Women and Minorities Have Worse Outcomes After Stroke

MedicalResearch.com Interview with:

Cheryl Bushnell, MD, MHS Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist Health Medical Center Boulevard Winston Salem, NC 27157

Dr. Cheryl Bushnell

Cheryl Bushnell, MD, MHS
Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist Health
Medical Center Boulevard
Winston Salem, NC  27157 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status.  But, we pre-specified gender and race because we knew these could be important predictors of outcome.  As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored.  Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important.  We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke.  Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities.

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Does Slow Heart Rate Signal Increased Heart Disease or Mortality Risk?

Ajay Dharod, M.D. Coordinator of Medical Informatics Department of Internal Medicine Wake Forest School of Medicine

Dr. Ajay Dharod

More on Heart Disease on MedicalResearch.com

MedicalResearch.com Interview with:
Ajay Dharod, M.D.
Coordinator of Medical Informatics
Department of Internal Medicine
Wake Forest School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Dharod: There is a relative paucity of data regarding asymptomatic bradycardia in adults free of clinical cardiovascular disease. Are individuals with low heart rates simply healthy individuals with a non-clinically significant finding or is there a subclinical disease process? That was the question that generated this study. Until now, there had not been any research to determine if a slow heart rate contributed to the development of cardiovascular disease. We found that a heart rate (HR) of less than 50 was not associated with an elevated risk of cardiovascular disease in participants regardless of whether they were taking Heart Rate-modifying drugs, such as beta blockers and calcium channel blockers. However, we did find a potential association between bradycardia and higher mortality rates in individuals taking HR-modifying drugs.

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HEART Pathway Improves Efficiency Of Chest Pain Evaluation In ER

Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem NC 27157MedicalResearch.com Interview with:
Simon A. Mahler MD, MS, FACEP

Associate Professor
Department of Emergency Medicine
Wake Forest School of Medicine
Winston-Salem NC 27157

Medical Research: What is the background for this study?

Dr. Mahler: Care patterns for patients with acute chest pain are inefficient. Most patients presenting to US Emergency Departments (ED) with chest pain, including those at low-risk for acute coronary syndrome (ACS), are hospitalized for comprehensive cardiac testing. These evaluations cost the US health system $10-13 billion annually, but have a diagnostic yield for ACS of <10%. American College of Cardiology/ American Heart Association (ACC/AHA) guidelines recommend that low-risk patients with acute chest pain should receive serial cardiac markers followed by objective cardiac testing (stress testing or cardiac imaging). However, guideline adherent care among low-risk patients fails to accurately focus health system resources on those likely to benefit. Among low-risk patients, who have acute coronary syndrome rates less than 2%, objective cardiac testing  is associated with a substantial number of false positive and non-diagnostic tests, which often lead to invasive testing. Consensus is building within the US health care system regarding the need to more efficiently evaluate patients with acute chest pain.

Medical Research: What are the main findings?

Dr. Mahler: Patients randomized to the HEART Pathway were less likely to receive stress testing or angiography within 30 days than patients in the usual care arm (an absolute reduction of 12%. P=0.048). Early discharge (discharges from the ED without stress testing or angiography) occurred in 39.7% of patients in the HEART Pathway arm compared to 18.4%: an absolute increase of 21.3% (p<0.001). Patients in the HEART Pathway group had a median LOS of 9.9 hours compared to 21.9 hours in the usual care group: a median reduction in LOS of 12 hours (p=0.013). These reductions in utilization outcomes were accomplished without missing adverse cardiac events or increasing cardiac-related ED visits or non-index hospitalizations.

The HEART Pathway, which combines the HEART score, with 0- and 3-hour cardiac troponin tests, is an accelerated diagnostic protocol (ADP), which may improve the value of chest pain care by identify patients who can safely be discharged from the ED without stress testing or angiography. Observational studies have demonstrated that the HEART Pathway can classify >20% of patients with acute chest pain for early discharge while maintaining a negative predictive value (NPV) for major adverse cardiac event (MACE) rate of greater than 99% at 30 days. However, prior to this study the real-time use of the HEART Pathway had never been compared with usual care. Therefore, we designed a randomized controlled trial to evaluate the efficacy of the HEART Pathway to guide providers’ testing and disposition decisions for patients with acute chest pain. The hypothesis was that the HEART Pathway would meaningfully reduce objective cardiac testing, increase early discharges, and reduce index hospital length of stay compared to usual care while maintaining high sensitivity and NPV (>99%) for MACE.

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St. John’s Wort May Cause Dangerous Drug Interactions

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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Stroke Patients Have Chronic Disease At High Risk For Readmissions

Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC  27157MedicalResearch.com Interview with:
Cheryl Bushnell, MD, MHS
Associate Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist School of Medicine
Winston Salem, NC  27157

MedicalResearch: What are the main findings of the study?

Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure).

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Brain Amyloid Deposition Strongly Related to Arterial Stiffness

MedicalResearch.com Interview Invitation with:
Timothy Hughes, PhD, MPH Roena B. Kulynych Center for Memory & Cognition Research Department of Internal Medicine Division of Gerontology and Geriatric Medicine Wake Forest School of Medicine Medical Center Boulevard, Winston-Salem, NC  27157-1207Timothy Hughes, PhD, MPH
Roena B. Kulynych Center for Memory & Cognition Research
Department of Internal Medicine
Division of Gerontology and Geriatric Medicine
Wake Forest School of Medicine
Medical Center Boulevard, Winston-Salem, NC  27157-1207

MedicalResearch.com: What are the main findings of the study?

