Alzheimer's - Dementia, Author Interviews, CMAJ, JAMA, Mayo Clinic, Parkinson's / 18.09.2013

Rodolfo Savica, MD, MSc Department of Neurology, College of Medicine Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with: Rodolfo Savica, MD, MSc Department of Neurology, College of Medicine Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota   MedicalResearch.com: What are the main findings of this study? Dr. Savica: This study is the first in North America to explore the incidence of DLB and PDD in a population based sample. We found that the overall incidence of dementia with Lewy bodies (DLB), considered the second leading cause of neurodegenerative dementia after Alzheimer`s disease, is lower than that of Parkinson`s disease (PD), increases steeply with age, and is markedly higher in men than in women. (more…)
Author Interviews, CMAJ, Johns Hopkins, Pain Research, Pharmacology / 16.09.2013

Matthew Daubresse, MHS Research Data Analyst Center for Drug Safety and Effectiveness Johns Hopkins School of Public Health 615 N. Wolfe Street, Suite W6023 Baltimore, MD 21205 MedicalResearch.com: What are the main findings of the study? Answer: Over the past decade, prescriptions for non-opioid medications remained stable or declined among ambulatory pain visits in the United States. In visits for new-onset musculoskeletal pain, non-opioid prescribing decreased from 38% of visits in 2000 to 29% of visits in 2010. During this time, opioid prescriptions nearly doubled. Few patient, provider, and visit characteristics were associated with the likelihood of opioid receipt, suggesting increases in opioid prescribing have occurred generally across different groups of patients.  (more…)
Author Interviews, Baylor College of Medicine Houston, CMAJ, Heart Disease, JAMA / 16.09.2013

Faisal G. Bakaeen, MD FACS Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, TexasMedicalResearch.com Interview with: Faisal G. Bakaeen, MD FACS Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas   MedicalResearch.com: What are the main findings of the study? Dr. Bakaeen:  The relative use of off-pump CABG peaked at 24% in 2003, followed by a slow decline after that to about 19%. In addition, the conversion rate from off- to on-pump decreased with time and has stayed below 3.5% in recent years. Perioperative mortality rates decreased over time for both on- and off-pump CABG and have stayed below 2% since 2006. The mortality associated with converted cases was high regardless of the surgery year. (more…)
Author Interviews, Baylor College of Medicine Houston, Blood Pressure - Hypertension, Cost of Health Care, JAMA / 16.09.2013

Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) 2002 Holcombe Blvd. Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine www.houston.hsrd.research.va.govAshley Motter HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical CenterMedicalResearch.com Interview with: Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical Center Houston, Texas 77030 MedicalResearch.com: What are the main findings of the study? Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension.  The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups.  Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year.  The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant.  None of the incentives resulted in increased incidence of hypotension compared with controls.  While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group.  The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000. (more…)
Author Interviews, Case Western, Cleveland Clinic, Respiratory / 13.09.2013

Pranab K. Mukherjee, Ph.D. Assistant Professor Center for Medical Mycology Department of Dermatology University Hospitals Case Medical Center Case Western Reserve University Cleveland, OH 44106-5028MedicalResearch.com Interview with: Pranab K. Mukherjee, Ph.D. Assistant Professor Center for Medical Mycology Department of Dermatology University Hospitals Case Medical Center Case Western Reserve University Cleveland, OH 44106-5028 MedicalResearch.com: What are the main findings of the study? Answer: We performed a randomized double-blinded placebo-controlled pilot clinical trial to assess the safety, tolerability and effectiveness of a cetylpyridinium chloride (CPC)-based oral spray in the prevention of acute upper respiratory tract infections (URIs).
  • The tested CPC spray (ARMS-I, developed by Arms Pharmaceutical LLC, Cleveland, OH) was safe and exhibited high tolerability and acceptability among study participants
  • The product exhibited a trend to protect against URIs (55% relative reduction compared to the placebo), based on confirmed URIs, post-medication exit interviews, and daily electronic diaries completed by study participants
  • There was statistically significant reduction in frequency of cough and sore throat in the active group
  • The number of days (duration) of cough was significantly reduced in the active group compared to placebo arm
  • URI-associated viruses (influenza, rhinovirus and coronavirus) were detected in three individuals, all in the placebo arm. No virus was detected in the active arm/
  • No drug-related adverse events or oral lesions were observed
  • Previous vaccination status of the study participants did not affect the study outcome.
(more…)
Author Interviews, Johns Hopkins, NEJM, Pulmonary Disease / 11.09.2013

