant Professor in Medicine
Member of Duke Cancer Institute
Duke University School of Medicine

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

Dr. Dinan: For many years we have known that overall, women with early stage, hormone receptor positive breast cancer show an overall survival benefit from the receipt of adjuvant chemotherapy.  However, depending on the age of the patient, we have also known that between 3 to 10% of patients appear to be truly experiencing this survival benefit and that we are treating a lot of women unnecessarily.  The use of the Oncotype DX assay has provided additional information for patients to assess who at low risk of disease progression and can forgo chemotherapy.

In this study we looked to see whether the adoption of this assay was associated with reduce rates of chemotherapy in women over the age of 65.  We found that somewhat surprisingly, there was no overall association with receipt of the assay and use of chemotherapy.  However, in women who had high risk disease, receipt of the assay was associated with reduced rates of chemotherapy use.  In patients with low risk disease, receipt of the assay was associated with increased chemotherapy use.

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Triple Anticoagulation Therapy Raises Bleeding Risk in Elderly Patients with AFib and Heart Attack

Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North CarolinaMedicalResearch.com Interview with:
Connie N. Hess, MD, MHS
Duke Clinical Research Institute
Duke University
Durham, North Carolina

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

Dr. Hess: Guidelines recommend the use of anticoagulation for thromboembolic prophylaxis in atrial fibrillation and also recommend use of dual antiplatelet therapy to reduce cardiovascular events after myocardial infarction and percutaneous coronary intervention.  The use of triple therapy in patients with indications for DAPT and anticoagulation is challenging due to the increased bleeding risk associated with this regimen.  The optimal antithrombotic regimen in this population has not yet been defined.

This study specifically focused on older patients, a population that is at greater risk for Atrial Fibrillation-related stroke and recurrent events after MI but also higher risk for bleeding. Despite a growing population of older patients with indications for triple therapy, these patients have been underrepresented in clinical trials and are therefore understudied.

We found that relative to DAPT, patients on triple therapy had a similar risk of 2-year major adverse cardiac events but a significantly increased risk of bleeding requiring hospitalization, including greater risk of intracranial hemorrhage.

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Bystander CPR Programs Can Save Lives After Cardiac Arrest

Carolina Malta Hansen, M.D Duke Clinical Research InstituteMedicalResearch.com Interview with:
Carolina Malta Hansen, M.D
Duke Clinical Research Institute

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

Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest.

We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time.

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Underweight Colon Cancer Patients May Have Worse Prognosis

S. Yousuf Zafar, MD, MHS Associate Professor of Medicine Duke Cancer Institute Duke Clinical Research InstituteMedicalResearch.com Interview with:
S. Yousuf Zafar, MD, MHS

Associate Professor of Medicine
Duke Cancer Institute
Duke Clinical Research Institute

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

Dr. Zafar: Multiple studies have suggested that obesity and colorectal cancer are related. For instance, obesity has been linked with an increased incidence of colon cancer. Obesity has also been associated with a greater risk of colon cancer recurrence. To date, no study has looked at the role of obesity in outcomes for patients with metastatic colorectal cancer. In our study of over 6000 patients receiving treatment for metastatic olcolorectal cancer, we found that patients with the lowest body mass index (BMI) were at greatest risk for worse survival. This does not mean that obesity is good. More likely, it means that those who are very underweight are least able to tolerate the best treatment, or being very underweight is a biologic marker of poor prognosis.

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ICD Implantation Rates Too Low In Elderly

Sean D. Pokorney, MD, MBA Division of Cardiology, Duke University Medical Center Duke Clinical Research Institute, Durham, North Carolina
MedicalResearch.com Interview with:
Sean D. Pokorney, MD, MBA
Division of Cardiology, Duke University Medical Center
Duke Clinical Research Institute, Durham, North Carolina

Medical Research: What is the background for this study?

Dr. Pokorney: About 350,000 people die of sudden cardiac death in the US each year. Patients who have weakened heart function, particularly those with heart muscle damage as a result of a heart attack, are more likely to experience sudden cardiac death.  Defibrillators have been around since the 1980s, and have prolonged countless lives.  A previous study showed that 87% of patients who had a cardiac arrest were eligible for an implantable-cardioverter defibrillator (ICD) beforehand but did not get an ICD implanted prior to their arrest.  The timing of ICD implantation is critical, as studies have not found a benefit to ICD implantation early after myocardial infarction (MI).  Guidelines recommend primary prevention ICD implantation in patients with an EF ≤ 35% despite being treated with optimal medical therapy for at least 40 days after an MI.  Given the need to wait for at least 40 days after an MI, ICD consideration is susceptible to errors of omission during the transition of post-MI care between inpatient and outpatient care teams.  Also, the benefit of ICDs remains controversial among older patients, as these patients were underrepresented in clinical trials.

