MedicalResearch.com Interview with: Dr Nikola Drca
Department of Cardiology at the Karolinska Institute,
Karolinska University Hospital
Stockholm Sweden
MedicalResearch: What are the main findings of the study?Dr. Nikola Drca: We found that intense physical activity like leisure-time exercise of more than five hours per week at the age of 30 increased the risk of developing atrial fibrillation later in life by 19%. In contrast, moderate-intensity physical activity like walking or bicycling of more than 1 hour per day at older age (age 60) decreased the risk by 13%. (more…)
MedicalResearch Interview with:
Arya Mani, M.D.
Department of Internal Medicine and Genetics
Yale Cardiovascular Research Center
Yale, New Haven CTMedicalResearch: What are the main findings of the study?Dr. Mani: Our group has identified a gene that when mutated it causes a form of truncal (central) obesity that is associated with a cluster of coronary artery disease risk factors, including high blood pressure, insulin resistance and possibly elevated blood lipids. These associated risk factors are collectively known as the metabolic syndrome, which may lead to development of diseases such as diabetes and coronary artery disease, both of which were very prevalent in the populations we studied. All identified mutations by our group have been so far gain of function mutations, which means they increased the activity of the gene in pathways related to adipogenesis and gluconeogenesis.
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MedicalResearch.com Interview with: Viveca Ritsinger MD
Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm
Unit for Research and Development Kronoberg County Council, Växjö, Sweden
MedicalResearch: What are the main findings of the study?Dr. Ritsinger:This is a long-term follow-up of the Swedish DIGAMI 1 study where patients with acute myocardial infarction and diabetes were randomized to either intensified insulin-based glycaemic control or to standard glucose lowering treatment. Patients and controls were followed for mortality for over 20 years and 90% of the patients died during follow up.
Survival improved during a period of about 8 years. Intensified insulin-based glycaemic control increased survival time by an average of 2.3 years.
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MedicalResearch.com Interview with: Gregory J. Tsongalis, PhD, HCLD, CC, FNACB
Professor of Pathology
Director, Molecular Pathology
Co-Director, Translational Research Program
Department of Pathology
Dartmouth Hitchcock Medical Center and
The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756
MedicalResearch: What are the main findings of the study?
Dr. Tsongalis: This was the first study of its kind looking at multiple genes and multiple mutations in tumors of the appendix. Many of the identified mutations may be clinically actionable with respect to response to therapy or selection of therapy.
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MedicalResearch.com Interview with: Aaron L. Leppin, MD
Knowledge and Evaluation Research Unit
Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What are the main findings of the study?Dr. Leppin: We conducted a systematic review and meta-analysis of randomized trials assessing the effectiveness of hospital discharge interventions on reducing 30-day readmission rates. We identified 47 trials, 42 of which contributed to the primary meta-analysis.
Overall, the interventions that have been tested to reduce early hospital readmissions reduce them by about 20%.
The ones that are most effective, though, reduce them by almost 40% and use a consistent but complex approach. These interventions make a robust effort to fully understand the patient’s post-discharge context, often by visiting the patient’s home. They focus on identifying all the things the patient needs to do to be well—whether that’s organizing medications, getting a ride to the clinic, or paying the electric bill—and they determine whether the patient has the necessary resources and capacity to pull it all off. When limitations are found, these interventions have a strategy in place to support the patient through the post-discharge period.
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MedicalResearch.com Interview with:Dr. Julie Paik, MD MPH MSc
Instructor, Harvard Medical School
Brigham and Women's Hospital
MedicalResearch: What are the main findings of the study?Dr. Paik: Many women in the United States take calcium supplements. One study found that over 60% of women aged 60 and over in the United States were taking calcium supplements. However, the medical community is still not certain of the effects of calcium supplements in women, particularly on cardiovascular disease risk. For this reason, we studied 74,245 women participating in the Nurses' Health Study over a 24-year follow-up period for their risk of developing cardiovascular disease (heart disease or stroke). We found that there was no increased risk of heart disease or stroke among women taking calcium supplements during the 24-year follow-up period. Our paper has several distinct strengths compared to prior studies including the large sample size, long follow-up period, cases of cardiovascular disease that were confirmed by medical record review, detailed and repeated assessment of calcium supplement use, and detailed information about other risk factors for cardiovascular disease.
