Medicare Spends Hundreds of Millions Annually to Treat Precancerous Skin Lesions

MedicalResearch.com Interview with:
“Actinic Keratosis” by Ed Uthman is licensed under CC BY 2.0Howa Yeung, MD
Assistant Professor of Dermatology
Emory University School of Medicine
Atlanta, GA 30322 

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses?

Response: Actinic keratoses are common precancerous skin lesions caused by sun exposure. Because actinic keratoses may develop into skin cancers such as squamous cell carcinoma and basal cell carcinoma, they are often treated by various destructive methods. We used Medicare Part B billing claims to estimate the number and cost of treated actinic keratoses from 2007 to 2015.

MedicalResearch.com: What are the main findings? 

Response: While the number of Medicare Part B beneficiaries increased only moderately, the number of actinic keratoses treated by destruction rose from 29.7 million in 2007 to 35.6 million in 2015. Medicare paid an average annual amount of $413.1 million for actinic keratosis destruction from 2007 to 2015. Independently billing non-physician clinicians, including advanced practice registered nurses and physician assistants, are treating an increasing proportion of actinic keratosis, peaking at 13.5% in 2015.

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

Response: Readers should understand that the burden of actinic keratosis treatment is increasing in the Medicare population. There is also an increasing proportion of actinic keratoses being treated by advanced practice registered nurses and physician assistants.  Continue reading

Cardiovascular Risks of Hormone Therapy in Transgender Individuals

MedicalResearch.com Interview with:

Michael Goodman, MD, MPH Professor of Epidemiology Director, MD/MPH program Emory University School of Public Health Atlanta, GA  30322

Dr. Goodman

Michael Goodman, MD, MPH
Professor of Epidemiology
Director, MD/MPH program
Emory University School of Public Health
Atlanta, GA  30322

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

Response: There is a concern that hormone therapy may be associated with higher risk of certain cardiovascular problems such as heart attacks, stroke and formation of blood clots (“venous thromboembolism”).

To study this concern we examined data on 4,960 transgender and gender non-conforming people enrolled in Kaiser Permanente health systems in Georgia, Northern California, and Southern California. They were matched to 48,686 cisgender men and 48,775 cisgender women.  Below are the main findings

  • Rates of venous thromboembolism in all transwomen were approximately twice as high as the rates among cisgender men or cisgender women. The data for stroke and myocardial infarction demonstrated little difference between transwomen and cisgender men, but 80% to 90% higher rates among transwomen compared to cisgender women.
  • When the analyses focused specifically on transwomen who started therapy with female hormone estrogen at Kaiser Permanente, the incidence of both venous thromboembolism and stroke was more clearly elevated relative to either reference group.  There was evidence that incidence of both of these conditions among transwomen was particularly increased two to six years after estrogen initiation. By contrast, the association between estrogen therapy and myocardial infarction was less evident due to relatively few observed events.
  • Transmen did not appear to have significantly higher rates of venous thromboembolism, ischemic stroke, or myocardial infarction than their non-transgender counterparts, but this group was rather young and included a relatively small proportion of participants who initiated their hormone therapy during the study.

Continue reading

Reduced Heart Rate Variability May Be Biomarker of Depression Risk

MedicalResearch.com Interview with:

Viola Vaccarino, MD, PhD Department of Epidemiology and Division of Cardiology Professor, Department of Medicine Emory University School of Medicine Atlanta, Georgia

Dr. Vaccarino

Viola Vaccarino, MD, PhD
Department of Epidemiology and Division of Cardiology
Professor, Department of Medicine
Emory University School of Medicine
Atlanta, Georgia 

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

Response: Previous studies have shown that people with depression tend to have lower heart rate variability (HRV), an index of autonomic nervous system dysregulation derived by monitoring the electrocardiogram over time, usually for 24 hours. Other literature, however, has pointed out that autonomic dysregulation (as indexed by reduced HRV) may also cause depression. Thus, the direction of the association between reduced HRV and depression still remains unclear. In addition, these two characteristics could share common pathophysiology, making shared familial background and genetic factors potential determinants of this association.
Continue reading

How a PET Can Save Your Heart

MedicalResearch.com Interview with:

Dr-W-Robert-Taylor

Dr. Taylor

Robert Taylor, MD, PhD
Marcus Chair in Vascular Medicine
Executive Vice Chair, Medicine
Director, Division of Cardiology
Professor of Medicine and
Biomedical Engineering
Emory University School of Medicine

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

Response: The early identification and localization of bacterial infections is a critical step for initiating effective treatment.   This is particularly challenging in the setting of infections associated with implanted medical devices.  We have developed a highly specific probe for bacteria that is based on the fact that bacteria have a specific system for taking up maltodextrins which are polysaccharides that mammalian cells cannot take up directly.  We can label this probe with either a fluorescent of radioactive tag that allows visualization of the bacteria.

