MedicalResearch.com Interview with: Mallika L. Mendu, M.D.
Division of Renal Medicine
Brigham and Women’s Hospital
Boston, MA 02115.
Medical Research: What are the main findings of the study?Dr. Mendu: Our study found that implementation of a chronic kidney disease (CKD) checklist, a tool that succinctly and clearly outlines CKD management guidelines, in a primary care clinic improved adherence to a number of significant management guidelines. We conducted a prospective study during a one year period among 13 primary care providers, four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD. Patients whose providers utilized a CKD checklist had higher rates of adherence to annual albuminuria testing, parathyroid hormone testing, phosphate testing, achieving a hemoglobin A1c target<7, documentation of avoidance of nonsteroidal anti-inflammatory drugs, use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker and vaccination for annual influenza and 5-year pneumococcus.
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MedicalResearch.com Interview with:Sosena Kebede, MD, MPH
Assistant Professor of Medicine, Department of Medicine
Associate Faculty, the Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine
Faculty, Department of Health Policy and Management and
Baltimore, MD 21287
Medical Research: What are the main findings of the study?Dr. Kebede: There were 3 main findings in this study:
1. Patients’ understanding of aspects of their hospital care is suboptimal on the domains of knowledge of diagnoses, indications for the medications they take and the types of procedures/tests they get. Some forms of poor shared understanding could have potentially serious implications for their health and for future care such as identifying a prescribed antidepressant as a blood thinner or mistaking an echocardiogram a left heart catheterization or thinking a liver cyst is a liver cancer. Other forms of poor shared understanding such as not accurately identifying why a procedure is done or what the results of the procedure show (a finding not discussed in the research letter) may seem less consequential but raise the issue of informed consent, patient empowerment and may alsoraise questions about patient and physician behavior towards appropriate use of in-patient procedures. Some of the questions we could ask here include: would patients demand more or less procedures if they had better understanding of what the procedures entail, and why they are beingordered? Conversely, would physicians recommend more or less of in-patient procedures, when they encounter patients whose understanding of procedure indications are optimal?(more…)
MedicalResearch.com Interview with: Mats Möller MD
Department of Surgery, Ersta Hospital
Department of Clinical Sciences
Karolinska Institutet
Danderyds Hospital, Stockholm, Sweden
Medical Research: What are the main findings of the study?Dr. Möller: The natural course of common bile duct stones seem not as favorable as previous studies have suggested. Leaving stones with no measures taken has in our study a less favorable outcome compared to removing the stones.
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MedicalResearch.com Interview with:Jan G. Jakobsson
Institution for Clinical Science
Karolinska Institutet, Danderyds Hospital
Stockholm, Sweden
Medical Research: What are the main findings of the study?Dr. Jakobsson: We found that anaesthesiologists and nurse anaesthetists were concerned about the risk for neurocognitive side effects, but there routines and practice for preoperative identification of patients at risk, intraoperative management to minimise risk and assessment and management of patients showing signs and/or symptoms of neurocognitive side effects after anaesthesia was rarely at place.
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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.
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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.
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MedicalResearch.com Interview with:Hurst M. Hall, MD and Sandeep Das, MD, MPH
Division of Cardiology
University of Texas Southwestern Medical Center
Dallas, TX
Medical Research: What are the main findings of the study?Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day. This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.
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MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
Medical Research: What are the main findings of the study? Dr. Bingener-Casey: “About half of patients seeking emergency care for gallbladder problems were immediately admitted and underwent urgent cholecystectomy, the other half went home. The half that went home was younger and had lower WBC counts, lower neutrophils and less people with elevated temperature than the patients immediately admitted. Of the half that went home, 31% returned at least once to the ED within 30 days and 20% were admitted to undergo urgent cholecystectomy after the return visit, 55% percent of those within 7 days of the initial ED visit. Patients who failed the elective treatment plan had similar WBC counts but were more likely to have an ASA >3, slightly higher creatinine and higher average maximum VAS pain score. Patients who were less than 40 years old or older than 60 years were more likely to fail the elective pathway.”
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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.
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MedicalResearch.com Interview with: Dr. Bing Lu, M.D., Dr.P.H.