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MedicalResearch.com Interview with:Dr. Adriaan J van der Meer
Department of Gastroenterology and Hepatology
Erasmus MC, University Medical Center
Rotterdam, The Netherlands
MedicalResearch: What are the main findings of the study?Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient's risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
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MedicalResearch Interview with:Dr. David Cook MD
Professor in the Department of Anesthesiology
Division of Cardiovascular Anesthesiology
Center for the Science of Health Care Delivery
Mayo Clinic College of Medicine
Rochester, Minnesota.
MedicalResearch: What are the main findings of the study?Dr. Cook: The main finding of the study was that segmentation of a population of surgical patients into groups of higher and lower complexity allowed us to apply a standardized practice, focused factory model to surgical care delivery. A standardized care model improved care process measures such as time on mechanical ventilation or duration of a bladder catheter indwelling. The model reduced resource utilization, decreasing patient time in all care environments (operating room, ICU and on ?the floor?). The care model improved outcomes at 30 days and reduced the costs overall and in every care environment. In addition to the absolute improvements in quality and in cost, the standardized care model reduced variation in all measured variables. That reduction in variation may be even more important than the improved outcomes or reduced costs because we now know it is possible to make the health care experience predictable for these patients. That predictability is critically important to patients and providers, but it also has implications for health care metrics and payment models.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Rates of bilateral mastectomy are higher in hospitals with immediate breast reconstruction available. Bilateral mastectomy rates were highest in hospitals with high volumes of immediate breast reconstruction. Large, teaching, urban, and Northeastern hospitals were more likely to have higher immediate breast reconstruction volumes.
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MedicalResearch.com Interview with:Amit Singal MD MS
Assistant Professor of Medicine
Medical Director, Liver Tumor Program
Dedman Scholar of Clinical Care
Division of Digestive and Liver Diseases
University of Texas Southwestern
Dallas TX 75201 - 8887
MedicalResearch: What are the main findings of the study?Dr. Singal: We conducted a meta-analysis of current studies to characterize the association between hepatocellular carcinoma surveillance and early detection, curative treatment rates, and overall survival in patients with cirrhosis. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had hepatocellular carcinoma detected by surveillance. Hepatocellular carcinoma surveillance was associated with improved early stage detection (OR 2.08, 95% CI 1.80–2.37) and curative treatment rates (OR 2.24, 95% CI 1.99–2.52). These associations were robust to several sensitivity analyses, including study design, study location, and study period. Hepatocellular carcinoma surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67–2.17), which remained significant in the subset of studies adjusting for lead-time bias. Three-year survival rates were 50.8% among patients who underwent surveillance, compared to only 28.2% among hepatocellular carcinoma patients with tumors detected outside of a surveillance program.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery.
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MedicalResearch.com Interview with:Kejal Kantarci, M.D. M.S.
Professor of Radiology
Division of Neuroradiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch: What are the main findings of the study?Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.
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MedicalResearch.com Interview with: Tina Hieken, M.D.
Associate Professor of Surgery
Mayo Clinic,Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation.
(more…)
MedicalResearch.com Interview with:M. Arfan Ikram, MD, PhD
Assistant professor in Neuroepidemiology
Erasmus Medical Center
Rotterdam, the Netherlands
MedicalResearch.com: What are the main findings of this study?Dr. Ikram: We show that the risk of stroke might be increased due to an increased risk of ischemic stroke or increased risk of hemorrhagic stroke. Because these subtypes of stroke require different -often opposite- clinical management, currently available prediction rules for any stroke are insufficient. We propose a novel prediction rule that provides separate risks for ischemic stroke and hemorrhagic stroke.