In the current article, we have used an animal model of implantable cardiac devices to demonstrate that our probe is very specific and sensitive for detecting bacterial infections.  It is worth noting that these are subclinical infections that could not be detected by any other means except for surgical removal.

Continue reading

Is Sickle Cell Really a Risk Factor for Stroke?

MedicalResearch.com Interview with :

Dr. Hyacinth I Hyacinth MD Aflac Cancer and Blood Disorder Center, Emory Children’s Center, Department of Pediatrics, Emory University School of Medicine Atlanta, GA 30322

Dr. Hyacinth

Dr. Hyacinth I Hyacinth MD
Aflac Cancer and Blood Disorder Center, Emory Children’s Center, Department of Pediatrics, Emory University School of Medicine
Atlanta, GA 30322

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

This study was conducted against the backdrop of a significantly higher risk for stroke among African Americans compared to non-Hispanic Whites, despite adjusting for traditional risk factors. Also, sickle cell disease is a well-known genetic risk factor for stroke and recent studies show that sickle cell trait is a risk factor for chronic kidney disease, venous thromboembolism and pulmonary embolism, all of which are potential risk factors for stroke.

Continue reading

Machine Learning Enhances Ability To Predict Survival From Brain Tumors

MedicalResearch.com Interview with:

Lee Cooper, Ph.D. Assistant Professor of Biomedical Informatics Assistant Professor of Biomedical Engineering Emory University School of Medicine - Georgia Institute of Technology

Dr. Cooper

Lee Cooper, Ph.D.
Assistant Professor of Biomedical Informatics
Assistant Professor of Biomedical Engineering
Emory University School of Medicine – Georgia Institute of Technology

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

Response: Gliomas are a form of brain tumor that are often ultimately fatal, but patients diagnosed with glioma may survive as few as 6 months to 10 or more years. Prognosis is an important determinant in selecting treatment, that can range from simply monitoring the disease to surgical removal followed by radiation treatment and chemotherapy. Recent genomic studies have significantly improved our ability to predict how rapidly a patient’s disease will progress, however a significant part of this determination still relies on the visual microscopic evaluation of the tissues by a neuropathologist. The neuropathologist assigns a grade that is used to further refine the prognosis determined by genomic testing.

We developed a predictive algorithm to perform accurate and repeatable microscopic evaluation of glioma brain tumors. This algorithm learns the relationships between visual patterns presented in the brain tumor tissue removed from a patient brain and the duration of that patient’s survival beyond diagnosis. The algorithm was demonstrated to accurately predict survival, and when combining images of histology with genomics into a single predictive framework, the algorithm was slightly more accurate than models based on the predictions of human pathologists. We were also able to identify that the algorithm learns to recognize some of the same tissue features used by pathologists in evaluating brain tumors, and to appreciate their prognostic relevance. Continue reading

Genetic Link Between Corneal Thickness and Risk of Glaucoma

MedicalResearch.com Interview with:

Eldon E. Geisert, PhD Professor of Ophthalmology Emory School of Medicine

Dr. Geisert

Eldon E. Geisert, PhD
Professor of Ophthalmology
Emory School of Medicine

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

Response: In the late 1990s a group of doctors began a study of glaucoma patients to determine if there were phenotypes that are predictive for developing glaucoma.

In this Ocular Hypertension Treatment Study (OHTS) one of the highly correlated ocular traits was central corneal thickness (CCT). The early clinical studies found that people with thinner corneas were at a higher risk of developing glaucoma. In two large studies, examining thousands of people a number of genes were identified that were risk factors for glaucoma or that controlled CCT in humans. In both cases the identified genes accounted for less than 10% of the genetic risk for glaucoma and less than for 10% of the genetic control for CCT. There was little data linking the genetic control of CCT to the glaucoma risk.

