Medical Research Centers
18 Nov Heart Failure Costs To Increase Due To Aging Population and Improved Medical Therapies
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.
18 Nov “Time-Outs” To Assess Antibiotics Reduce Both Antibiotics Use and Costs
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.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.
12 Nov High Preterm Birth Rates Persist In Upwardly Mobile African American Women
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.
10 Nov Eradicating Hepatitis C In Liver Transplant Patients With Less Toxic Combination Therapy
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.
10 Nov Breast Cancer: Overcoming Tumor Resistance With Combinatinon Therapy
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.
10 Nov Septic Shock Patients Often Require Hospital Readmission
Posted at 14:38h
in Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, University of Pennsylvania
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.
10 Nov Age-Related Macular Degeneration: Computerized Imaging Predicts Risk Progression
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.
10 Nov Multivitamins May Have Little Influence on Cardiovascular Disease
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.
09 Nov Surgical Quality Enhanced By Electronics Records Data
Posted at 20:57h
in Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD
MedicalResearch.com Interview with:
Jamie Anderson MD MPH
Department of Surgery
University of California, San Diego
Medical 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.
07 Nov CT Screening For Lung Cancer Can Be Cost-Effective If Right Patients Offered Screening
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.
07 Nov Age-Related Macular Degeneration: SD-OCT Imaging Predicts Dry To Wet Progression
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.
07 Nov Does Dental Trauma Play A Role in Oral Cavity Cancer?
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.07 Nov Childhood Pneumococcal Vaccine Linked To Sharp Decline In Hospitalizations
MedicalResearch.com Interview with:
Marie R Griffin MD MPH
Director, Vanderbilt MPH Program
Department of Health Policy Vanderbilt University Medical Center
Nashville TN 37212
Medical 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.
06 Nov Telomerator Tool Enhances Construction of Designer DNA
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.
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.05 Nov Hepatitis C: Pilot Study Investigates Re-treatment After Relapse
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.04 Nov Atrial Fibrillation: More Bleeding With Dabigatran Than Warfarin
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.
03 Nov Lifestyle Modifications Decrease Coronary and Carotid Atherosclerosis
MedicalResearch.com Interview with Dr. 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.03 Nov Family Support Mitigates Negative Impact of Cyberbullying
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.
03 Nov Practical Approach to Management of Incidental Thyroid Nodules
MedicalResearch.com Interview with:
Dr. Jenny Hoang MBBS (Hons)
Associate Professor of Radiology and Radiation Oncology
Duke University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.
The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience.
30 Oct Ebola: Infectiousness Greatly Increases With Disease Progression
MedicalResearch.com Interview with:
Dan Yamin PhD
Postdoctoral Associate
Yale School of Public Health
New Haven, CT 06520
Medical Research: What is the background for this study?
Dr. Yamin: With limited resources, West Africa is currently overwhelmed by the most devastating Ebola epidemic known to date. In our research, we seek to address two questions:
- 1) who is mostly responsible for transmission? and 2) what intervention programs should be applied to contain the current Ebola outbreak?
30 Oct Study Identifies Potential Target In Huntington’s Disease Pathway
MedicalResearch.com Interview with:
Srinivasa Subramaniam, Ph.D., Assistant Professor
Department of Neuroscience
The Scripps Research Institute Jupiter, Florida 33458
Medical Research: What is the background for this study? What are the main findings?
Dr. Subramaniam: Huntington’s disease (HD) is a genetic disorder occurs due to a mutation in a protein called huntingtin (mHtt), which affects 5-10 people per 100000 populations worldwide. Our research revolves around the question— why mutant huntingtin despite its ubiquitous expression through out the body selectively affects brain regions such as striatum, a region that regulates voluntary movement. We now found that mHtt activates a protein kinase complex, mammalian target of rapamycin complex 1 (mTORC1), which is required for normal functions such as translation of genes into proteins and also organelle recycling. We found the mTORC1 activation is so robust and sustained in the striatum that lead to the severe motor disabilities and premature death of HD mice. Our study indicates a functional relationship between huntingtin and mTOR the developmentally important genes with implication in Huntington’s disease pathogenesis.