MedicalResearch.com Interview with: Dr. Robert A. Wise MDMedicalResearch.com Interview with: Dr. Robert A. Wise MD Professor of Medicine Johns Hopkins University School of Medicine 5501 Hopkins Bayview Circle Baltimore, MD 21224   MedicalResearch.com: What are the main findings of the study?
 Dr. Wise: The TIOSPIR trial was a landmark study, one of the largest ever conducted for chronic obstructive pulmonary disease (COPD).  It was designed to test the comparative safety and effectiveness of two delivery devices of tiotropium, a long-acting bronchodilator.  One formulation is the Respimat multi-dose soft mist inhaler and the other formulation is the single dose HandiHaler dry powder inhaler. After following more than 17000 patients for an average of 2.3 years, TIOSPIR showed that there was no difference in either the safety in terms of mortality or adverse cardiovascular events between the two devices.  Moreover, both devices showed similar effectiveness in terms of time to first COPD exacerbation. A lung function substudy in 1370 patients showed that the 5 microgram dose of Respimat was equivalent to the HandiHaler as a bronchodilator, but the 2.5 microgram dose was not quite as effective. (more…)
Addiction, Author Interviews, Memory, Methamphetamine, Scripps / 11.09.2013

MedicalResearch.com Interview with: Ph.D., Neurobiology & Behavior and Center for the Neurobiology of Learning & Memory (2005), University of California, Irvine, CaliforniaCourtney A. Miller, PhD Assistant Professor Department of Metabolism & Aging Department of Neuroscience The Scripps Research Institute Jupiter, FL 33458 MedicalResearch.com: What are the main findings of the study? Dr. Miller: The relapse rate for drug abusers, smokers and alcoholics is high because abstinence is so difficult. A major factor is the craving that drug associations can trigger. These range from seeing the neighborhood where someone used to buy, in the case of illicit drugs, to social drinking for a smoker. We’ve found a way to disrupt these drug-associated memories without affecting other, more benign memories. (more…)
Case Western, Esophageal, Gastrointestinal Disease, University of Michigan / 11.09.2013

Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center 111-D 2215 Fuller Rd. Ann Arbor, MI 48105MedicalResearch.com Interview with: Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center Ann Arbor, MI 48105 MedicalResearch.com: What are the main findings of the study? Dr. Rubenstein: In a set of case-control studies within the same population, we found that H. pylori was inversely associated with erosive esophagitis, and with Barrett’s esophagus, but we did not find such a relation with symptoms of gastroesophageal reflux disease (GERD). (more…)
Author Interviews, Duke, Heart Disease, Outcomes & Safety, Surgical Research / 05.09.2013

Marco D. Huesch, MBBS, Ph.D., Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business.MedicalResearch.com Interview with: Marco D. Huesch, MBBS, Ph.D. Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business. MedicalResearch.com: What are the main findings of the study? Answer: This study asked whether ‘learning by doing’ works backwards too, as ‘forgetting by not doing’. In an nutshell, the answer is ‘no’ among the Californian cardiac surgeons I examined with short breaks of around a month. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease, Medical Research Centers / 05.09.2013