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MedicalResearch.com Interview with:Dr. Gregg C. Fonarow MD
Director, Ahmanson-UCLA Cardiomyopathy Center
Professor, Department of Medicine
Associate Chief, Cardiology
David Geffen School of Medicine Los Angeles, CA
MedicalResearch.com: What are the main findings of the study?Dr. Fonarow: This study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke, which aims to increase the number of stroke patients treated with clot-busting drugs for ischemic stroke within 60 minutes or less after hospital arrival. Initiated nationwide in 2010, Target: Stroke provided 10 key strategies as well as tools to facilitate timely tPA administration, as well as additional approaches to improve stroke care and outcome.
Data from 71,169 tPA-treated stroke patients at 1,030 hospitals participating in Target: Stroke were analyzed to compared the time to treatment and incidence of complications before implementation, from 2003 to 2009, to the post-implementation years, from 2010 to 2013.
This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. In addition, the average time to treatment dropped by 15 minutes, from 74 to 59 minutes.
Faster treatment was associated with lower rates of complications, including death. Before Target: Stroke, 9.9% of stroke patients died in the hospital, compared to 8.3% of patients treated after the initiative started, a difference which was statistically significant. In addition, patients treated by Target: Stroke strategies were less likely to develop the complication of symptomatic intracranial hemorrhage.
(more…)
MedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhD
Director, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of Health
Bethesda, MD, 20892
MedicalResearch.com: What are the main findings of the study?Dr. Rosenzweig: We diagnosed a disease called CDG-IIb in two siblings with severe development issues and very low levels of immunoglobulins, which include infection-fighting antibodies. These children were referred to the NIAID Primary Immunodeficiency Clinic through the NIH Undiagnosed Diseases Program. CDG-IIb is an extremely rare congenital disorder of glycosylation (CDG), with only one other case reported. The genetic defect of the disease disrupts glycosylation, the process for attaching and trimming sugars from proteins. Almost 50% of our proteins have sugars attached, and these are called glycoproteins. They include immunoglobulins and also some viral glycoproteins that are made when cells are infected by a virus. The spread of some viruses, including HIV and influenza, depend on viral glycoproteins in order to infect additional cells and form viral protective shields. We found that this type of virus was less able to replicate, infect other cells, or create adequate protective shields in CDG-IIb patient cells because of the glycosylation defect. In comparison, adenovirus, poliovirus, and vaccinia virus, which either do not rely on glycosylation or do not form protective glycoprotein shields, replicated normally when added to both CDG-IIb and healthy cells.
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MedicalResearch.com Interview with:Li-Ching Lee, PhD, ScM
Associate Scientist,
Departments of Epidemiology and Mental Health
Johns Hopkins Bloomberg School of Public Health
Baltimore MD 21205
MedicalResearch.com: What are the main findings of the study?Dr. Li-Ching Lee: This population-based case-control study in young children provides evidence that prenatal selective serotonin reuptake inhibitor (SSRI) use may be a risk factor for autism and other developmental delays (DD). Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with autism spectrum disorder (ASD) relative to children with typical development; the strongest association occurred with first-trimester exposure. Exposure was also elevated among boys with DD and was strongest in the third trimester.
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MedicalResearch.com Interview with:Daniel I. Sessler, M.D.
Michael Cudahy Professor and Chair, Department of Outcomes Research
Cleveland Clinic, Cleveland, OH
MedicalResearch.com: What are the main findings of the study?Dr. Sessler: Free fatty acids, arachidonic acid and linoleic acid, and their metabolites hydroxyeicosatetraenoic acids (5-HETE, 11-HETE, 12-HETE, and 15-HETE) were 1.8 to 5.7-fold greater in 37 patients with adenocarcinoma versus 111 patients without cancer (all P<0.001). Areas under the receiver operating characteristics (ROC) curve were significantly greater than 0.50 discriminating lung cancer patients and controls for all biomarkers and phospholipids, and ranged between 0.69 and 0.82 (all P<0.001) for lung cancer patients versus controls. Arachidonic acid, linoleic acid, and 15-HETE showed sensitivity and specificity >0.70 at the best cutpoint. Concentrations of free fatty acids and their metabolites were similar in 18 squamous-cell carcinoma patients and 54 non-cancer controls.