29 Oct Reliability of East German Pharmaceutical Investigations Questioned
MedicalResearch.com Interview with:
Dr. med. Rainer Erices
Institut für Geschichte und Ethik der Medizin
Medical Research: What are the main findings of the study?
Dr. Erices: The study presents the results of a first systematic investigation of clinical drug trials carried out by Western pharmaceutical firms in Eastern Germany in the 1980s. The scientific investigation of the East German Health system has only just started. The study shows that in that period of time, around 220 clinical trials were carried out. We now know how many patients took part and what remuneration the GDR received. It continues to be difficult to evaluate these tests. Despite intensive research efforts in different archives, we have been unable to find documentation on how detailed (and systematically) patients were informed about the trial they were taking part in. The responsible institutions repeatedly advised testers to stick to the law during the clinical trials. The law required that these trials should only be carried out on patients which had given their informed consent and had decided to participate voluntarily. However, so far there is no convincing proof that these legal requests were met.
29 Oct Community Interventions Improved Blood Pressure Control In Diverse Populations
Posted at 12:57h
in AHA Journals, Author Interviews, Blood Pressure - Hypertension, Duke, Race/Ethnic Diversity
MedicalResearch.com Interview with:
Kevin L Thomas, MD
Assistant Professor of Medicine
Division of Clinical Cardiac Electrophysiology
Duke Clinical Research Institute
Medical Research: What are the main findings of the study?
Dr. Thomas: The number of participants with controlled blood pressure (readings of less than 140/90) increased by 12 percent in the six months between the first and last readings. Mean systolic blood pressure for the population decrease by 4.7mmHg. The number of participants who had high blood pressure in the range of 140-149/90-99 decreased systolic blood pressure by a mean of 8.8mmHg and those with readings in the higher range of 150/100 or above decreased systolic blood pressure by 23.7percent. The study concluded that a program that followed this type of approach was associated with improved blood pressures across a diverse high-risk community.”
29 Oct Gut Bacteria Linked To Heart Failure and Mortality Risk
MedicalResearch.com Interview with:
W. H. Wilson Tang, MD FACC FAHA
Professor of Medicine,
Cleveland Clinic Lerner College of Medicine at CWRU
Director, Cardiomyopathy Program, Kaufman Center for Heart Failure
Research Director, Section of Heart Failure and Cardiac Transplantation Medicine
Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195
Medical Research: What are the main findings of the study?
Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk.
29 Oct Leftover US Hospital Supplies Can Have Lifesaving Impact Overseas
MedicalResearch.com Interview with: Eric Wan BS and Miceile Barrett BS Johns Hopkins University School of Medicine Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Answer: Access to surgery is limited in resource-poor settings and low-and-middle income countries (LMICs) due to a lack of human and material resources. In contrast, academic hospitals in high-income countries often generate significant amounts of unused and clean medical supplies that cannot be re-used in the operating rooms of high-income countries. Programs such as Supporting Hospitals Abroad with Resources and Equipment (SHARE) provide an avenue for recovery of these supplies and donation to resource-poor hospitals in LMICs. From data collected from SHARE supplies donated by Johns Hopkins, we found that the nationwide impact for these programs to be $15.4 million among US academic hospitals, which accounts for only 19 categories of commonly recovered supplies. When we tracked our donated supplies to hospitals in Ecuador serving the poor, we found that the cost-effectiveness of these donations was US $2.14 per disability-adjusted life-year prevented.27 Oct Traumatic Brain Injury Raises Dementia Risk in Elderly
MedicalResearch.com Interview with:
Raquel C. Gardner, MD, Research Fellow
San Francisco VA Medical Center
Clinical Instructor
Memory and Aging Center, Department of Neurology
University of California, San Francisco
Medical Research: What are the main findings of the study?
Dr. Gardner: We found that people who experience a traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma.