Erasmus
02 Jan Time Means Brain! Fast Treatment for Acute Ischemic Stroke Improves Recovery
MedicalResearch.com Interview with:
Diederik Dippel MD, PhD
Senior Consultant in Neurology
Erasmus MC University Medical Center
Rotterdam The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Dippel: MR CLEAN is the first randomized clinical trial to show that intra-arterial treatment of ischemic stroke to get the clot out, really works. It leads to more recovery and less handicap. Previous studies had shown that intra-arterial treatment leads to recanalization, but the final proof that the treatment leads to recovery more often than standard treatment was lacking.
With standard treatment, less than 1 out of 5 recovers without handicap, but with this new treatment, this will be 1 out of 3. The treatment did not lead to more complications than standard treatment. The rate of symptomatic intracranial hemorrhage was similar in both arms.
Our study differs from previous, neutral trials.
- First, we required patients to have an intracranial arterial occlusion confirmed by neuro-imaging.
- Second, we used third generation thrombectomy devices, such as retrievable stents in most of the cases.
- Third, our trial was conducted in a country with a very good infrastructure, which allowed rapid transfer to intervention centers, which are spread throughout the country. Our rate of iv tPA in Dutch hospitals is over 11% on average.
- Last, all intervention centers participated, and almost no patients were treated outside the trial. Moreover, reimbursement of the treatment was conditional on participation in the trial.
17 Dec Over Half Colon Cancer Deaths Due To Not Getting Screened
MedicalResearch.com Interview with: Reinier G.S. Meester, M.Sc Department of Public Health, ErasmusMC, Rotterdam, Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Despite decreasing death rates from colorectal cancer over the past decades, it still ranks as the second leading cause of cancer deaths in the U.S. Screening for colorectal cancer is highly effective, but only 58% of the eligible population reported up-to-date with screening. This suggests that a substantial proportion of current colorectal cancer deaths in the U.S. are avoidable. We found that approximately 60% (32,200 deaths) of current deaths from colorectal cancer may be due to not receiving screening.13 Dec Complaints of Memory Loss May Signal Increased Stroke Risk
MedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD,and Ayesha Sajjad, MD Department of Epidemiology Erasmus University Medical Center, Rotterdam Rotterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The occurrence of cognitive impairment and dementia after a stroke event are already known. Since these neuro-degenerative processes and stroke share vascular pathways in their pathogenesis such as small vessel disease, we aimed to study whether early cognitive impairment can be predictive of stroke onset in the elderly. We also hypothesized that a higher cognitive reserve (due to higher education attainment) may mask early symptoms of memory loss and thus put these older individuals at a higher risk of stroke. We found that self-reported subjective memory complaints as answered by a single question: “ Do you have memory complaints?” was highly predictive of stroke especially in older persons who were highly educated. In comparison, objective measures of cognitive impairment such as MMSE did not show any association with the risk of stroke.16 Nov Effect of Second Generation Drug Eluting Stents on Cardiovascular Events
MedicalResearch.com Interview with:
Marco Valgimigli, MD, PhD
Associate Professor of Medicine
Erasmus MC, Thoraxcenter,
Rotterdam The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to Bare Metal Stents. We have pooled all available datasets comparing a specific second generation Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal Stents and found that cardiac mortality along with all other non-fatal endpoints investigated, including myocardial infarction or stent thrombosis were reduced after co-Cr EES.
12 Nov Improved Longevity of Hepatitis C Patients Who Respond To Therapy
MedicalResearch.com Interview with:
Adriaan J. van der Meer, MD, PhD
Department of Gastroenterology and Hepatology
Erasmus MC University Medical Center Rotterdam,
Rotterdam, the Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. van der Meer: This study was performed in order to assess the association between the virological response to antiviral therapy and the long-term clinical outcome among patients with advanced liver disease, who have the highest risk of cirrhosis-related complications and death due to their chronic viral infection. At the time this study was initiated there was scarce data on the relation between a sustained virological response (SVR; sustained elimination of hepatitis C RNA) and reduced all-cause mortality, the most definite clinical endpoint. With our large international multicenter cohort study we were able to show this association. After 10 years of follow-up the cumulative mortality rate was 9% among patients with SVR as compared to 26% among patients without SVR after antiviral therapy (p<0.001). The current JAMA research letter concerns a related analyses, in which we compared the survival among patients included in our cohort with that of an age- and sex-matched general population. Importantly, the survival among patients with SVR was comparable to the general population, despite the fact that all these patients had histological proof of advanced hepatic fibrosis. In contrast, the survival among patients without SVR was markedly lower as compared to the general population.
