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: Dr. John A. Copland, PhD
Associate Professor of Biochemistry/Molecular Biology
Professor of Cancer Biology
Cancer Basic Science
Mayo Clinic, Jacksonville, Florida
MedicalResearch: What are the main findings of the study?Dr. Copland: In our study we identified a pro-cancerous role for a novel protein- neuronal pentraxin 2 (NPTX2). This protein, normally found expressed in brain and nervous system tissues, is highly overexpressed in kidney tumors at all stages of disease. It has never previously been associated with kidney cancer, nor has it been associated with an oncogenic function in any other cancer. NPTX2 appears to play a significant role in not only tumor cell survival, but it also promotes tumor cell migration through activation of the ionotropic glutamate receptor 4 (GluR4). GluR4, also commonly associated with nervous system tissues, appears to be manipulating the flow of calcium into the tumor cell. Both NPTX2 and GluR4 are not components of normal kidney cell function. Because calcium is an important co-factor for many signaling pathways controlling cell growth, survival, and mobility, unconstrained calcium levels in a cell can promote malignancy. We show that calcium calmodulin kinase and AKT, two oncogenic signaling pathways are activated by NPTX2 via calcium influx.
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MedicalResearch.com Interview with: Tracie A. Caller, MD , MPH
Neurophysiology Fellow
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr., Lebanon NH 03756, USA
MedicalResearch: What are the main findings of the study?Dr. Caller: We identified factors that appeared to increase the risk for a 30 day readmissions in the epilepsy population, which included refractory seizures but also coexistence of nonepileptic seizures and psychiatric comorbidities.
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MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
MedicalResearch: What are the main findings of the study?Dr. Sui: In the present study, cancer survivors who reported performing resistance exercise (RE) at least 1 day of the week had a 33% lower risk of all-cause mortality compared with individuals who did not report participation in resistance exercise. Further, there was an inverse relationship between resistance exercise and all-cause mortality in those who were physically active, but not in those who were physically inactive. Although leisure-time physical activity was not associated with a lower risk of all-cause mortality, the present results support the benefits of resistance exercise and physical activity was during cancer survival.
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MedicalResearch.com Interview with: Prashanthi Vemur, Ph.D.
Mayo Clinic
Rochester, Minnesota
MedicalResearch: What are the main findings of the study?Dr. Vemuri: Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic. We studied two non-overlapping components of lifetime intellectual enrichment: education/occupation-score and mid/late-life cognitive activity measure based on self-report questionnaires. Both were helpful in delaying the onset of cognitive impairment but the contribution of higher education/occupation was larger.
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MedicalResearch.com Interview with: Kay W. Chang, MD
Associate Professor of Otolaryngology and Pediatrics
Stanford University
Department of Otolaryngology
Lucile Packard Children's Hospital at Stanford
Division of Pediatric Otolaryngology
MedicalResearch: What are the main findings of the study?Dr. Chang:At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight.
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MedicalResearch.com Interview with:Colin R. Cooke, MD, MSc, MS;
Assistant Professor of Medicine,
Division of Pulmonary & Critical Care Medicine
Faculty, Center for Healthcare Outcomes & Policy
University of Michigan
MedicalResearch: What are the main findings of the study?Dr. Cooke: There were three primary findings from our study.
First,we determined that between 1992 and 2005 there was almost a 40% increase in the number of admissions to an intensive care unit (ICU) among patients with lung cancer who were hospitalized for reasons other than surgical removal of their cancer.
Second, most of this increase was because doctors were admitting these patients to intermediate intensive care units. These are units that provide greater monitoring and nurse staffing than typically available in general hospital wards, but usually also have less ability to provide life support measures than full service ICUs.
Third, over the same period the reasons for ICU admission have changed. Although the most common reason for admission continues to be for problems related to the patients’ lung cancer, problems such as breathing difficulties requiring a ventilator and severe infections are increasingly common.
These findings suggest that although overall use of the ICU for patients with lung cancer is increasing over time, providers may be shifting some of the intensive care for lung cancer patients toward less aggressive settings such as the intermediate care unit.
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