MedicalResearch.com Interview with:
Michele D. Levine Ph.D.
Associate Professor of Psychiatry and PsychologyWestern Psychiatric Institute and Clinic
Department of Statistics, University of Pittsburgh, Pittsburgh PA
Medical Research:What is the background for this study? What are the main findings?Dr. Levine: Many women quit smoking as a result of pregnancy. However, psychiatric disorders, which are prevalent among smokers can contribute to weight gain. Thus, we sought to examine the relationship between maternal psychiatric disorders and gestational weight gain in a sample of pregnant former smokers. Results from the present study demonstrate that the rates of psychiatric disorders were high among pregnant former smokers and that more than half of women gained more weight than recommended by the IOM. Although a history of having had any psychiatric disorder was not associated with gestational weight gain, a history of alcohol use disorder specifically was positively related to gestational weight gain.
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MedicalResearch.com Interview with:Wenjie Ma MS Doctoral Student
Harvard School of Public Health
Medical Research:What is the background for this study? What are the main findings?Response: De novo lipogenesis (DNL) is the process whereby excess carbohydrate and protein are converted into saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs). Emerging animal and in vitro evidence suggests that DNL might play an important role in metabolic regulation and influence the pathogenesis of type 2 diabetes. We used circulating biomarkers SFAs and MUFAs to investigate the prospective associations with incident diabetes in the Cardiovascular Health Study, a community-based cohort of older US adults. We found that circulating palmitic acid and stearic acid were associated with higher risk of incident diabetes, whereas vaccenic acid was associated with lower risk. In contrast, dietary intakes of saturated fatty acids and monounsaturated fatty acids were not associated with diabetes risk.
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MedicalResearch.com Interview with:
Jennifer Choi Tudor, Ph.D. Postdoctoral Fellow
Ted Abel Lab Department of Biology 10-17
Smilow Center for Translational Research
Philadelphia, PA 19104
Medical Research: What is the background for this study? What are the main findings?Dr. Tudor: We (Dr. Tudor, Dr. Abel, and colleagues) are interested in better understanding the molecular changes that occur with sleep deprivation. Previously, we found that the expression of over 500 genes changes with sleep deprivation and that many of the genes were involved with protein synthesis. Upon further investigation, we found that 5 hours of sleep deprivation impairs protein synthesis in the hippocampus, a brain region critical for memory. This impairment is due to changes in mammalian target of rapamycin (mTOR) signaling and eukaryotic initiation factor 4E binding protein 2 (4EBP2) is critical to this process. When we boosted levels of 4EBP2 in the hippocampus, mice that were sleep deprived were resistant to the detrimental effects of sleep deprivation on memory.
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MedicalResearch.com Interview Invitation with:
Dr. Heekyeong Park
Assistant Professor of Psychology
University of Texas at Arlington
Medical Research: What is the background for this study? What are the main findings?Dr. Park: This study shows that music experts with extensive musical training may have altered neural processing related to improved memory.
There has been much interest in the beneficial effects of musical training on cognition. Notably, musical training has been reported to boost processing of verbal material. Previous studies have indicated that musical training was related to superior verbal working memory and that these differences in musical training were associated with differences in neural activity in brain regions important for verbal processing. However, it was not clear whether musical training impacts memory in general, beyond working memory for verbal items. By recruiting professional musicians with vast instrumental training, we investigated if extensive musical training has a broad impact on memory with corresponding changes in the brain.
For this study, we compared highly trained musicians (10+ years of experience) and individuals with little or no formal musical training on working memory and long-term memory tasks. Each memory task included both verbal and pictorial items. We measured memory accuracy on tasks and scalp-recorded changes in the brain’s electrical activity (ERPs) while participants studied and remembered items. Musicians showed enhanced performance on the working memory task for both words and pictures. For the long-term memory task, musicians also remembered studied pictures better than non-musicians. These behavioral findings demonstrate the relationship between extensive musical training and improved memory broadly. ERP waveforms were also different between musicians and non-musicians while they performed long-term memory tasks.
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MedicalResearch.com Interview with:
Regina Marie Sullivan PhD
Professor Child and Adolescent Psychiatry
Nathan Kline Institute
The Child Study Center at NYU Langone Medical Center
Department of Child and Adolescent Psychiatry
One Park Ave 8th Floor, New York, NY 10016
Medical Research: What is the background for this study? Dr. Sullivan: Managing pain during medical procedures in a critically important issue in medicine today. Our study was designed to better understand one method of reducing pain in young infants - having the caregiver be in contact with the baby during the painful procedure, which reduces the infant's behavioral response to the medical procedure. This study explored the neural basis of the ability of the caregiver to reduce the pain response.