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MedicalResearch.com Interview with:Angelo M. De Marzo MD PhD
Professor of Pathology
Johns Hopkins School of Medicine
Baltimore, MD 21231
MedicalResearch.com: What are the main findings of the study?Dr. De Marzo: Working as a team with Dr. Elizabeth Platz and a group of other investigators we found that men with chronic inflammation in their benign areas of their prostate biopsies had a higher chance of prostate cancer, and especially higher grade cancers, which are associated with disease aggressiveness. A key unique aspect of the study is that the samples were taken from man who were enrolled in the Prostate Cancer Prevention Trial (PCPT), a trial in which all men entering the study had a relatively low PSA, and, all men at the end of study who did not already have a diagnosis of prostate cancer were offered a prostate biopsy regardless of their PSA. This study design, unlike a standard association study, allowed us to minimize the potential bias whereby inflammation is associated itself with elevations in PSA. In this standard design approach, when cancer is detected it could artifactually appear that inflammation is associated with cancer because the inflammation was in part driving the PSA elevation, which prompted the biopsy in which cancer was detected.
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MedicalResearch.com Interview with:Dr. Lorraine R. Reitzel Ph.D
Associate Professor in the Health Program of the Department of Educational Psychology
College of Education, University of Houston in Houston, Texas.
MedicalResearch.com: Please tell us about your study.Dr. Reitzel: The current study represented a secondary analysis of data that were collected by Dr. Lorna McNeill and colleagues at The University of Texas MD Anderson Cancer Center. The parent study was focused on better understanding factors associated with cancer risk among African American adults, and several faculty members including myself contributed ideas about the variables we thought might play a role. The current study represents one of several studies emerging from these data. The current study was led by Ms. Pragati S. Advani, a graduate student on my research team, who was interested in better understanding the associations between financial strain and modifiable behavioral risk factors for cancer among African American adults. Financial strain represents an unfavorable income to needs ratio and was assessed using a questionnaire that tapped into current difficulty affording things that represent pretty basic components of life, including suitable food, clothing, and housing for the respondent and their family. The modifiable behavioral risk factors for cancer examined included smoking cigarettes, at-risk alcohol use, being overweight/obese, getting insufficient physical activity, and having inadequate fruit and vegetable intake. We also included a tally of the total number of these factors (0 to 5) as an outcome variable of interest.
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MedicalResearch.com Interview with: Dr Hardeep Singh MD MPH
Chief of the health policy, quality & informatics program at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, based at the Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine in Houston
MedicalResearch.com: What are the main findings of the study?Dr Singh: We built estimates of diagnostic error by compiling and analyzing data from three previous studies. These studies evaluated situations such as unexpected return visits and lack of timely follow up and provided researchers with an estimated frequency of diagnostic error. This frequency was then applied to the general adult population. Diagnostic errors, which we defined as missed opportunities to make a correct or timely diagnosis based on available evidence—occur in about 5 percent of adults in the United States.
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MedicalResearch.com Interview with:Ethan K Gough, PhD candidate
Department of Epidemiology
Biostatistics and Occupational Health
McGill University, Montreal, QC, Canada
MedicalResearch.com: What are the main findings of the study?Answer: Antibiotic use produces significant gains toward expected growth in children, for their age and sex, from low- and middle-income countries. Children included in our study were generally smaller in height and weight than adequately nourished children of the same age, reflecting the spectrum of stunting and wasting malnutrition seen in low- and middle-income countries. Antibiotic use had a larger impact on weight than height, and the effect on weight was larger in populations who may be at greater risk of infections and early mortality, such as populations with a high prevalence of HIV infection or exposure, and a high prevalence of severe acute malnutrition.