MedicalResearch.com Interview with: Gearoid M. McMahon, MB, BCh Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, Massachusetts MedicalResearch.com: What are the main findings of the study? Answer: This study examined the incidence, causes and outcomes of rhabdomyolysis in two large University Teaching hospitals. Rhabdomyolysis is a characterized by an increase in serum creatine phosphokinase (CPK) and results from muscle damage from a variety of causes. The most important complication of rhabdomyolysis is acute kidney injury which can result in a need for dialysis. Using a series of laboratory and clinical variables that are readily available on admission, we constructed a risk score that can predict with some accuracy the likelihood that a patient with rhabdomyolysis might die or need dialysis during an admission. The final variables included in the model were age, gender, the cause of rhabdomyolysis and the admission CPK, creatinine, phosphate, bicarbonate and calcium. One of the advantages of this study was, because we had access to data from two institutions, we were able to derive the risk score in one hospital and confirm its accuracy in the second institution. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Medical Research Centers, PLoS, Social Issues / 05.09.2013

Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, UtahMedicalResearch.com Interview with: Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, Utah, MedicalResearch.com: What are the main findings of the study? Dr. Uchino: The main findings from our paper is that independent of one’s own social network quality, the quality of a spouse’s social network was related to daily life ambulatory blood pressure (ABP) levels.  More specifically, the more supportive (positive) ties, and the less aversive (negative) or ambivalent (both positive and negative) ties in a spouse’s social network, the lower was one’s own  ABP.  In addition, looking at the social networks of couples as a whole showed that couples who combined had more supportive ties and less aversive or ambivalent ties showed lower ABP. (more…)
Author Interviews, HIV, Social Issues, UCLA / 03.09.2013

Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los AngelesMedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles Dr. Young: Here's the main take-home point: There is a lot of excitement about the possibility of using technologies, big data, and mHealth to improve health outcomes and change behavior. However, 1) little work has been done on this topic using sound research methods (for example, studies have asked people to report whether a technology changed behavior rather than objectively measuring whether it actually changed behavior. (more…)
Author Interviews, Kidney Disease, University of Michigan / 03.09.2013

Afshinnia, Farsad, M.D., M.S. Research Fellow and Clinical Lecturer Department of Nephrology University of Michigan Health System MedicalResearch.com: What are the main findings of the study? Answer: Spontaneous Renal Artery Dissection (SRAD) is most commonly observed in middle aged individuals. Although SRAD can have no association with other comorbidities at the time of presentation, we have noticed association with a number of systemic disorders such as hypertension, cancer, congestive heart failure, and rheumatologic diseases. In particular clustering of Fibromascular dysplasia (FMD), Ehlers-Danlos syndrome, poly arteritis nodosa, Poland syndrome, and nail patella syndrome in our patients has been striking. The most commonly observed presenting symptom is sudden onset severe flank pain which may be spontaneous or following physical stress. Other presenting features may include uncontrolled hypertension, groin and/or testicular pain, headache, nausea, vomiting, fever, dysuria, hematuria and blurry vision. (more…)
Author Interviews, Heart Disease, Infections, JACC, Yale / 31.08.2013

Behnood Bikdeli, MD Yale/YNHH Center for Outcomes Research and Evaluation One Church St, Suite 200 New Haven CT 0651MedicalResearch.com Interview with: Behnood Bikdeli, MD Yale/YNHH Center for Outcomes Research and Evaluation One Church St, Suite 200 New Haven CT 0651 MedicalResearch.com: What are the main findings of the study?
 Dr. Bikdeli: We determined the trends in hospitalizations and mortality from endocarditis among US older adults from 1999 to 2010. Endocarditis is the most serious cardiovascular infection and our study that had a very large sample, signified the high burden of endocarditis in this time period. (more…)
Author Interviews, Case Western, Cleveland Clinic, Cost of Health Care, Pain Research, Surgical Research / 30.08.2013

MedicalResearch.com Interview with: Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047 MedicalResearch.com: What are the main findings of the study? Answer: Our goal was to see whether the transversus abdominis plane (TAP) block reduced complications and shortened the hospital stay of patients undergoing colorectal operations.  The TAP block is a nerve block injection given at the conclusion of the operation which reduces pain in the operative area.  Results showed that the mean hospital stay dropped to less than 2.5 days after the surgical procedure, significantly lower than the 3.7 days which the University Hospitals Case Medical Center Care pathway had already described for more than 1,000 consecutive patients. In our new study, we employed the TAP block and the Enhanced Recovery Pathway (ERP) on 100 patients.  We found that 27 patients went home the next day and another 35 went home 48 hours after their operations. That is considerably better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation.  With a third of patients leaving the day after colorectal resection, we feel these results are significant. (more…)
Author Interviews, Duke, JAMA, Mental Health Research / 30.08.2013