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MedicalResearch.com Interview with:
Dr. Grace Hsiao-Wei Lo
Baylor College of Medicine
Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine
Faculty, Immunology, Allergy, and Rheumatology Section,Michael E. DeBakey VA Medical Center
Medical Research:What is the background for this study? What are the main findings?Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee. There is concern that chronic repetitive loading of the knee could physically damage structures within the knee. Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis. Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable. Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality.
To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6. Twenty-nine percent of the participants reported that they ran at some time in their lives.
Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older.
Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA.
After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded. (more…)
MedicalResearch.com Interview with:
Dr. Kristy Lynn Kummerow MD
Division of Surgical Oncology and Endocrine Surgery
Vanderbilt University Medical Center
Tennessee Valley Healthcare System, Veterans Affairs Medical Center
Geriatric Research, Education, and Clinical Center
Nashville, Tenn
Medical Research: What is the background for this study? What are the main findings?Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer. It is helpful to understand the historical context of how we treat early breast cancer. Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area. Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation. In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer. However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women. This has been found in other institutions as well, and is supported by smaller national studies. We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States.
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MedicalResearch.com Interview with: Weian Zhao PhD
Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine.
Medical Research:What is the background for this study?Dr. Zhao: Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The extremely high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages. The present gold standard to detect a blood infections, is a blood culture and it takes 2-5 days for the detection and the identification of the bacteria. Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with blood infections. Therefore, less expensive and less technically demanding methods are urgently needed for the rapid and sensitive identification of blood infections.
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MedicalResearch.com Interview with:
Yvonne M. Terry-McElrath, MSA
Research Associate, Survey Research Center, Institute of Social Research
University of Michigan Tobacco Research Center
Medical Research: What is the background for this study? What are the main findings?Dr. Terry-McElrath: The United States Department of Agriculture (USDA) recently improved nutrition standards for federally-reimbursable school lunch and breakfast programs. Most lunch standards were implemented at the beginning of the 2012-13 school year and changes in breakfast began with the 2013-14 school year. Beginning in 2014, schools participating in federally-reimbursable meal programs were also required to improve nutrition standards for foods and beverages sold in vending machines, stores/snack bars/carts, and à la carte cafeteria lines. The new standards limit fats, sodium, sugar, and calories; and will eventually remove candy; regular-fat salty snacks/sugary treats; higher-fat milks; high-fat, high-calorie savory foods; and sugar-sweetened beverages, like regular soda, fruit drinks and high calorie sports drinks. They were developed in response to rising overweight/obesity among US children and adolescents.
This study uses five years of data from nationally-representative samples of middle and high school students—and their school administrators—to examine three research questions: What percentage of US secondary students attended schools in 2008-2012 where foods and beverages met at least some of the USDA standards that were to begin phased implementation starting in 2012-13? Is there evidence that those standards were associated with student overweight/obesity? Is there evidence of the effect of those standards on racial/ethnic minorities and students from lower income families? Using data from schools even before the new USDA standards went into effect can indicate potential effect of the standards once they have been in effect for several years. The research was conducted through two studies: The Monitoring the Future study, supported by a grant from the National Institute on Drug Abuse, and the Youth, Education and Society study, part of a larger research initiative funded by the Robert Wood Johnson Foundation, titled “Bridging the Gap: Research Informing Policy and Practice for Healthy Youth Behavior.”
Study findings show that from 2008-2012, few middle or high school students attended schools where food and beverage standards would be judged to meet at least some of the USDA school nutrition standards that began to be implemented in 2012-13. Significant increases in the number of standards over time were seen for middle but not high school students. Among high school students, having fruits and vegetables available wherever foods were sold, the absence of higher-fat milks, and increasing the number of positive nutrition standards were associated with significantly lower odds of overweight/obesity. Not having sugar-sweetened beverages was associated with lower overweight/obesity for middle and high school minority students.
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MedicalResearch.com Interview with:
Boback Ziaeian MD
Cardiology Fellow, UCLA Division of Cardiology
PhD Candidate, UCLA Fielding School of Public Health
Medical Research: What is the background for this study? What are the main findings?Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030. Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited.
Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand.
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MedicalResearch.com Interview with:Todd Lee MD MPH FRCPC
Consultant in Internal Medicine and Infectious Diseases
Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit,
McGill University Health Centre
Medical Research: What is the background for this study? What are the main findings?Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs. Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use. Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy. Sometimes this means that no antibiotics should be given.