Medical Research: What are the main findings?

Dr. Pokorney: We looked at Medicare patients discharged from US hospitals after a heart attack between 2007 and 2010.  We focused on those patients who had weak heart function, and this left us with a little over 10,300 patients from 441 hospitals for our study.  This was an older patient population with a median age of 78 years.  We looked to see how many of these patients got an ICD within the first year after MI, and how many patients survived to 2 years after their heart attack.  Only 8% of patients received an ICD within 1 year of their heart attack.  ICD implantation was associated with a third lower risk of death within 2 years after a heart attack, and this was consistent with the benefit that were seen in the randomized clinical trials.  Importantly, 44% of the patients in our study were over 80 years old, and we found that the relationship between ICD use and mortality was the same for patients over and under age 80 years.  Increased patient contact with the health care system through early cardiology follow-up or re-hospitalization for heart failure or MI was associated with higher likelihood of ICD implantation.  Rates of ICD implantation remained around 1 in 10 patients within 1 year of MI even among patients with the largest heart attacks and the weakest hearts (lowest ejection fractions), who were least likely to have improvement in their heart function over time.  Similarly, even after excluding patients at highest risk for non-arrhythmic death (prior cancer, prior stroke, and end stage renal disease), ICD implantation rates remained around 1 in 10 patients.

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High Blood Pressure In Young Adulthood Increases Risk Of Later Heart Failure

Satoru Kishi, MD Division of Cardiology Johns Hopkins University Baltimore, MarylandMedicalResearch.com Interview with:
Satoru Kishi, MD
Division of Cardiology
Johns Hopkins University
Baltimore, Maryland

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

Dr. Kishi: Blood pressure (BP) at the higher end of the population distribution may represent a chronic exposure that produces chronic injury to the cardiovascular system. Cumulative BP exposure from young adulthood to middle age may adversely influence myocardial function and predispose individuals to heart failure (HF) and other cardiovascular disease (CVD) later in life. The 2005 guidelines for the diagnosis and treatment of HF from the American College of Cardiology and American Heart Association highlight the importance of early recognition of subclinical cardiac disease and the importance of non-invasive tests in the clinical evaluation of heart failure.

Our main objective was to investigate how cumulative exposure to high blood pressure from young to middle adulthood influence LV function. In the Coronary Artery Risk Development in Young Adults (CARDIA) study, multiple repeated measures of BP and other cardiovascular risk factors was recorded over a 25 year time span, starting during early adulthood (ages 18-30). Continue reading

Choosing Among Diets Did Not Improve Weight Loss

William S. Yancy, Jr., MD, MHSc Research Associate Center for Health Services Research in Primary Care Durham, NC 27705 Associate Professor Department of Medicine Duke University Medical CenterMedicalResearch.com Interview with:
William S. Yancy, Jr., MD, MHSc
Research Associate
Center for Health Services Research in Primary Care
Durham, NC  27705
Associate Professor Department of Medicine
Duke University Medical Center

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

Dr. Yancy: A number of studies have compared different diet approaches for weight management with many of these finding that several different diets can result in significant weight loss. This has led many experts to advise that we should offer a choice among these diet options to our patients who are seeking to lose weight. We know that adherence is the best predictor of weight loss during dietary interventions, so the thought is that patients will adhere better to a diet that they prefer, resulting in more successful weight loss. In addition, allowing choice enhances patient autonomy, which is patient-centered and has been shown to increase treatment adherence. However, the previous studies of various diet approaches did not let people choose a diet, so we don’t actually know if letting them choose will lead to better weight loss. Our study specifically tested this assumption. We randomized participants to a condition where they were allowed to choose between 2 common weight loss diets or to a condition where they were randomly assigned to one of the diets. The 2 diets we used were a low-carbohydrate diet without calorie restriction and a low-fat diet combined with calorie restriction. Participants received counseling about the diets, and about behavioral strategies and physical activity, in 19 group sessions over the span of 12 months. They also received 6 phone calls with motivational counseling in the latter half of the program.

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Oncotype DX Breast Cancer Assay Quickly Adopted Under Medicare Guidelines

Michaela Dinan, Ph.D. Duke Clinical Research Institute and Duke Cancer Institute Department of Medicine Duke University School of Medicine Durham, North CarolinaMedicalResearch.com Interview with:
Michaela Dinan, Ph.D.
Duke Clinical Research Institute and Duke Cancer Institute
Department of Medicine
Duke University School of Medicine
Durham, North Carolina

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

Response: I think it will be critical to further explore the implications of Oncotype DX breast cancer assay (ODX testing) in women with breast cancer.  The ODX test helps predict which cancers will be more aggressive as well as guide recommendations as to which patients would most likely benefit from chemotherapy. I think we should look to see what impact this test is really having on the use of chemotherapy and its associated costs and outcomes for real-world breast cancer patients.

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Improved Hospital Discharge Process May Reduce Medication Nonadherence

Robin Mathews, MD Duke Clinical Research Institute Duke University Medical Center Durham, NCMedicalResearch.com Interview with:
Robin Mathews, MD
Duke Clinical Research Institute
Duke University Medical Center
Durham, NC

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

Dr. Mathews: Though treatment for patients with an acute myocardial infarction with evidence based therapies has increased significantly over the years, adherence to these therapies after discharge remain sub optimal. We used a validated instrument, the Morisky scale, to assess patient medication adherence.  We found that in a contemporary population of 7,425 patients across 216 hospitals, about 30% of patients were not adherent to prescribed cardiovascular medications as early as 6 weeks after discharge. Patients with low adherence were more likely to report financial hardship as well as have signs of depression. In addition, we found that patients who had follow up arranged prior to discharge and those that received explanations from the provider on the specific medications, were more often adherent to therapies. There was a non significant increase in risk of death or readmission at 2 months (HR [95% CI]: 1.35 [0.98-1.87]) among low adherence patients.

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Depression Linked To Worse Heart Failure Outcomes in Blacks

 Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research InstituteMedicalResearch.com Interview with:
Dr. Robert J. Mentz MD
Assistant Professor of Medicine
Director, Duke University Cooperative Cardiovascular Society
Advanced Heart Failure and Cardiac Transplantation
Duke University Medical Center
Duke Clinical Research Institute

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

Dr. Mentz: Previous studies have shown that depression is associated with worse outcomes in heart failure patients; however, most of these prior studies were conducted in primarily white patient populations. The impact of depressive symptoms on outcomes specifically in blacks with heart failure has not been well studied. We used data from the HF-ACTION trial of exercise training in heart failure patients, which collected data on depressive symptoms via the Beck Depression Inventory (BDI-II), to assess the association between depressive symptoms and outcomes in black patients as compared with white patients. We found that in blacks with heart failure, baseline symptoms of depression and worsening of symptoms over time were both associated with increased all-cause mortality/hospitalization.

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Divorce Raises Risk of Heart Attack, Especially For Women

Matthew E. Dupre, PhD Associate Professor of Medicine Department of Community and Family Medicine Department of Sociology Duke Clinical Research InstituteMedicalResearch.com Interview with: 
Matthew E. Dupre, PhD
Associate Professor of Medicine
Department of Community and Family Medicine
Department of Sociology
Duke Clinical Research Institute

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

Dr. Dupre: The negative health consequences of divorce have been known for some time.  However, we showed that lifetime exposure to divorce can have a lasting impact on ones’ cardiovascular health, particularly in women.  Results from our study showed that risks for acute myocardial infarction (AMI) were significantly higher in women who had one divorce, two or more divorces, and among the remarried compared with continuously married women after adjusting for multiple risk factors.  Risks for AMI were elevated only in men with a history of two or more divorces relative to continuously married men. We were especially surprised to find that women who remarried had risks for AMI that were nearly equivalent to that of divorced women.  Men who remarried had no significant risk for acute myocardial infarction.

The results of this study provide strong evidence that cumulative exposure to divorce increases the risk of acute myocardial infarction in older adults.  Also somewhat unexpected was that the associations remained largely unchanged after accounting for a variety socioeconomic, psychosocial, behavioral, and physiological factors.  However, we lacked information on several factors that we suspect may have contributed to the risks related to divorce – such as elevated stress, anxiety, and the loss of social support; as well as possible changes is medication adherence or other prophylactic behaviors.

MedicalResearch: What should clinicians and patients take away from your report? Continue reading

Coronary Heart Disease: CT Scans May Reduce Tests, Procedures and Radiation Exposure

Pamela S. Douglas, M.D. Duke University School of Medicine Duke University Medical Center Durham, NC 27715MedicalResearch.com Interview with:
Pamela S. Douglas, M.D.
Duke University School of Medicine
Duke University Medical Center
Durham, NC 27715

Medical Research: What is the background for this study?