Division of Rheumatology
Immunology & Allergy
Brigham & Women's Hospital and Harvard Medical School
Boston, MA 02115
Medical Research: What are the main findings of the study?Dr. Lu: In two large cohorts of women, we observed that being obese increased the risk of rheumatoid arthritis in women by 40–70% depending on age and serologic status. The highest risk for rheumatoid arthritis was among women who were overweight or obese at age 18 years, emphasizing the public health importance of combating the obesity epidemic at all ages. Our study implicates being overweight or obese throughout adult life as a risk factor in the development of seropositive and seronegative RA for women diagnosed with rheumatoid arthritis at age 55 years or younger. The attenuated association between BMI and rheumatoid arthritis diagnosed at older ages may reflect differences in the pathophysiology of RA diagnosed at earlier ages compared with that diagnosed at older ages, or may be a result of the limitations of BMI as a measure of total fat mass as women age.
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MedicalResearch.com Interview with Dr. John C. Lieske, MD
Mayo Clinic, Rochester, MN
Medical Research: What are the main findings of the study?Dr. Lieske:We followed 11 women before, 6 and 12 months after Roux en Y gastric bypass surgery. The patients successfully lost weight as mean BMI fell from 46 kg/m2 preoperatively to 28 kg/m2 postoperatively. Mean serum creatinine did not significantly change from baseline (0.8 mg/dl) to 12 months (0.7 mg/dl). Hence mean GFR estimated by the CKD-EPI equation (eGFR) did not significantly change from 84 ml/min/1.73 m2 (baseline) to 90 ml/min/1.73 m2 (12 months). However, GFR measured by iothalamate clearance (mGFR) significantly decreased from 108 ml/min/1.73m2 (121 ml/min) to 85 ml/min/1.73 m2 (90 ml/min).
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MedicalResearch.com Interview with:Richard J. O'Reilly, MD
Memorial Sloan Kettering Cancer Center
Medical Research: What are the main findings of the study?Dr. O'Reilly:
1. In a comparison of the results of HLA-matched sibling transplants with other established transplant approaches, including T-cell depleted half-matched parental marrow grafts, unmodified transplants from matched unrelated donors and cord blood transplants in the current era (2000-2009), transplants from donors other than HLA-matched siblings had 5 year survival outcomes similar to those of matched siblings when applied to young infants (≤ 3.5 months of age) or infants of any age that were not infected at the time of transplants. Thus any child born with SCID can now be successfully transplanted.
2. Active infection at the time of transplant significantly reduced chances of long-term survival for all infants except those who received transplants from HLA-matched siblings. Thus, infection is a dominant determinant of transplant outcome. Control of treatable infections prior to transplant should be a major clinical objective.
3. Treatment with chemotherapy containing busulfan significantly enhances the likelihood of recovering a normal ability to make antibodies and fosters better recovery of T-cells that provide cell mediated immunity, and may be an acceptable risk in uninfected infants. However, use of any chemotherapy prior to transplant in an infant who is infected, greatly decreases chances of survival. In infected patients who lack a matched sibling, T-cell depleted transplants from half matched related donors had the best outcomes.
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MedicalResearch.com Interview with: Rainbo Hultman, PhD
Postdoctoral Research Associate
Laboratory for Psychiatric Neuroengineering, Principal Investigator
Affective Cognitive and Addiction Disorders (ACAD) Research Group
Department of Psychiatry and Behavioral Sciences
Center for Neuroengineering Duke University Medical Center
Durham, NC 27710
Medical Research: What are the main findings of the study?Dr. Hultman: Using a mouse model of stress-induced psychiatric dysfunction, we found that the brainwave patterns in two key brain regions (prefrontal cortex, PFC and amygdala, AMY) encode for susceptibility to such dysfunction. Furthermore, such susceptibility can be predicted from the brainwave patterns in these regions before the onset of stress.
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MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS
Assistant Professor of Health Policy and Clinical Practic
The Dartmouth Institute
Lebanon, NH
Medical Research: What are the main findings of the study?Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab. Among patients with pre-existing kidney disease, we prevent kidney injury in 30% of patients.
We believed that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients. Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included:
Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure),
Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were "NPO" for up to 12 hours and came in dehydrated),
Training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money),
and creating stops in the system to delay a procedure if that patient had not received enough oral or IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety.