MedicalResearch.com Interview with: Arif Khan, MD Medical Director, Northwest Clinical Research Center Adjunct Professor of Psychiatry Duke University Medical Center and Christine Khan, Psychiatric Nurse 1951 – 152nd  Place NE Northwest Clinical Research Center Bellevue, WA 98007 MedicalResearch.com: What are the main findings of your study?
  1. The original idea set in early 20th century that psychiatric patients discharged from mental hospitals had a shortened life span or faced early death was supported by this analysis of psychiatric patients participating in research trials for new medications.  There was no increased risk of early death or shortened life span for participating in these research clinical trials. 
  2. Life span shortening or increased risk of early death is highest among patients with schizophrenia, followed by patients with major mood disorders such as Bipolar Mood Disorder and Major Depression. (more…)
BMJ, Brigham & Women's - Harvard, General Medicine, Medical Research Centers / 30.08.2013

Qi Sun, MD ScD Assistant Professor of Medicine Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Assistant Professor Department of Nutrition, Harvard School of Public Health 665 Huntington Avenue, Boston, MA 02115MEDICALRESEARCH.COM: INTERVIEW WITH: Qi Sun, MD ScD Assistant Professor of Medicine Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School, Assistant Professor Department of Nutrition, Harvard School of Public Health 665 Huntington Avenue, Boston, MA 02115 MEDICALRESEARCH.COM: What are the main findings of the study? Response: We have three major findings.
  • First, we found that total fruit consumption was consistently associated with lower risk of developing type 2 diabetes in these large scale studies among U.S. men and women.
  • Second, we found that different individual fruits were differentially associated with diabetes risk. For example, higher intakes of blueberries, grapes or raisins, apples or pears are particularly associated with a lower diabetes risk.
  • Last, we found that fruit juice was associated with a higher diabetes risk, and replacing fruit juices with whole fruits will likely lead to reduced diabetes risk. (more…)
Author Interviews, BMJ, Case Western, Rheumatology / 29.08.2013

Dr Janet E Pope Division of Rheumatology, Department of Medicine The University of Western Ontario, St Joseph's Health Centre 268 Grosvenor Street, London, ON, Canada N6A 4V2MedicalResearch.com Interview with: Dr. Janet E Pope Division of Rheumatology, Department of Medicine The University of Western Ontario, St Joseph's Health Centre 268 Grosvenor Street, London, ON, Canada N6A 4V2   MedicalResearch.com: What are the main findings of the study?  Dr. Pope: We performed a RCT of patients who were stable for 6 months of etanercept added to methotrexate (inadequate responders to Mtx) who were randomized to stopping Mtx or continuing Mtx to determine if in the next 6 months (and later as the trial continues) the response rate would be the same if Mtx was discontinued. Overall, Mtx + etanercept was not statistically equivalent to etanercept alone (ie non-inferiority did not occur); implying 6 months after stopping Mtx, the etanercept patients on monotherapy performed slightly less well than those on combination therapy. (more…)
Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF / 29.08.2013

MedicalResearch.com Interview with: Dr. Marc Jaffe, MD Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group Associate Clinical Professor of Medicine, UCSF Endocrinology and Internal Medicine Kaiser South San Francisco Medical Center 1200 El Camino Real South San Francisco, California 94080 MedicalResearch.com:    What are the main findings of the study? Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates. If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period. (more…)
Author Interviews, Cost of Health Care, Duke / 29.08.2013