Dr. Douglas: The primary objective of the PROMISE study was to compare the health outcomes of people who went to the doctor with new symptoms such as shortness of breath and/or chest pain that were suggestive of coronary artery disease and that required additional evaluation. This was an important investigation because no large research trial has ever been conducted to help guide the care of such patients. Instead, the selection of tests for such patients—which constitutes at least 4 million patients in the United States each year—has been largely left up to physician and patient preference rather than proven results.

Medical Research: What are the main findings?

Dr. Douglas: 10,003 patients from 193 different medical facilities across the US and Canada agreed to be part of the PROMISE study and  were randomized to a functional stress test or an anatomic test Using CT angiography.  The study found that the clinical outcomes of participants with suspected coronary artery disease were excellent overall, and were similar in terms of death and major cardiac conditions regardless of whether patients had a functional stress test or a computed tomographic scan. However, the CT scan may be better at ruling out the need for subsequent tests and procedures in patients who are free of heart disease, and involved a lower radiation exposure relative to a stress nuclear study. We also found, in a separately reported study, that the costs of the two diagnostic strategies were similar.

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Random Stem Cell Divisions May Play Role in Persistent HPV Infections

Marc Ryser PhD Visiting Assistant Professor Department of Mathematics Duke University Durham, North CarolinaMedicalResearch.com Interview with:
Marc Ryser PhD
Visiting Assistant Professor Department of Mathematics
Duke University Durham, North Carolina

Medical Research: What is the background for this study

Dr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical.

The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years.  However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response.

Interestingly, recent studies about the stem cell dynamics in epithelial tissues – the types of tissues that are affected by HPV –  have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections.
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Mobile Health Technologies Will Change Chronic Disease Management

Ryan Jeffrey Shaw, PhD, MS, RN Assistant Professor School of Nursing Center for Health Informatics Center for Precision Medicine Duke University MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN

Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University

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

Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.

Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.

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Study Examines Use Of Oncotype DX® Breast Cancer Test In Medicare Patients

Dr. Michaela A. Dinan Ph.D Department of Medicine Duke UniversityMedicalResearch.com Interview with:
Dr. Michaela A. Dinan Ph.D

Department of Medicine
Duke University

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

Dr. Dinan: We wanted to examine how  Oncotype DX® Breast Cancer Test (ODX) was being used in real-world practice at the population level. ODX has been examined in clinical trials and limited academic settings but we know that these patients are often younger, have fewer medical comorbidities, and do not necessarily accurately reflect the majority patients with cancer.  In our study, we observed that Oncotype DX® Breast Cancer Test was being used predominately in accordance with guidelines which recommend the test for women with estrogen-receptor positive, node negative disease. We also looked just at women under the age of 70 who met guideline criteria for testing, because this population would include those women who were more likely to be chemotherapy candidates, and we saw a rapid uptake of the test between 2005 and 2009, with use of the test increasing from 8% to 39%.

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Non-Adherence to Guidelines May Lead To Inappropriate Radioactive Iodine Treatment for Thyroid Cancer

Sanziana Roman MD FACS Professor of Surgery Duke University  Section of Endocrine Surgery Director of the Endocrine Surgery Fellows and Scholars Program Duke University School of Medicine Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMCMedicalResearch.com Interview with:
Sanziana Roman MD FACS

Professor of Surgery Duke University
Section of Endocrine Surgery
Director of the Endocrine Surgery Fellows and Scholars Program
Duke University School of Medicine
Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMC

Medical Research: What is the background for this study?

Dr. Roman: Adjuvant radioactive iodine (RAI) is commonly used in the management of differentiated thyroid cancer. The main goals of adjuvant RAI therapy are to ablate remnant thyroid tissue in order to facilitate long-term follow-up of patients, decrease the risk of recurrence, or treat persistent and metastatic lesions.

On the other hand, Adjuvant radioactive iodine ( therapy is expensive, with an average cost per patient ranging between $5,429.58 and $9,105.67. It also carries the burden of several potential complications, including loss of taste, nausea, stomatitis with ulcers, acute and/or chronic sialoadenitis, salivary duct obstruction, dental caries, tooth loss, epiphora, anemia, neutropenia, thrombocytopenia, acute radiation pneumonitis, pulmonary fibrosis, male infertility, and radiation-induced malignancies. Therefore, Adjuvant radioactive iodine ( should be used only for appropriately selected patients, for whom the benefits would outweigh the risks.

Based on current guidelines, adjuvant RAI is not recommended for patients with papillary thyroid cancers confined to the thyroid gland when all foci are ≤1 cm (papillary thyroid microcarcinoma, or PTMC). Similarly, Adjuvant radioactive iodine ( does not have a role in the treatment of medullary and anaplastic thyroid cancer. Given the fact that variation in treatments exist, our goal was to analyze patterns of inappropriate adjuvant RAI use in the U.S. in order to identify potential misuses leading to an increase of costs for the healthcare system and unnecessary patients’ exposure to risks of complications.
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Researchers Coax Engineered Muscle Cells To Contract in 3D Matrices

Nenad Bursac PhD Rooney Family Associate Professor of Biomedical Engineering Associate Professor of Medicine Duke UniversityMedicalResearch.com Interview with:
Nenad Bursac PhD

Rooney Family Associate Professor of Biomedical Engineering
Associate Professor of Medicine Duke University

 

 

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

Dr. Bursac: Researchers have tried for a long time to coax human muscle cells (obtained from needle biopsies) into contracting muscle fibers in a dish in order to be able to study human muscle physiology ex vivo. We are the first group that succeeded by carefully optimizing culture conditions including methods to expand and then culture cells in three-dimensional hydrogel matrices under passive tension. By doing so, we made first human muscle model that in response to electrical stimulation generates classical muscle contractile responses (twitch and tetanus). We have also shown that these engineered muscles (that we call “myobundles”) contract in response to acetylcholine as it naturally happens when neurons in our body activate muscle. We demonstrated reproducibility and robustness of the approach by generating functional myobundles with similar properties from 10 independent donor muscle samples. We further went to show that myobundles have intact signaling characteristic of native muscle and respond to diverse set of drugs as human muscles do in clinics.

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Breast Cancer: Older Patients Still Receiving Radiation Therapy Despite Limited Benefit

Rachel Blitzblau, M.D., Ph.D. Butler Harris Assistant Professor Department of Radiation Oncology Duke University Medical Center Durham, NC 27710MedicalResearch.com Interview with:
Rachel Blitzblau, M.D., Ph.D.

Butler Harris Assistant Professor
Department of Radiation Oncology
Duke University Medical Center
Durham, NC 27710

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

Dr. Blitzblau: Radiation reduces the risk of loco-regional recurrence. Data from the CALGB 9343 study suggests that the local benefit from adjuvant radiation is less in older women with small, estrogen receptor positive breast cancers. The potential acute and late toxicities of radiotherapy, patient inconvenience and healthcare costs must be considered given the small clinical benefit associated with adjuvant radiotherapy in this patient group. We looked at rates of radiotherapy in women fitting the entry criteria of this trial before and after publication of 5 year results of the CALGB trial. We found an approximately 5% decrease in use of radiotherapy overall, and noted that there seemed to be a small but significant shift in the type of radiotherapy used for these patients. Less patients received standard whole breast radiotherapy, and more received a short course of treatment to just the tumor bed plus margin called accelerated partial breast irradiation. We concluded that the publication of the trial therefore had only a very small impact on practice patterns.

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Practical Approach to Management of Incidental Thyroid Nodules

Dr. Jenny Hoang MBBS (Hons) Associate Professor of Radiology and Radiation Oncology Duke University Medical CenterMedicalResearch.com Interview with:
Dr. Jenny Hoang MBBS (Hons)

Associate Professor of Radiology and Radiation Oncology
Duke University Medical Center

 

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

Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.

The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience. Continue reading

Community Interventions Improved Blood Pressure Control In Diverse Populations

Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research InstituteMedicalResearch.com Interview with:
Kevin L Thomas, MD
Assistant Professor of Medicine
Division of Clinical Cardiac Electrophysiology
Duke Clinical Research Institute

 

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

Dr. Thomas: The number of participants with controlled blood pressure (readings of less than 140/90) increased by 12 percent in the six months between the first and last readings. Mean systolic blood pressure for the population decrease by 4.7mmHg. The number of participants who had high blood pressure in the range of 140-149/90-99 decreased systolic blood pressure by a mean of  8.8mmHg and those with readings in the higher range of 150/100 or above decreased systolic blood pressure by 23.7percent. The study concluded that a program that followed this type of approach was associated with improved blood pressures across a diverse  high-risk community.”
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Brainwaves Demonstrate Susceptibility To Stress