MedicalResearch.com Interview with: John Blosnich, Ph.D., M.P.H.,
Post-doctoral fellow at the Center for Health Equity Research and Promotion
Veterans Affairs Pittsburgh Healthcare System.
Medical Research: What are the main findings of the study?Dr. Blosnich: I think there are two main findings from our study:
First, since the beginning of the All-Volunteer U.S. military in 1973, there has been a shift in childhood experiences among men who have served in the military.
Second, the childhood experiences of women who have served in the military have been largely similar across the Draft and All-Volunteer Eras.
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MedicalResearch.com Interview Invitation Dr. Bryan K. Woodruff
Assistant Professor of Neurology
Mayo Clinic, Arizona
Medical Research: What are the main findings of the study?Dr. Woodruff: There is evidence in the medical literature supporting a negative impact of losing a spouse for health conditions such as cancer or cardiovascular disease, but this has not been evaluated in terms of the impact of widowhood on the development of dementia. We used the National Alzheimer’s Disease Coordinating Center (NACC) database, which pools data gathered by multiple federally-funded Alzheimer’s disease research centers to try to answer this question. Specifically, we looked at the age at which individuals ultimately developed dementia in both individuals who lost their spouse and in those who remained married over the course of the study. Surprisingly, the data we analyzed did not support a negative impact of losing a spouse in individuals who had no cognitive difficulties when they entered the study, and we saw a paradoxical effect of widowhood in those with mild cognitive impairment (MCI).
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MedicalResearch.com Interview with:Stephanie Faubion, M.D
Director of the Women’s Health Clinic
Mayo Clinic in Rochester
Medical Research: What are the main findings of the study?Dr. Faubion:In this study that included over 1800 women, we found that caffeine intake was associated with more bothersome hot flashes and night sweats in postmenopausal women.
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MedicalResearch.com Interview withLynn E. Fiellin, M.D.
Associate Professor of Medicine
Director, play2PREVENT Lab
Yale University School of Medicine
New Haven, CT 06510
Medical Research: What are the main findings of the study?Dr. Fiellin: The current findings are part of a larger study evaluating an interactive evidence-based video game, PlayForward: Elm City Stories, developed on the iPad and targeting risk reduction and HIV prevention in 333 young teens (ages 11-14). The larger study is examining a range of outcomes including knowledge, intentions, self-efficacy and actual behaviors and we are collecting at baseline, 6 weeks, 3, 6, 12, and 24 months. We are examining these outcomes in our experimental group compared with a control group playing a set of off-the-shelf games on the iPad. The current findings of the 196 teens who have completed the 6 weeks of gameplay and for whom we have baseline and 3 month data, reveal that, while the two groups had no differences in their baseline HIV risk knowledge, the PlayForward group had statistically significant gains in knowledge at 6 weeks (p<0.0001), sustained at 3 months (p<0.01). In addition, examining the association between exposure to the game and performance on the standardized assessments revealed that the number of game levels completed (a measure of exposure to the intervention) was positively correlated with knowledge gains measured at 3 months (r=0.42; p<0.001).
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MedicalResearch.com Interview with: Eva DuGoff, PhD, MPP
Graduate Student
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Medical Research: What are the main findings of the study?Dr. DuGoff:In this study we investigate average life expectancy in older adults living with one to 10 or more different chronic conditions. Our main finding is that life expectancy decreases with each additional chronic condition.
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MedicalResearch.com Interview with: Qiuyin Cai, M.D., Ph.D.
Associate Professor of Medicine
Vanderbilt University
Medical Research: What are the main findings of the study?Dr. Cai: We conducted a genome-wide association study in East Asians to search for additional genetic changes that are linked to breast cancer development. The study was conducted as part of the Asia Breast Cancer Consortium, which includes 22,780 women with breast cancer and 24,181 control subjects. We found DNA sequence changes in two genes, PRC1 and ZC3H11A, and a change near the ARRDC3 gene were associated with breast cancer risk. These results were also replicated in a large consortium, including 16,003 breast cancer cases and 41,335 control subjects of European ancestry.
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MedicalResearch.com Interview with:Allison Lipitz-Snyderman, PhD
Assistant Attending Outcomes Research Scientist
Center for Health Policy and Outcomes
Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center New York, NY 10065
Medical Research: What are the main findings of the study?Dr. Lipitz-Snyderman:Long-term central venous catheters are used to administer intravenous fluids and treatments such as chemotherapy. These catheters can also be a source of bloodstream infections which can be harmful to cancer patients. However, this risk is not well understood. In our study, we found that the use of these catheters was associated with an increased risk of infections for patients with cancer. We used a population-based dataset, SEER-Medicare, to study this issue in older adult cancer patients. This dataset allowed us to study patients treated in different institutions and follow them over time.
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MedicalResearch.com Interview with:Erin Brown, MD
General Surgery PGY6
UC Davis Medical Center
Medical Research: What are the main findings of the study?Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting. We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children. We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores. Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting.
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MedicalResearch.com Interview with:
Aakriti Gupta, MD, MBBS
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital,
New Haven, Connecticut
Medical Research: What were the main findings?
Dr. Gupta: Using a national database, we found that heart attack hospitalization rates for patients under the age of 55 have not declined in the past decade while their Medicare-age counterparts have seen a 20 percent drop.
We also found that among younger patients below 55 years of age, women fare worse because they have longer hospital stays, and are more likely to die in the hospital after a heart attack. Young women were also more likely to have higher prevalence of co-existing medical conditions including diabetes, high blood pressure and higher cholesterol levels. Overall, all patient groups in the study saw increases in these conditions including diabetes and high blood pressure in the past decade.
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MedicalResearch.com Interview with Steven Grinspoon, MD
Professor of Medicine, Harvard Medical School
Director, MGH Program in Nutritional Metabolism
Co-Director, Nutrition Obesity Research Center at Harvard
Massachusetts General Hospital
Boston, MA 02114
Medical Research: What are the main findings of the study?Dr. Grinspoon:The primary finding is that tesamorelin, a hypothalamic peptide that increases the endogenous pulsatile secretion of growth hormone, reduced liver fat in HIV-infected patients with increased visceral (abdominal) fat. Increased visceral fat is very closely linked with increased liver fat in HIV patients, but the effects on liver fat were not known. Our data show that tesamorelin reduces liver fat in conjunction with decreasing visceral fat, which may be clinically important for patients with HIV-infection who have both increased abdominal fat and fatty liver disease. In addition the study demonstrated that this treatment strategy was neutral to glucose by the end of the 6 month study.
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MedicalResearch.com Interview with:Andrea Bellavia
From the Unit of Nutritional Epidemiology and the Unit of Biostatistics
Institute of Environmental Medicine
Karolinska Institutet, Stockholm, Sweden
Medical Research: What are the main findings of the study?Dr. Bellavia:By evaluating together the consumption of processed and fresh red meat, we observed that processed red meat consumption was associated with shorter life, implying a potential negative effect on health. On the other hand, consumption of only fresh red meat was not associated with either shorter or longer survival. Therefore, the main finding of this work is that the negative effects of red meat consumption might only be due to meat processing, which counteract the positive effects of the beneficial nutrients of meat.
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MedicalResearch Interview with: Dr. Lu Wang MD PhD
Associate Epidemiologist, Brigham and Women's Hospital
Assistant Professor of Medicine, Harvard Medical School
Brigham and Women's Hospital
Department of Medicine Preventive Medicine
Boston, MA 02115
Medical Research: What are the main findings of the study?Dr. Wang: We found that vitamin E supplement 400 IU every other day and vitamin C supplement 500 mg daily had no effect on total cancers, the incidence of prostate cancer and other site-specific cancers during periods of intervention, post-trial observation, or overall.
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MedicalResearch.com Interview with:
Claudia Robertson, MD
Professor, Department of Neurosurgery
Baylor College of Medicine
One Baylor Plaza
Houston, Texas 77030
Medical Research: What are the...
MedicalResearch.com Interview with: Dr. Robert Foote MD
Chair, Department of Radiation Oncology
Mayo Clinic, Rochester, MN
MedicalResearch: What are the main findings of the study?Dr. Foote: Charged particle therapy (mainly protons and carbon ions) provide superior overall survival, disease-free survival and tumor control when compared to conventional photon therapy. In particular, it appears that proton beam therapy provides superior disease-free survival and tumor control when compared to the state of the art intensity modulated radiation therapy using photons.
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MedicalResearch.com Interview with: Scott A. Davis, MA
Research Administrative Coordinator
Department of Dermatology
Wake Forest School of Medicine
MedicalResearch: What are the main findings of the study?Answer: St. John’s wort (SJW), a common complementary and alternative medicine (CAM) treatment for depression, is frequently used together with drugs that may interact dangerously with it. In data from the 1993-2010 National Ambulatory Medical Care Survey, a nationally representative survey of physician visits from the National Center for Health Statistics, SJW was prescribed together with drugs such as selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, warfarin, statins, digoxin, verapamil, and oral contraceptives. Using SJW together with other antidepressants may cause serotonin syndrome, a potentially fatal condition.
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MedicalResearch.com Interview with Sai-Ching Jim Yeung, MD, PhD, FACP
Professor of Medicine
The University of Texas MD Anderson Cancer Center
Department of Emergency Medicine
Department of Endocrine Neoplasia & Hormonal Disorders
Houston, Texas 77230-1402
MedicalResearch: What are the main findings of the study?Dr. Yeung: We believe that this study has bridged a significant gap in knowledge between epidemiological data (the association of obesity and poor breast cancer prognosis) and biological mechanisms mediating the impact of obesity on cancer. This study provides an important mechanistic insight into the causal relationship between obesity and breast cancer growth.
Direct evidence for the links between obesity-associated changes in the biological processes and hallmarks of cancer in human estrogen receptor-positive (ER+) breast cancer.
It is well known that obesity is associated epidemiologicaly with decreased survival in ER+ breast cancer patients. Although a body of experimental literature exists to suggest important roles for estrogen, insulin/IGF-1 and adipokine signaling and inflammation in the mechanisms mediating the impact of obesity on cancer, direct evidence for these mechanisms and their importance relative to one another is lacking in cancers from obese humans.
Functional transcriptomic analysis of a prospective observation cohort with treatment-naïve ER+ breast cancer samples identified the insulin/PI3K signaling and secretion of cytokines among the top biological processes involved. Many of the obesity-associated changes in biological processes can be linked to cancer hallmarks. Upstream regulator analysis identified estrogen (?-estradiol), insulin (INS1), insulin-like growth factor-1 (IGF1), and adipokines [vascular endothelial growth factor A (VEGFA), tissue necrosis factor (TNF), interleukin-6 (IL6), oncostatin-M (OSM), chemokine ligand 5 (CCL5), leptin (LEP), leukemia inhibitory factor (LIF), C-reactive protein (CRP), adiponectin (ADIPOQ), and interleukin-10 (IL10)] in mediating the impact of obesity on human ER+ breast cancer.
Experimental evidence that obesity causes accelerated oncogene-driven ER+ breast cancer carcinogenesis.
While it is not possible to conduct a human experiment to prospectively examine the causal relationship between obesity and breast cancer, we created a transgenic mouse model with genetically induced obesity and oncogene-driven breast cancer. With this model we found strong in vivo evidence using both longitudinal experiments and cross-sectional experiments that obesity accelerated oncogene-driven breast carcinogenesis.
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MedicalResearch.com Interview with:
Mallika L. Mendu, M.D.
Division of Renal Medicine
Brigham and Women’s Hospital
Boston, MA 02115.
Medical Research: What are the main findings of the study?
Dr. Mendu: Our study found that implementation of a chronic kidney disease (CKD) checklist, a tool that succinctly and clearly outlines CKD management guidelines, in a primary care clinic improved adherence to a number of significant management guidelines. We conducted a prospective study during a one year period among 13 primary care providers, four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD. Patients whose providers utilized a CKD checklist had higher rates of adherence to annual albuminuria testing, parathyroid hormone testing, phosphate testing, achieving a hemoglobin A1c target<7, documentation of avoidance of nonsteroidal anti-inflammatory drugs, use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker and vaccination for annual influenza and 5-year pneumococcus.
(more…)