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MedicalResearch.com Interview with:Finlay A McAlister MD
University of Alberta, Edmonton, Canada
MedicalResearch.com: What are the main findings of the study?Dr. McAlister:We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets).
The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician.
The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians. However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor.
Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .
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MedicalResearch.com Interview with:
Kimon Bekelis, MD
Department of Neurosurgery
Dartmouth-Hitchcock Medical CenterDr. Bekelis
MedicalResearch.com: What are the main findings of the study?
Dr. Bekelis: We...
MedicalResearch.com Interview with:Roger Paul Baxter, MD
Co-Director Kaiser Permanente Vaccine Study Center
Oakland, CA 94612.
MedicalResearch.com What are the main findings of the study?Dr. Baxter: Menveo, the currently licensed CRM-conjugate meningococcal vaccine, showed an excellent booster response in adolescents, regardless of which conjugate vaccine they had received previously. Also, although titers from the priming dose waned, at 3 years there were still protective antibodies in the majority of immunized individuals. The other US-licensed meningococcal conjugate vaccine, Menactra, uses a different protein conjugate.
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MedicalResearch.com Interview with:Jamie Hui, MD
Center for Health Services Research
Virginia Mason Medical Center
Seattle, Washington
MedicalResearch.com: What are the main findings of the study?Dr. Hui: Through a quality improvement intervention aimed at how radiologists report on findings in female pelvic ultrasound examinations, we were able to decrease the number of unnecessary recommendations for follow-up imaging of benign adnexal cysts, preventing duress for these women.
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MedicalResearch.com Interview with:Eric Matteson, M.D.
Chairman of Rheumatology
Mayo Clinic, Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Matteson: “The main points are that kidney disease is more common in patients with rheumatoid arthritis than in the general population and that moderate reduction in kidney function was more likely to be associated with cardiovascular disease in these patients as well. Patients with more active disease week are also at higher risk for kidney disease. “
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MedicalResearch.com Interview with: Michael B. Blank, PhD
Associate Professor of Psychology in Psychiatry
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104-3309
MedicalResearch.com: What are the main findings of the study?Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection.
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MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk
Head,Lab for Clinical Neurochemistry
and Neurochemical Dementia Diagnostics,
Universitätsklinikum Erlangen,
Department of Psychiatry and Psychotherapy,
91054 Erlangen, Germany
MedicalResearch.com: What are the main findings of the study?Prof. Dr. med. Piotr Lewczuk: In our study, we investigated the concentrations of four isoforms of amyloid beta peptides in the blood of healthy young volunteers without memory complains. The participants were stratified into three groups according to their apolipoprotein E (APOE) genotype, which is the mostly investigated and generally accepted genetic risk factor for sporadic Alzheimer’s Disease (AD). It is known that the alterations of the amyloid beta metabolism are the earliest changes in the course of AD, occurring many years (or even decades) before the onset of the clinical symptoms, but it is actually not known how early these alterations start. Correspondingly, we wanted to investigate if healthy persons with genetic risk factor show changes in their amyloid beta metabolism already 30-40 years before the age when AD is usually diagnosed. We did not find any differences between the groups with and without APOE-driven risk, which might be carefully interpreted as no signs of Alzheimer’s Disease pathology in persons at risk at such an early life stage. Taken together, we think that the Alzheimer’s Disease pathology starts some 10-20 years before the beginning of the clinical symptoms, but not earlier.
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MedicalResearch.com Interview with Dr. Judy C. Boughey MD
Professor of Surgery
Mayo Clinic, Rochester MN
MedicalResearch.com: What are the main findings of the study? Dr. Boughey: This study showed that the rate of reoperation after lumpectomy for breast cancer was significantly lower at Mayo Clinic in Rochester compared to national data. Mayo Clinic in Rochester uses frozen section analysis of margins at time of lumpectomy to direct any margin re-excisions during the surgery and therefore has a significantly lower rate of need for a second operation to ensure clean margins. The rate of reoperation was four times higher in the national data set than in the Mayo Clinic data set. (more…)
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