Rainbo Hultman, PhD Postdoctoral Research Associate Laboratory for Psychiatric Neuroengineering, Principal Investigator Affective Cognitive and Addiction Disorders (ACAD) Research Group Department of Psychiatry and Behavioral Sciences Center for Neuroengineering Duke University Medical Center Durham, NC 27710MedicalResearch.com Interview with:
Rainbo Hultman, PhD
Postdoctoral Research Associate
Laboratory for Psychiatric Neuroengineering, Principal Investigator
Affective Cognitive and Addiction Disorders (ACAD) Research Group
Department of Psychiatry and Behavioral Sciences
Center for Neuroengineering Duke University Medical Center
Durham, NC 27710

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

Dr. Hultman: Using a mouse model of stress-induced psychiatric dysfunction, we found that the brainwave patterns in two key brain regions (prefrontal cortex, PFC and amygdala, AMY) encode for susceptibility to such dysfunction. Furthermore, such susceptibility can be predicted from the brainwave patterns in these regions before the onset of stress.
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New Antibody Can Block Pain and Itch Simultaneously

MedicalResearch.com Interview with:
Seok-Yong Lee, Ph.D. Assistant Professor of BiochemistrySeok-Yong Lee, Ph.D.
Assistant Professor of Biochemistry and

Ru-Rong Ji, Ph.D. Distinguished Professor  of Duke University Professor of Anesthesiology  and Neurobiology Chief of Pain ResearchRu-Rong Ji, Ph.D.
Distinguished Professor  of Duke University
Professor of Anesthesiology  and Neurobiology
Chief of Pain Research
Duke University Medical Center
Durham, NC 27710

MedicalResearch: What are the main findings of the study?



Answer: We have developed an antibody that can block the pain and itching sensations in mice simultaneously with high efficacy. We would like to point out that our discovery has the potential to be applied to human once the antibody is humanized. Given the high selectivity, general safety profile, and long half-lives of monoclonal antibodies, this method we developed to raise antibodies against therapeutic targets (e.g., ion channels) can have broad applications to other diseases.
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New Hypertension Guidelines Potentially Affect Millions of Americans

MedicalResearch.com Interview with:
Ann Marie Navar-Boggan, MD, PhD
Division of Cardiology,
Duke University Medical Center
Durham, North Carolina

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

Dr. Navar-Boggan: Two groups of adults are really affected by the updated guidelines. First, 13.5 million adults, including one in five adults over the age of 60, were previously considered to have uncontrolled blood pressure but now meet new guideline goals.

Next, 14 million adults over the age of 60 (one in four adults in this age group) are currently on blood pressure lowering therapy and meeting the older, more stringent targets. The guidelines state that no changes are necessary in this group, but they may be eligible for reduced therapy, particularly if they have had side effects or difficulty with the therapies they are taking.
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New Statins Guidelines Will Prevent More Heart Attacks, Stroke But Treat More Who May Not Need Them

Michael J. Pencina, PhD Professor of Biostatistics and Bioinformatics Director of Biostatistics Duke Clinical Research Institute Durham, NC 27710 MedicalResearch.com Interview with:
Michael J. Pencina, PhD
Professor of Biostatistics and Bioinformatics
Director of Biostatistics
Duke Clinical Research Institute
Durham, NC 27710

MedicalResearch.com: What motivated your research?

Dr. Pencina: After the new guidelines were issued last November, we were intrigued by the change in treatment philosophy from that based on cholesterol levels (used by the “old guidelines” known as NCEP ATPIII) to one based on 10-year risk of cardiovascular disease (used by the new AHA-ACC guidelines).  We were curious what the practical consequences of this shift would be.

Furthermore, the media quoted a lot of experts making educated guesses on the impact.  We realized that this question can be answered much more precisely based on the NHANES data.

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Ocular Injuries from Laser Pointers

Glenn Yiu, MD, PhD Duke Ophthalmology Duke University Medical CenterMedicalResearch.com Interview with:
Glenn Yiu, MD, PhD
Duke Ophthalmology
Duke University Medical Center


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

Dr. Yiu: This paper reported a child who suffered injury to both eyes from a powerful blue laser pointer purchased via the internet from overseas. Our report reviews the scientific basis for laser injuries in eyes and the factors that may affect outcomes, such as power, wavelength, duration, and distance of exposure. Newer green and blue lasers, especially high-powered ones, may be more prone to inducing eye injuries. We summarized the clinical features of ocular laser injuries, methods of prevention, and discussed how consumer availability of high powered lasers may require careful federal regulations.

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