S. Yousuf Zafar, MD, MHS Assistant Professor of Medicine Duke Cancer Institute twitter: @yzafarMedicalResearch.com Interview with: S. Yousuf Zafar, MD, MHS Assistant Professor of Medicine Duke Cancer Institute twitter: @yzafar MedicalResearch.com: What are the main findings of the study? Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients  used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan. (more…)
Author Interviews, Coffee, Prostate Cancer, Stanford / 28.08.2013

MedicalResearch.com Interview with: Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center 1100 Fairview Ave. N. M4-B874 Seattle, WA 98109-1024Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center 1100 Fairview Ave. N. M4-B874 Seattle, WA 98109-1024   MedicalResearch.com: What are the main findings of the study? Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease.  In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day.  The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients. (more…)
Author Interviews, Mental Health Research, UCSF / 23.08.2013

MedicalResearch.com Interview with: Vanja Douglas, MD Sara & Evan Williams Foundation Endowed Neurohospitalist Chair Assistant Professor of Clinical Neurology UCSF Department of Neurology Neurology Clerkship Director Editor in Chief, The NeurohospitalistVanja Douglas, MD Sara & Evan Williams Foundation Endowed Neurohospitalist Chair Assistant Professor of Clinical Neurology UCSF Department of Neurology Neurology Clerkship Director Editor in Chief, The Neurohospitalist MedicalResearch.com: What are the main findings of the study? Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient's risk of developing delirium during that hospitalization. (more…)
Author Interviews, Cost of Health Care, Electronic Records, NYU / 23.08.2013

MedicalResearch.com Interview with: Saul Blecker, MD, MHS Assistant Professor Department of Population Health NYU School of Medicine 227 East 30th St., #648 New York, NY 10016Saul Blecker, MD, MHS Assistant Professor Department of Population Health NYU School of Medicine 227 East 30th St., #648 New York, NY 10016 MedicalResearch.com: What are the main findings of the study? Dr. Blecker: We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends. (more…)
Author Interviews, McGill, Sleep Disorders / 22.08.2013

MedicalResearch.com Interview with: Ruifeng Cao, MD,PhD Postdoctoral Fellow Laboratory of Nahum Sonenberg McGill University Department of Biochemistry Montreal, QC H3A 1A3, Canada MedicalResearch.com: What are the main findings of the study? Answer: Circadian (~24h) timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria.  In mammals, including humans, a circadian clock in the brain drives daily rhythms in sleep and wakefulness, feeding and metabolism, and many other essential processes. We studied how protein synthesis, which is a fundamental process underlying many biological activities, is controlled in the brain clock in mice and identified a protein that functions as a clock repressor. By removing the repressor protein, the clock function is improved. (more…)
Author Interviews, JAMA, Outcomes & Safety, Yale / 20.08.2013

Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, ConnecticutMedicalResearch.com Interview with: Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut MedicalResearch.com: What are the main findings of the study? Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
  • 40% of patients could not understand or explain the reason they were in the hospital in the first place;
  • A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
  • Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
  • Only 44% accurately recalled details of their appointments.
In other words, we didn't do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home. We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients - that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients - we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn't even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn't find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies. (more…)
Author Interviews, Lung Cancer, University of Pennsylvania / 20.08.2013

Sandra Ryeom, PhD, Assistant professor of Cancer Biology, Perelman School of Medicine, University of Pennsylvania MedicalResearch.com Interview with: Sandra Ryeom, PhD, Assistant professor of Cancer Biology, Perelman School of Medicine, University of Pennsylvania MedicalResearch.com: What are the main findings of the study? Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases. MedicalResearch.com: Were any of the findings unexpected? Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling  was all unexpected. (more…)
Author Interviews, General Medicine, Heart Disease, Mayo Clinic, Surgical Research / 16.08.2013