05 Nov Fussy Eating Linked To Constipation in Preschoolers
MedicalResearch.com Interview with: Anne Tharner, PhD and Jessica C. Kiefte-de Jong, PhD Department of Epidemiology Erasmus Medical Center, Rotterdam The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Constipation is one of the most common health problems in children, and occurs in most cases without organic reason. In our study, we examined if fussy eating behavior might be related to constipation in children. “Fussy eaters” are children who reject specific foods – often (green and bitter) vegetables – and often compensate this with the intake of less healthy but highly palatable foods (such as fast food or sweets). This kind of diet might be one of the reasons for constipation in children, but at the same time, children might develop difficult eating patterns due to digestive problems such as constipation. Therefore, we examined whether fussy eating and functional constipation mutually affect each other, which might point to the development of a vicious cycle. We examined this in a large study including almost 5000 children aged 2-6 years who participated in a longitudinal study in Rotterdam, the Netherlands. Families were regularly followed up starting in pregnancy. Our main finding was that fussy eating co-exists with functional constipation and also predicts subsequent development of functional constipation. In addition, we also found evidence for the reverse, as functional constipation predicted subsequent fussy eating behavior. Together with previous studies, our findings suggest that indeed a vicious cycle may develop throughout childhood in which children’s constipation problems and problematic eating behavior mutually affect each other. On the one hand, fussy eating might affect the development of functional constipation via poor dietary quality which is a characteristic for the diet of fussy eaters. On the other hand, our findings show that functional constipation in also predicts future fussy eating. This pathway is less well studied, but it is conceivable that children with constipation and the accompanying abdominal pain and painful defecation may develop problematic eating behavior.17 Oct Coumarin Users at Higher Risk For Cerebral Microbleeds
MedicalResearch.com: Interview Invitation S. Akoudad, MD Msc PhD candidate Dep. Epidemiology, Radiology, Neurology Erasmus MC, Rotterdam , the Netherlands Medical Research: What are the main findings of the study? Dr. Vernooij: We found that compared to never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and probably also a higher incidence of any microbleeds. A higher maximum international normalized ratio (INR) was associated with deep or infratentorial microbleeds, and among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds.15 Oct Relatives Key To Quality of Dying in Hospitals
MedicalResearch.com Interview with:
F.E. (Erica) Witkamp RN MSc
Senior lecturer University of Applied Sciences
Erasmus MC and Erasmus MC Cancer Institute
Rotterdam, The Netherlands.
Medical Research: What are the main findings of the study?
Response: We investigated the experiences of 249 bereaved relatives (response 51%) of patients who had died in the hospital, after a hospitalization of at least six hours. The main outcome measure was their global score of the quality of dying (QOD) on a 0-10 scale, with zero being “very poor” and ten “almost perfect”. Further, we assessed multiple experiences in the last days of life, such as symptom burden, preparedness for life closure, awareness of impending death, and care in the last days of life. We analyzed which of these factors was related to the quality of dying score, and subsequently whether the related factors represented specific domains of the dying phase.
Relatives rated the overall score of QOD on average at 6.3 (sd 2.7) with a range from 0-10.
During the last day(s) of life, 26% of the patients, and 49% of the relatives had been fully aware of imminent death. In the end 39% of the patients and 50% of the relatives had said goodbye; 77% of the patients had died in the presence of a relative.
According to relatives patients had suffered moderately to severely from on average 7 out of 22 symptoms.
In 53% relatives reported that in the last 24 hours symptoms had sufficiently been alleviated; efforts to control symptoms had been sufficient in 75%. In 64% relatives had been informed by the physician about the imminence of death, and in 70% they were satisfied about their involvement in decision making. In 55% relatives had experienced sufficient attention to individual preferences and wishes, and in 70% hospital facilities had been sufficient. Patients had been sufficiently affirmed as a person in 63%.
19 Aug More Intensive Colorectal Cancer Screening than Recommended Often Harmful for Medicare Beneficiaries
MedicalResearch.com Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands
Medical Research: What are the main findings of the study?
Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
18 Aug Many U.S. Elderly Screened for Colon Cancer More Frequently Than Recommended
MedicalResearch.com Interview with:
Frank van Hees, MSc
Researcher, Department of Public Health, Erasmus MC
Rotterdam, The Netherlands
Medical Research: What are the main findings of the study?
Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
10 Aug PSA Screening and Prostate Cancer Mortality
MedicalResearch.com Interview with:
Professor Fritz H Schröder
Department of Urology, Erasmus University Medical Center
Rotterdam, Netherlands
Medical Research: What are the main findings of the study?
Professor Schröder: I consider as the main finding that we could report a continuing effect of PSA driven screening on prostate cancer mortality for men aged 55 – 69 years in the screen arm of our study after 13 years of follow-up. The absolute reduction in the risk of death from prostate cancer amounts to 1.28 per 1000 men randomized to the screening arm. This translated into numbers to be invited to screening and numbers needed to be diagnosed to save one prostate cancer death of 781 and 27. These figures show an increasing effect with increasing time of follow-up. The relative risk reduction related to the control arm has remained unchanged with respect to the 11 year follow-up period. For men who actually participated and were screened the relative risk reduction amounted to 27%, the figure most applicable to men who consider to be tested.
03 Jun Colon Cancer Screening May Be Worthwhile In Previously Unscreened Elderly
Posted at 04:39h
in Annals Internal Medicine, Author Interviews, Colon Cancer, Erasmus, Sloan Kettering
MedicalResearch.com Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands and
Ann G. Zauber PhD
Memorial Sloan Kettering Cancer Center, New York
MedicalResearch: What are the main findings of the study?
Answer: The main finding of our study is that colorectal cancer screening of individuals without previous screening is worthwhile well beyond age 75, which is the recommended age to stop screening in individuals with an adequate screening history. The exact age up to which screening should be considered in unscreened elderly depends on an individual's health status: in healthy individuals screening remains worthwhile up to age 86, whereas in individuals with a severe illness, such as heart failure, screening remains worthwhile up to age 80.
12 May Chronic Hepatitis C: Clinical Outcome Tool
MedicalResearch.com Interview with:
Dr. Adriaan J van der Meer
Department of Gastroenterology and Hepatology
Erasmus MC, University Medical Center
Rotterdam, The Netherlands
MedicalResearch: What are the main findings of the study?
Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient's risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
25 Apr Stroke: Prediction Tool Separates Risk For Ischemic vs Hemorrhagic Event
MedicalResearch.com Interview with:
M. Arfan Ikram, MD, PhD
Assistant professor in Neuroepidemiology
Erasmus Medical Center
Rotterdam, the Netherlands
MedicalResearch.com: What are the main findings of this study?
Dr. Ikram: We show that the risk of stroke might be increased due to an increased risk of ischemic stroke or increased risk of hemorrhagic stroke. Because these subtypes of stroke require different -often opposite- clinical management, currently available prediction rules for any stroke are insufficient. We propose a novel prediction rule that provides separate risks for ischemic stroke and hemorrhagic stroke.
09 Apr NSAIDS Associated with Atrial Fibrillation
MedicalResearch.com Interview with: Bruno Stricker, MB PhD Professor of Pharmaco-epidemiology Professor of Pharmacoepidemiology Erasmus MC MedicalResearch.com: What are the main findings of the study? Dr. Stricker: NSAIDs/painkillers may cause atrial fibrillation. MedicalResearch.com: What should patients and provider take away from this study? Dr. Stricker: Atrial fibrillation is the main risk factor of stroke. Patients with cardiovascular disease should...
18 Feb Stroke: Intracranial Atherosclerosis as a Major Risk Factor
MedicalResearch.com Interview with:
M. Arfan Ikram, MD, PhD
Departments of Radiology, Epidemiology, and Neurology
Erasmus Medical Center,
Rotterdam, the Netherlands
MedicalResearch.com: What are the main findings of the study?
Dr. Ikram: The main finding of the study, carried out within the Rotterdam Study and led by drs. Daniel Bos and Arfan Ikram (both from the Erasmus Medical Center Rotterdam, the Netherlands), was that intracranial atherosclerosis is a major risk factor for stroke in the Western (white) population. Traditionally, intracranial atherosclerosis has not been considered of major importance to stroke risk in Western populations. In contrast, most research on intracranial atherosclerosis originates from Asian and African populations, where is was actually recognized as the most important risk factor of stroke. Our study demonstrates that also in the Western population intracranial atherosclerosis is a major risk factor for stroke and should get more focus in clinical practice. Moreover, our findings indicate that its contribution to the proportion of all strokes is greater than that of atherosclerosis in other vessel beds that are further away from the brain.
25 Nov Neurofibromatosis: Simvastatin for Cognitive Deficits
MedicalResearch.com Interview with:
Prof Ype Elgersma PhD
Professor, Neuroscience
Neuroscience Institute, Erasmus University Rotterdam
Rotterdam, Netherlands
MedicalResearch.com: What are the main findings of the study?
Answer: Research in genetic mouse models suggested that inhibition of HMG-CoA-reductase by statins might ameliorate the cognitive and behavioral phenotype of children with Neurofibromatosis type 1 (NF1), an autosomal dominant disorder. In a 12-month randomized placebo-controlled study including 84 children with NF1, we found that simvastatin, an inhibitor of the HMG-CoA-reductase pathway had no effect on full-scale intelligence, attention problems or internalizing behavioral problems, or on any of the secondary outcome measures.
10 Oct More Fatalities Mean More Donors and Bigger Donations
MedicalResearch.com Interview with:
Ioannis Evangelidis, Ph.D. candidate
Department of Marketing Management,
Rotterdam School of Management
Erasmus University, Rotterdam
MedicalResearch.com: What are the main findings of the study?
Answer: We find that donors pay more attention to the number of people killed when donating to a disaster, than to the number of people who are affected (survive but need money). In other words, people are more likely to donate, and donate more money, the more people die in a disaster, but not when more people survive and need assistance.