Our group has taken an indirect approach to the question, using well-defined mouse genetic system to identify genes modulating CCT and then interrogating human glaucoma data to determine if these genes are associated with glaucoma risk.   Continue reading

Disruptions In Medicaid Coverage For Depression Linked To Increased ER Visits

MedicalResearch.com Interview with:
Xu Ji PhD Candidate
Emory University
Department of Health Policy and Management
Rollins School of Public Health
Emory University
Atlanta, GA

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

Response: Gaps in Medicaid coverage (sometimes called “churning”) can disrupt ongoing outpatient care needed to manage chronic conditions, such as depression, and trigger use of emergency care. This study examined how disruptions in Medicaid coverage impacted acute care use—specifically emergency department visits and hospital stays—in nearly 140,000 adults treated for major depression.

We found that those with disruptions in Medicaid coverage were more likely to have emergency department visits and longer hospital stays when they went back on Medicaid compared to those with continuous coverage.

We also found that disruptions in Medicaid coverage occurred less frequently for Medicaid enrollees with depression in states requiring only yearly recertification (i.e., more streamlined re-enrollment procedures) than those in states that required recertification every six months or more frequently (i.e., more stringent procedures). Eligibility recertification usually requires enrollees to visit the social welfare office to provide income or other documentation to prove eligibility. Failure to complete the recertification process would drop enrollees out of Medicaid.
Continue reading

Majority of Murdered Women Are Killed By Current or Former Partners

MedicalResearch.com Interview with:

EmikoPetrosky MD M.P.H Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention Centers for Disease Control and Prevention Emory University Rollins School of Public Health

Dr. Petrosky

EmikoPetrosky MD M.P.H
Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Emory University Rollins School of Public Health

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

Response: Homicide is one of the leading causes of death for women aged 44 years and younger. In 2015, 3,519 girls and women died by homicide in the United States.  It is the 5th leading cause of death for women under 45 years age (defining women as 18-44 years of age).

The National Violent Death Reporting System (NVDRS) links together data from death certificates, coroner/medical examiner reports, and law enforcement reports, resulting in more information about the circumstances of death than what is available elsewhere.

Continue reading

Dissolvable Microneedle Patches Can Be Vaccination Game Changer

MedicalResearch.com Interview with:
Dr Nadine G Rouphael MD
Associate Professor of Medicine, Emory University
Director of the VTEU and HIPC networks at the
Hope Clinic of the Emory Vaccine Center
Decatur GA 30030, USA

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

Response: Different groups including a group of researchers at Georgia Tech have been working on the microneedle technology for more than 20 years. The dissolvable microneedle patches are already used in several cosmetic products and drugs. However, vaccination with microneedle patches has been studied mostly in animals.

Our phase 1 trial published this week in The Lancet showed that vaccination with the microneedle patches was safe, with no related serious adverse events reported. Local skin reactions to the patches were mostly mild itching and faint redness that lasted two to three days. No new chronic medical illnesses or influenza-like illnesses were reported with either the patch or the injection groups. Antibody responses generated by the vaccine, as measured through analysis of blood samples, were similar in the groups vaccinated using patches and those receiving intramuscular injection, and these immune responses were still present after six months. When asked after immunization, more than 70 percent of patch recipients reported they would prefer patch vaccination over injection or intranasal vaccination for future vaccinations.

Continue reading

Are Your Prefrontal Neurons Oscillating? You May Be In Love

MedicalResearch.com Interview with:

Dr. Robert Liu, PhD Silvio O. Conte Center for Oxytocin and Social Cognition Center for Translational Social Neuroscience Department of Biology Graduate Program in Neuroscience Emory University, Atlanta, Georgia

Dr. Liu

Dr. Robert Liu, PhD
Silvio O. Conte Center for Oxytocin and Social Cognition
Center for Translational Social Neuroscience
Department of Biology
Graduate Program in Neuroscience
Emory University, Atlanta, Georgia 

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

Response: This study describes for the first time some of the novel brain mechanisms underlying how social relationships are formed.  In this case we studied the formation of a pair bond in voles.  Pair bonding in voles is not exactly the same as love in humans, but we believe that pair bonding in voles likely shares many of the underlying neural mechanisms as falling in love in humans, such as developing a rewarding feeling towards your partner.

Basically, we discovered that rhythmic oscillations of groups of neurons in the prefrontal cortex, an area of the brain that is involved in decision making and executive function, can control the strength of oscillations at a different frequency in populations of neurons in the nucleus accumbens, an area that is involved in pleasure and reward, as well as addiction.  We show that the strength of that PFC-NAc control predicted how quickly animals would begin to show affectionate behavior, analogous to people who may fall in love quicker than others.  But the most intriguing thing was that when animals mated for the first time, the strength of the control of the reward system by the decision making circuit increased, and the greater the increase in that control, the faster the animal started huddling or showing affection toward its partner.  We think that this cortical control of the reward system allows for the neural encoding of the partner’s features (odors, sounds) to become stamped into the reward system, so that the partner becomes rewarding themselves.  Indeed in studies in humans, parts of the striatum, to which the nucleus accumbens belongs, become activated when men look at images of their lovers or when mothers look at images of babies.

We not only observed that during pair bond formation the cortex controls rhythmic activity within the reward system, but we actually recreated that communication using a highly innovative technique that allows us to control neural activity using light.  We expressed a light sensitive protein in the cortical neurons that project to the reward system, and then light stimulated those projections in the reward system in animals at the same frequency as normally happens during mating, but in this case the animals were not allowed to mate. By simply recreating the neural oscillatory control of the cortex of the reward area when the female was near the male, we biased how affectionately she acted towards him.

We think that the implications for this is not restricted to forming bonds or falling in love, but tells us something fundamental about how certain brain circuits communicate with each other to build social relationships, to make us feel pleasure from being with others that we like.  We believe that by understanding how social cues get instantiated into the brain’ reward system, we may ultimately be able to use this information to help people with impairments in the forming strong social relationships, such as in autism or schizophrenia.

Continue reading

Functional Brain Markers Can Suggest Susceptibility to PTSD

MedicalResearch.com Interview with:

Jennifer Stevens, PhD Director, Neuroscience of Memory, Emotion, and Stress Laboratory Instructor, Dept of Psychiatry & Behavioral Sciences Emory University School of Medicine

Dr. Stevens

Jennifer Stevens, PhD
Director, Neuroscience of Memory, Emotion, and Stress Laboratory
Instructor, Dept of Psychiatry & Behavioral Sciences
Emory University School of Medicine

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

Response: Post-traumatic stress disorder (PTSD) was once thought to be a disorder of combat veterans, however, we now know that more than 60% of Americans experience a traumatic event during their lifetimes, and that this can have negative consequences for mental and physical health. Many people recover from the psychological effects of trauma without any intervention, but a significant proportion have long-lasting debilitating symptoms.

Supported by the NIH, the cutting edge of PTSD research includes new strategies for preventing the disease, rather than treating PTSD after patients have been living with symptoms for months to years. In order to prevent the disease, it is critical that we are able to quickly identify people who will be at risk for the disease following a trauma, so that preventive strategies can be deployed bedside in the emergency room or in the battlefield. In the current study, we used functional MRI to predict which individuals would recover from trauma, and which individuals would have long-lasting symptoms of PTSD.

Continue reading

Virtual Reality Environments Can Advance Psychiatric Treatment and Research

MedicalResearch.com Interview with:

Jessica Maples-Keller Emory University School of Medicine.

Jessica Maples-Keller

Jessica Maples-Keller
Emory University School of Medicine.

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

Response:  This manuscript is a review of the use of Virtual Reality (VR) technology within psychiatric treatment. VR refers to an advanced technological communication interface in which the user is actively participated in a computer generated 3-d virtual world that includes sensory input devices used to simulate real-world interactive experiences. VR is a powerful tool for the psychiatric community, as it allows providers to create computer-generated environments in a controlled setting, which can be used to create a sense of presence and immersion in the feared environment for individuals suffering from anxiety disorders.
Continue reading

Standardized EEG Reporting Helps Predict Risk of Seizures

MedicalResearch.com Interview with:

Andres Rodriguez Ruiz, MD</strong> Clinical Neurophysiology and Neurology Emory School of Medicine

Dr. Andres Rodriguez Ruiz

Andres Rodriguez Ruiz, MD
Clinical Neurophysiology and Neurology
Emory School of Medicine

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

Response: The Critical Care EEG monitoring research consortium (CCEMRC) was established with the goal of promoting collaboration and research among healthcare institutions highly involved in continuous EEG monitoring of critically ill patients. This group together with the American Clinical Neurophysiology Society (ACNS) established the standardized critical care EEG terminology that allowed uniform reporting of EEG findings in critically ill patients. As part of this effort, a database was developed for collection and clinical reporting of such EEG findings and was adopted for daily clinical use by Yale University, Emory University and Brigham and Women’s Hospital.