In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions.
Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship". This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist. These audits were performed by our senior resident physicians in the context of providing their routine clinical care. We also provided local antibiotic guidelines and regular educational sessions once a rotation.
We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority. We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested.
Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
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.
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MedicalResearch.com Interview with:Adriaan J. van der Meer, MD, PhD
Department of Gastroenterology and Hepatology
Erasmus MC University Medical Center Rotterdam,
Rotterdam, the NetherlandsMedical 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.
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MedicalResearch.com Interview with: Paula Braveman, MD, MPH
Director, Center on Social Disparities in Health
Professor, Family and Community Medicine
University of California San Francisco
San Francisco, CA 94118
Medical Research: What are the main findings of the study?Dr. Braveman: There were a couple of striking findings from this study of preterm birth (PTB) among non-Latino White and Black women born in the U.S..
First, we found that women who were poor or socioeconomically disadvantaged in other ways (who had not or whose parents had not graduated from high school or who lived in neighborhoods (census tracts) with highly concentrated (25% or more of residents) poverty) had similarly high preterm birth rates. In addition, we found that while preterm birth rates among White women consistently improved as their socioeconomic status (SES) improved, higher-SES Black women generally did no better –and sometimes did worse—than lower-SES Black women.
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Medical Research.com Interview with:
Surakit Pungpapong, M.D.
Transplant Hepatologist
Associate Professor of Medicine
Mayo Clinic, Jacksonville, Fla.
Medical Research: What is the background for this study? What are the main findings?Dr. Pungpapong: This study reports our multicenter experience from Mayo Clinic’s three sites using sofosbuvir and simeprevir with/without ribavirin for 12 weeks to treat hepatitis C genotype 1 recurrence after liver transplantation. We found that this all-oral interferon-free antiviral regimen was very well tolerated with minimal to mild side effects. It required minimal dose adjustment of immunosuppression and no episode of acute rejection occurred. Overall, sustained virologic response rate was very high, more than 90 percent.
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MedicalResearch.com Interview with:
Ruth Keri, PhD, Professor and Vice Chair Department of Pharmacology
Case Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer Center Case Western Reserve University
Medical Research: What is the background for this study? Dr. Keri: Over the last several decades, the discovery of targeted therapies for certain types of breast cancer, and their use in the clinic, have greatly improved the long-term outcome of patients. Yet some breast cancers don’t respond to these therapies, and ones that do often become resistant over time, resulting in patient relapse and metastatic disease. Why does resistance occur? There are many tricks a tumor employs to evade death. When a drug targets a certain protein or pathway the cancer cell relies on for survival, one potential route of resistance is the cancer cell’s ability to adapt and find another pathway to maintain growth. We reasoned that targeting two separate proteins or pathways important for cancer cell growth may be more effective at preventing or delaying this adaptation.
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MedicalResearch.com Interview with: Mark E Mikkelsen, MD, MSCE
Assistant Professor of Medicine
Hospital of the University of Pennsylvania
Medical Research: What is the background for this study? What are the main findings?Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized?
We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice.
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MedicalResearch.com Interview with:Daniel L. Rubin, MD, MS
Assistant Professor of Radiology and Medicine (Biomedical Informatics)
Department of Radiology | Stanford University
Stanford, CA 94305-5488
Medical Research: What is the background for this study? What are the main findings?Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives.
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MedicalResearch.com Interview with: Susanne Rautiainen, PhD
From the Department of Institute of Environmental Medicine
Karolinska Institutet, Stockholm, Sweden
Divisions of Preventive Medicine Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Medical Research: What is the background for this study? What are the main findings?Dr. Rautiainen: Multivitamins are the most commonly used dietary supplement in the US and other developed countries and it has been shown that many take them with the goal of maintaining or improving their health. Multivitamins typically provide low-doses of essential vitamins and minerals to prevent deficiency. Yet many people who take multivitamins are not deficient. Despite the widespread use, limited number of studies have investigated how multivitamins are associated with major chronic diseases, including cardiovascular disease. We therefore examined how self-reported multivitamin use was associated with both short- and long-term risk of cardiovascular diseases in the Women’s Health Study which is a prospective cohort of 37,193 women aged ≥45 years and free of CVD and cancer at baseline.
In this study of middle-aged and elderly women who were apparently healthy at baseline and followed for an average of 16.2 years, we observed that multivitamin use was not associated with neither short- nor long-term risk risk of major CVD events, including MI, stroke, or CVD death. Moreover, there was no significant association observed for women who had taken multivitamins for ≥10 years at baseline. There were some important indications that the association between multivitamin use and long-term risk of major CVD events may be modified by age and fruit and vegetable intake, suggesting that women who were older and had low fruit and vegetable intake may benefit more from multivitamin supplement use. However, these results should be interpreted with caution. Moreover, relying on self-reports of multivitamin use may be subject to misclassification, plus other unmeasured factors may have biased the results despite our best effort to account for everything.
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MedicalResearch.com Interview with: Jamie Anderson MD MPH
Department of Surgery
University of California, San DiegoMedical Research: What is the background for this study? What are the main findings?Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population.
Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel.
With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements.
We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records.
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MedicalResearch.com Interview with:William C. Black, MD
Professor of Radiology
Department of Radiology
Dartmouth-Hitchcock Medical Center
Lebanon, NH 03756
Medical Research:What is the background for this study? What are the main findings?
Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014.
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MedicalResearch.com Interview with:Theodore Leng, MD, MS , one of the article’s senior authors
Byers Eye Institute at Stanford
Stanford University School of Medicine
Palo Alto, CA 94303
Dr. Leng: What is the background for this study? What are the main findings?Medical Research: Age-related macular degeneration (AMD) is the leading cause of blindness and central vision loss among adults older than 65 years. 80-85% of patients have the dry, non-exudative, form of the disease, but the wet, exudative, form of advanced AMD is of primary concern as it accounts for a majority of severe vision loss in Age-related macular degeneration. In wet AMD, abnormal blood vessels grow under the retina and can leak blood and fluid.
Until now, there has been no effective way to tell which patients with dry AMD are likely to progress to the wet stage. In our recent Investigative Ophthalmology & Visual Science article, we describe a new mathematical model that can predict which patients are likely to progress.
The predictive model identifies likely progressors by analyzing 3D spectral domain optical coherence tomography (SD-OCT) retinal imaging data that’s routinely obtained during retinal encounters.
We analyzed data from 2,146 SD-OCT scans of 330 eyes in 244 patients seen at The Byers Eye Institute at Stanford over a five-year period. We found that the area and height of drusen, the amount of reflectivity at the macular surface and the degree of change in these features over time, could be weighted to generate a patient’s risk score. Predictions from the model were compared with cases where patients actually progressed to wet Age-related macular degeneration. Our model accurately predicted every occurrence of progression within a year. There was a false positive rate of around 40%, but we thought this was a good tradeoff because we would not miss any potential progressors by using this sensitivity threshold.
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MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS
Princess Alexandra Hospital
Brisbane, Queensland, Australia
MedicalResearch: What is the background for this study? What are the main findings?Dr. Brendan J. Perry:Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice.
This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort.
We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor.
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MedicalResearch.com Interview with:Marie R Griffin MD MPH
Director, Vanderbilt MPH Program
Department of Health Policy Vanderbilt University Medical Center
Nashville TN 37212Medical Research: What is the background for this study? What are the main findings?
Dr. Griffin: In Tennessee, the introduction in 2010 of a new pneumococcal vaccine for infants and young children was associated with a 27 percent decline in pneumonia hospital admissions across the state among children under age 2. The recent decline in Tennessee comes on top of an earlier 43 percent decline across the United States associated with the introduction in 2000 of the first pneumococcal vaccine for children under 2 years of age. (more…)
MedicalResearch.com Interview with:
Leslie Mitchell, PhD
New York University Langone Medical Center
Boeke Lab, Institute for Systems Genetics
NY NY, 10016
Medical Research: What is the background for this study? What are the main findings?
Dr. Mitchell: One of our major interests is building synthetic chromosomes. Typically we construct synthetic chromosomes using a bottom-up approach, first designing the sequence in silico and then synthesizing and piecing together the DNA to build the designer molecule. While eukaryotic chromosomes are usually linear in structure, oftentimes we build our designer synthetic chromosomes as circular molecules to take advantage of cloning technologies available in E. coli, an organism that tolerates only circular chromosomes. We developed the telomerator as a means by which to convert circular synthetic chromosomes into linear molecules, which more closely resemble the native chromosomes found in eukaryotic cells.
We discovered that the telomerator is an extremely effective tool for generating linear derivatives of circular synthetic chromosomes. There are two main reasons for this.
First, the action of the telomerator can be assessed using a simple phenotypic assay so it is easy to differentiate cells that encode linear synthetic chromosomes from those with the circular format.
Second, the telomerator encodes ‘telomere seed sequences’ that are exposed and recognized by the cell upon linearization, thus the ends of a newly linearized chromosome are protected, which ensures its stability over generations.
We put the telomerator to the test by integrating it in 54 different positions on a circular synthetic yeast chromosome called synIXR (Dymond et al. 2011). In 51 of the 54 positions we could successfully linearize the synIXR chromosome and recover viable cells, however many of the different linear derivatives conferred growth defects. We determined the mechanism underlying both the growth defects and lethality associated with linearization to be telomere position effect. In other words, when essential genes were re-positioned near telomeres their reduction in expression due to subtelomeric silencing was detrimental to the cell.
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.(more…)
MedicalResearch.com Interview with:
Anita Kohli, MS, MD
Clinician Investigator, Clinical Monitoring Research Program (CMRP)
Leidos Biomedical Research, Inc. formerly SAIC-Frederick, Inc.
National Institutes of Health Bethesda, MD 20892
Medical Research: What is the background for this study? What are the main findings?Dr. Kohli: We previously treated 60 patients with sofosbuvir and ribavirin for 24 weeks. Patients who relapsed after treatment were offered re-treatment with another regimen of directly acting antivirals alone. 13 patients who relapsed were treated with sofosbuvir and ledipasvir for 12 weeks. All patients achieved SVR12. This is the first report of re-treating patients who failed a regimen including sofosbuvir with another regimen incorporating this same antiviral.
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MedicalResearch.com Interview with:
Yuting Zhang, Ph.D.
Associate Professor and Director
Pharmaceutical Economics Research Group
University of Pittsburgh Graduate School of Public Health
Department of Health Policy and Management.
Medical Research: What are the main findings of the study?
Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems.
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MedicalResearch.com Interview withDr. Sunny Jhamnani MD
Clinical Fellow in Cardiology at Yale School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Jhamnani: Lifestyle modifications are the crux of atherosclerotic disease management. However adherence to them is not adequate. Additionally, randomized controlled trials (RCTs) looking effects of diet and exercise on atherosclerotic disease progression have not been convincing.
We did a systematic review and a meta-analysis of all RCTs looking at the effects of diet and exercise on coronary and carotid atherosclerotic disease progression. We found that , lifestyle modifications were associated with a decrease in coronary atherosclerotic burden in percent stenosis by -0.34 (95% CI: -0.48 to -0.21) standardized mean difference (SMD), with no significant publication bias and heterogeneity (p:0.21, I2:28.25). Similarly, in the carotids, there was a decrease in the carotid intimal medial thickness in mm by -0.21 (95% CI: -0.36 to -0.05) SMD and by -0.13 (95% CI: -0.25 to -0.02) SMD, before and after accounting for publication bias and heterogeneity (p:0.13, I2:39.91 and p:0.54, I2:0), respectively.
(more…)
MedicalResearch.com Interview with:
Frank J. Elgar, PhD
Associate Professor of Psychiatry
Canada Research Chair in Social Inequalities in Child Health
Institute for Health and Social Policy, McGill University
Montreal, Quebec, Canada
Medical Research: What are the main findings of the study?Dr. Elgar: Our study addressed two questions. The first was whether cyberbullying has unique links to adolescent mental health, or is an extension of traditional (face-to-face) bullying. We measured various forms of bullying and found that cyberbullying does indeed have a unique impact on mental health.
Our second question about protective factors in the home environment. We examined the frequency of family dinners as potential a moderating factor - understanding, of course, that dinners are a proxy of various family characteristics that benefit adolescents, such as communication, support, and parental monitoring. We found that teens who were targeted by cyberbullying but had ate dinner with their families more often had significantly better mental health outcomes as a result.
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MedicalResearch.com Interview with:
Michele D. Levine Ph.D.
Associate Professor of Psychiatry and Psychology
Western Psychiatric Institute and Clinic
Department of Statistics, University of Pittsburgh, Pittsburgh PA
Medical Research: What is the background for this study? What are the main findings?
Dr. Levine: Many women quit smoking as a result of pregnancy. However, psychiatric disorders, which are prevalent among smokers can contribute to weight gain. Thus, we sought to examine the relationship between maternal psychiatric disorders and gestational weight gain in a sample of pregnant former smokers. Results from the present study demonstrate that the rates of psychiatric disorders were high among pregnant former smokers and that more than half of women gained more weight than recommended by the IOM. Although a history of having had any psychiatric disorder was not associated with gestational weight gain, a history of alcohol use disorder specifically was positively related to gestational weight gain.
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