MedicalResearch.com Interview with: Rakesh M. Suri MD, D.Phil. Mayo Clinic College of Medicine, Rochester, Minnesota MedicalResearch.com: What might clinicians “take home” from this study? Answers: a. The contemporary outcomes of surgical correction of mitral regurgitation are excellent based upon results observed in this large multinational, multi-institutional study, Mitral valve surgery now has a low peri-operative risk of death or complications, and a very high likelihood of saving a patient’s own heart valve (>90% - repair); thereby avoiding the need for replacement with an artificial valve substitute. b. All patients with severe degenerative mitral regurgitation are at risk for heart failure and/or death when surgical correction is delayed.  A safe period of “watchful waiting” in those with severe mitral regurgitation due to flail leaflets, even in the absence of traditional Class I triggers for surgery (symptoms or left ventricular dilation/dysfunction) does not exist. c. Prompt mitral valve surgery within months following the diagnosis of severe degenerative mitral regurgitation, even in those without symptoms, is associated with important and sustained long term benefits including a 40% decrease in death and 60% less heart failure risk, sustained many years following surgical intervention (more…)
Author Interviews, Hepatitis - Liver Disease, HIV, McGill / 16.08.2013

Marina Klein, MD, MSc, FRCP(C) Associate Professor of Medicine McGill University Health Centre Division of Infectious Diseases and Chronic Viral Illness Service 3650 Saint Urbain Montreal, Quebec H2X 2P4MedicalResearch.com Interview with: Marina Klein, MD, MSc, FRCP(C) Associate Professor of Medicine McGill University Health Centre Division of Infectious Diseases and Chronic Viral Illness Service 3650 Saint Urbain Montreal, Quebec H2X 2P4 Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis                MedicalResearch.com: What are the main findings of the study? Dr. Klein: We showed that people with HIV and hepatitis C infection who smoked marijuana did not tend to progress more rapidly to liver fibrosis, liver cirrhosis or end-stage liver disease, even with increasing numbers of joints smoked per week. Previous studies that reported that marijuana was harmful to the liver were likely biased because they did not ensure that marijuana smoking occurred before the development of liver problems. (more…)
Author Interviews, Biomarkers, Parkinson's, University of Pennsylvania / 13.08.2013

Alice Chen-Plotkin, MD Assistant Professor Department of Neurology University of Pennsylvania School of Medicine MedicalResearch.com: Interview with Alice Chen-Plotkin, MD Assistant Professor Department of Neurology University of Pennsylvania School of Medicine   MedicalResearch.com: What are the main findings of the study? Answer: Parkinson's disease (PD) is an incurable neurodegenerative disease.  Many neurons die, but the neurons that make dopamine (dopaminergic neurons) are particularly vulnerable.  We think that the disease actually starts well before the time when people show clinical symptoms.  We were therefore interested in finding proteins from the blood that correlated with better or worse dopaminergic neuron integrity.  Since it's hard to access the dopaminergic neurons directly, we looked at a tracer that labels the ends of the dopaminergic neurons in people who do not have Parkinson's disease but are at high risk for developing it, and we also looked at the age at onset of PD in people who are already symptomatic.  Screening just under 100 different proteins from the blood, we found that higher plasma levels of apolipoprotein A1 (ApoA1) were correlated with better tracer uptake in the people who did not yet have PD, and with older ages at onset in the people who already had PD.  These data suggest that plasma ApoA1 may be a marker for PD risk, with higher levels being relatively protective. (more…)
Author Interviews, Breast Cancer, Johns Hopkins, Stem Cells / 13.08.2013

Harvard Stem Cell Institute's Kornelia Polyak, MD, PhD, MedicalResearch.com Interview with: Kornelia Polyak, MD, PhD Professor of Medicine Dana-Farber Cancer Institute Harvard Medical School Boston, MA 02215 MedicalResearch.com: What are the main findings of the study? Dr. Polyak: We found that when comparing normal breast tissue of women who have not had children (nulliparous) and those who had children in their early 20s, the largest changes are in breast epithelial progenitors. The frequency of these cells is lower in parous women (women who had children) and the properties are also altered in a way that they are less likely to proliferate. Women with high risk of breast cancer, such as BRCA1 and BRCA2 mutation carriers, have very high frequency of these cells, and also parous women who did get cancer have more than those who did not. These results indicate that the frequency of these cells may predict breast cancer risk. (more…)