Prior retrospective reports have acknowledged an association between periodic discharges and seizures. However, many of these reports were small series and did not include specific characteristics of these patterns. Our goal was to ascertain whether features of periodic and rhythmic patterns such as location (generalized vs. lateralized), frequency and prevalence influenced seizure risk in a large cohort of critically ill adults.

Continue reading

National Trends and Outcomes of Embryo Donation

Jennifer F. Kawwass, MD, FACOG Assistant Professor, Emory Reproductive Center Director of Third Party Reproduction, Emory Reproductive Center

Dr. Jennifer F. Kawwass

MedicalResearch.com Interview with:
Jennifer F. Kawwass, MD, FACOG

Assistant Professor, Emory Reproductive Center
Director of Third Party Reproduction, Emory Reproductive Center

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

Response: With the increasing use of assisted reproductive technology (ART), the number of cryopreserved embryos in storage has increased, as residual viable embryos from an in vitro fertilization (IVF) cycle may be frozen for future use. Each embryo maintains attributes reflective of the age of the female at time of the original oocyte retrieval. Embryo donation, a form of third-party reproduction, involves donation without compensation of previously formed embryos to another couple for implantation.

Limited published data exist detailing outcomes of donor embryo cycles. Patients and clinicians would benefit from information specific to donor embryo cycles to inform fertility treatment options, counselling, and clinical decision-making. We sought to quantify trends in donor embryo cycles in the United States, to characterize donor embryo recipients, and to report transfer, pregnancy, and birth outcomes of donor embryo transfers.

Continue reading

Children With Autism Miss Social Cues of Eye Contact

MedicalResearch.com Interview with:

Warren Jones, PhD Director of Research, Marcus Autism Center Children's Healthcare of Atlanta CHOA Distinguished Chair in Autism Asst. Professor, Dept. of Pediatrics Emory University School of Medicine Atlanta, Georgia 30329

Dr. Warren Jones

Warren Jones, PhD
Director of Research, Marcus Autism Center
Children’s Healthcare of Atlanta
CHOA Distinguished Chair in Autism
Asst. Professor, Dept. of Pediatrics
Emory University School of Medicine
Atlanta, Georgia 30329

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

Response: These results help clarify an important and longstanding question in autism: why do children with autism look less at other people’s eyes?

Two ideas for reduced eye contact in autism have been proposed:
– One idea is that children with autism avoid eye contact because they find it stressful and negative.
– The other idea is that children with autism look less at other people’s eyes because the social cues from the eyes are not perceived as particularly meaningful or important.

This study is important because each idea reflects a very different understanding of what autism is. And maybe even more importantly, each idea reflects a very different view about the right treatment approach to autism and to reduced eye contact in autism.

To answer this question, we used eye-tracking technology to study how 86 children with and without autism paid attention to other people’s eyes.

Children were tested when they were just two years old, at their time of initial diagnosis.

Continue reading

The Health ABC Study: Simple Exercise Test Predicts Heart Failure

MedicalResearch.com Interview with:

Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine

Dr. Vasiliki Georgiopoulou

Vasiliki Georgiopoulou MD MPH PhD
Assistant Professor of Medicine (Cardiology)
Emory University School of Medicine

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

Response: Although existing evidence suggests that more exercise capacity is associated with lower risk of CV disease and death, we don’t know whether more exercise capacity would lead to lower risk for heart failure also. This would be especially important for older adults, who are the group with the highest risk to develop heart failure. We used the data of a cohort study to test this association.

The exercise capacity was evaluated by a walking test that is easy to perform – the long-distance corridor walk test. We observed that older adults who were able to complete the test had the lowest risk to develop heart failure and the lowest mortality rates, when compared with those who were not able to complete the test and those who could not do the test for medical reasons. We also observed that changes in exercise capacity 4 years later did not predict subsequent heart failure or mortality – perhaps because less fit older patients had already developed heart failure or had died.

Continue reading

Majority of US Adults Have At Least One Chronic Health Condition

MedicalResearch.com Interview with:

Elizabeth Walker, PhD, MPH, MAT Research Assistant Professor Assistant Director of Evidence-based Learning Department of Behavioral Sciences and Health Education Rollins School of Public Health Emory University

Dr. Elizabeth Walker

Elizabeth Walker, PhD, MPH, MAT
Research Assistant Professor
Assistant Director of Evidence-based Learning
Department of Behavioral Sciences and Health Education
Rollins School of Public Health
Emory University

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

Response: Previous research has shown that many adults in the United States have one or more chronic health condition; however, not much was known about multimorbidities – having multiple chronic conditions – among people with mental disorders. We used nationally representative data from the National Survey on Drug Use and Health to determine the patterns of co-occurrence of mental illness, substance abuse and/or dependence, and chronic medical conditions. We also examined the association between the cumulative burden of these conditions, as well as living in poverty, and self-rated health.

Continue reading

Costs of Prescription Opioid Overdose, Abuse and Dependence Top $75 Billion

MedicalResearch.com Interview with:

Curtis Florence, PhD National Center for Injury Prevention and Control and Assistant professor, Department of Health Policy Management Rollins School of Public Health at Emory

Curtis Florence, PhD

Curtis Florence, PhD
National Center for Injury Prevention and Control and
Assistant professor, Department of Health Policy Management
Rollins School of Public Health
Emory

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

  • This study presents most recent CDC estimates of the economic burden of prescription opioid abuse, dependence and overdose in the United States.
  • In 2013, over 16,000 persons died of prescription opioid overdoses, and almost 2 million people met the diagnostic criteria for abuse and/or dependence.

Continue reading

Stem Cells May Be Stimulated in Women With Chest Pain But Normal Coronary Arteries

MedicalResearch.com Interview with: Arshed A. Quyyumi MD; FRCP

Dr. Arshed Auyyumi

MedicalResearch.com Interview with:
Arshed A. Quyyumi MD; FRCP
Professor of Medicine, Division of Cardiology
Emory University School of Medicine
Co-Director, Emory Clinical Cardiovascular Research Institute
Atlanta GA 30322

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

Response: Circulating progenitor or stem cells were discovered in adults 15 years ago. We now know that they may be stimulated by injury or ischemia, and they go down in number and function with aging, particularly when aging is associated with risk factors.

Women with chest pain despite normal coronary arteries are thought to have ischemia because of microvascular dysfunction. We found that these women, with the worst microvascular function (measured as coronary flow reserve), had higher levels of circulating stem or progenitor cells. This implies that the mild ischemia they are having during their normal daily life, leads to stimulation of their stem cells. Also, the vascular abnormality may be a stimulus for repair.

Continue reading

Model Developed For Prediction of Sudden Cardiac Death

MedicalResearch.com Interview with:

Alvaro Alonso, MD, PhD Associate Professor Department of Epidemiology Rollins School of Public Health Emory University Atlanta, GA

Dr. Alvaro Alonso

Alvaro Alonso, MD, PhD
Associate Professor
Department of Epidemiology
Rollins School of Public Health
Emory University
Atlanta, GA

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

Response: Sudden cardiac death (SCD) is a major public health problem. Each year, 300,000-400,000 Americans experience SCD and, in more than half of these cases, sudden cardiac death is the first manifestation of heart disease. To date, however, we lack effective strategies to identify those at higher risk of developing sudden cardiac death so targeted preventive strategies can be applied.

In this study, we develop and validate the first model for the prediction of SCD in ~18,000 adults without a prior history of cardiovascular disease. We show that information on demographic variables (age, sex, race), some traditional cardiovascular risk factors (smoking, elevated blood pressure, diabetes, HDL cholesterol) as well as some factors more specifically related to SCD causes (electrocardiogram QT interval) and novel biomarkers (albumin, potassium in blood, kidney function) can be leveraged to predict risk of SCD and identify individuals more likely to suffer this event.

Continue reading

EKG Plus Framingham Score Improves Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Dr. Amit J. Shah MD MSCR Research Assistant Professor Assistant Professor of Epidemiology Rollins School of Public Health Emory University Adjunct appointment in Medicine (Cardiology) Atlanta VA Medical Center

Dr. Amit Shah

Dr. Amit J. Shah MD MSCR
Research Assistant Professor
Assistant Professor of Epidemiology
Rollins School of Public Health
Emory University
Adjunct appointment in Medicine (Cardiology)
Atlanta VA Medical Center

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

Response: Nearly ½ of sudden cardiac deaths occur in individuals who were not aware that they had heart disease; this increases the need for primary prevention. We studied whether the electrocardiogram could be a useful tool in helping to measure risk of cardiovascular disease in approximately 10,000 community-based adults aged 40-74 with a simple risk equation that is based on age, sex, and 3 numbers from the ECG: heart rate, T-axis, and QT interval. We found that such an equation estimates risk as well as the Framingham risk equation, which is the standard of care (based on traditional risk factors like smoking and diabetes). When combining both the Framingham and ECG risk assessments together, the accuracy improved significantly, with a net 25% improvement in the risk classification of cardiovascular death compared to using the Framingham equation alone.

Continue reading

High Dose Statins Reduce Amputations In PAD

MedicalResearch.com Interview with:

Shipra Arya MD, SM Assistant Professor, Division of Vascular Surgery Emory University School of Medicine Assistant Professor of Epidemiology (Adjunct) Rollins School of Public Health Staff Physician, Atlanta VA Medical Center Director, AVAMC Vascular Lab and Endovascular Therapy

Dr. Shipra Arya

Shipra Arya MD, SM
Assistant Professor, Division of Vascular Surgery
Emory University School of Medicine
Assistant Professor of Epidemiology (Adjunct)
Rollins School of Public Health
Staff Physician, Atlanta VA Medical Center
Director, AVAMC Vascular Lab and Endovascular Therapy 

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

Dr. Arya: Peripheral Arterial Disease is the next cardiovascular epidemic. It is poorly recognized and not adequately treated compared to heart disease – and research is lacking on the optimal use of statins for PAD patients. Very few randomized clinical trials have been done specifically in PAD patients to assess the impact of statins on cardiovascular outcomes and none on limb related outcomes. The 2013 ACC/AHA guidelines for cholesterol lowering medications recommends high intensity statins for PAD patients extrapolated from the level 2 and 3 evidence and empirically based on CAD and stroke data.

In this study we looked at the amputation and mortality risk based on statin dosage in a large cohort of patients from the VA population and found that high intensity statins are associated with a significant reduction in limb loss (~30%) and mortality (~25%) in PAD patients followed by a smaller risk reduction [~23% for amputation risk reduction and 20% reduction in mortality risk] by low-moderate intensity statins as compared to no statin therapy.

Continue reading

Bisphosphonate in First Year of HIV Treatment Reduces Bone Loss

MedicalResearch.com Interview with:

Dr. Igho Ofotokun MD MSc Division of Infectious Diseases, Department of Medicine Emory University School of Medicine, Atlanta, Georgia Grady Healthcare System, Atlanta, Georgia

Dr. Igho Ofotukun

Dr. Igho Ofotokun MD MSc
Division of Infectious Diseases, Department of Medicine
Emory University School of Medicine, Atlanta, Georgia
Grady Healthcare System, Atlanta, Georgia

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

Dr. Ofotokun:  This work is focused on preventing further bone loss in HIV-infected patients and thus reducing the risk of future bone fractures. HIV infection is associated with a state of enhanced bone loss. HIV treatment with highly active antiretroviral therapy (HAART) further worsens rather than improve bone loss. Almost all HAART regimens that have been examined have been associated with bone loss. The consequence of this skeletal assualt is markedly elevated fracture prevalence among individuals living with HIV across a wide age range.

It turns that the predominance of HAART associated bone loss occur within the first year of initiating therapy. In this study, we administered a single dose of 5 mg IV zoledronic acid, a long-acting bisphosphonate at the same time of HAART initiation to prevent HAART associated bone loss. At this dose, zoledronic acid prevented enhance bone resorption in all participants and completely blunted bone mineral density loss over the 48 weeks study follow up period.

Continue reading

Minorities Place Less Trust In Their Doctors

Abigail Sewell PhD Assistant Professor of Sociology Emory University

Dr. Abigail Sewell

MedicalResearch.com Interview with:
Abigail Sewell PhD
Assistant Professor of Sociology
Emory University

Medical Research: What is the background for this study?
Dr. Sewell: Ethnoracial minorities report poorer quality of care than do whites. However, one key dimension of health care quality – trust in one’s personal physician – indicates mixed associations with race. This study examines five dimensions of the patient-physician relationship independently of each other to identify the aspects of health care where minorities feel most alienated from their doctors.

Medical Research: What are the main findings?

Dr. Sewell: The results of the study show that Blacks and Latinos are less likely to believe that their doctors really care about them as a person than are Whites.

Continue reading