Dr. Hughes: This study is a follow-up to our recent paper that showed a novel relationship between arterial stiffness (commonly measured by pulse wave velocity) and the presence and extent of amyloid deposition in the brain, a hallmark of Alzheimer’s disease. For this study, we repeated brain amyloid imaging (using the Pittsburgh Compound B during PET imaging) in order to look for predictors of change in amyloid over two years in n=81 elderly adults aged 80+ and free from dementia. We observed that measures of systemic arterial stiffness (e.g. brachial ankle pulse wave velocity) was strongly associated with the extent of amyloid deposition in the brain at both baseline and follow-up. The change in brain amyloid accumulation over two years resulted in an increase in in the number of participants with Alzheimer’s-like (amyloid-positive) from 45% at baseline to a surprising 75% after just two years. This change in brain amyloid accumulation over two years was strongly related to having greater central stiffness (as measured by carotid femoral pulse wave velocity). These relationships between arterial stiffness and brain amyloid deposition were independent of the effects of age, gender, body mass index, antihypertensive medication use and even current blood pressure.

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Decreasing Bacterial Contamination from Surgical Gloves, Gowns

William G Ward, Sr. MD Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line - Guthrie Clinic One Guthrie Square Sayre, Pennsylvania 18840 (Professor Emeritus - Wake Forest University Dept of Orthopaedic Surgery)MedicalResearch.com Interview with:
William G Ward, Sr. MD
Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line – Guthrie Clinic
Sayre, Pennsylvania 18840
(Professor Emeritus – Wake Forest University Dept of Orthopaedic Surgery)

MedicalResearch.com: What are the main findings of this study?

Dr. Ward: The main findings of the study include:

  1. The use of disposable spun-lace “paper” gowns was associated with a dramatic decrease in the likelihood of culture-detected bacterial contamination on the surgeon’s gloved hand and gown sleeve.
  2. For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%.
  3. Bacteria suspended in saline solution transgressed the material of standard reusable scrub attire in 96% (26/27) of tested gowns and in 0% (0/27) of spun-lace disposable “paper” gowns. Continue reading

Football Helmet Types: Large Differences in Concussion Risk

Steven Rowson, Ph.D. Research Assistant Professor Virginia Tech Wake Forest UniversityMedicalResearch.com Interview with:
Steven Rowson, Ph.D.
Research Assistant Professor
Virginia Tech
Wake Forest University

 

A significant difference in concussion risk was found between these two helmet designs Riddell Revolution (left) and the Riddell VSR4 (right).  Virginia Tech

A significant difference in concussion risk was found between these two helmet designs Riddell Revolution (left) and the Riddell VSR4 (right).
Virginia Tech

MedicalResearch.com: What are the main findings of the study?

Dr. Rowson: We found that there were large differences in concussion risk between football helmet types.  This is the first study to address this question while controlling for the number of times each helmet type was impacted.

This allowed us to compare apples to apples.  For example, we’re not comparing starters who frequently get hit in one helmet type to second string players who don’t get hit as much.
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Hypertension Mechanisms May Differ Between Men and Women

Carlos M Ferrario, MD, FAHA, FASH, FACC Dewitt-Cordelll Professor of Surgical Sciences Professor, Internal Medicine-Nephrology Professor, Physiology-Pharmacology Wake Forest University School of Medicine Winston-Salem, NC 27157-1032 Vice-President, Consortium Southeastern Hypertension Control Editor-in-Chief Therapeutic Advances in Cardiovascular DiseaseMedicalResearch.com Interview with:
Carlos M Ferrario, MD, FAHA, FASH, FACC
Dewitt-Cordelll Professor of Surgical Sciences
Professor, Internal Medicine-Nephrology
Professor, Physiology-Pharmacology
Wake Forest University School of Medicine
Winston-Salem, NC 27157-1032
Vice-President, Consortium Southeastern Hypertension Control
Editor-in-Chief, Therapeutic Advances in Cardiovascular Disease

MedicalResearch.com: What are the main findings of the study?

Dr. Ferrario: A significant and unexpected difference in the hemodynamic mechanisms that account for the elevated blood pressure between untreated hypertensive men and women.

The main findings were:

“Despite there being no differences between women and men in terms of office blood pressure, heart rate and body mass index, men demonstrated lower values of pulse pressure, systemic vascular resistance, brachial artery pulse wave velocity and augmentation index. In each of the three hypertension categories, the increased blood pressure in men was associated with significant augmentations in stroke volume and cardiac output compared with women. Sex-related hemodynamic differences were associated in women with higher plasma levels of leptin, hs-CRP, plasma angiotensin II and serum aldosterone. In women but not men, hs-CRP correlated with plasma concentrations of transforming growth factor β1 (TGFβ1) and body weight; in addition, plasma TGFβ1 correlated with levels of serum vascular cell adhesion molecule 1.”
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Atrial Fibrillation Increases Risk of Heart Attack

Elsayed Z Soliman MD, MSc, MS, FAHA, FACC Director, Epidemiological Cardiology Research Center (EPICARE) Wake Forest School of Medicine Medical Center Blvs, Winston Salem, NC 27157MedicalResearch.com Interview with:
Elsayed Z Soliman MD, MSc, MS, FAHA, FACC
Director, Epidemiological Cardiology Research Center (EPICARE)
Wake Forest School of Medicine
Medical Center Blvs, Winston Salem, NC 27157
Atrial Fibrillation and the Risk of Myocardial Infarction

MedicalResearch.com: What are the main findings of the study?

Dr. Soliman: Using data from the REGARDS study, one of the largest US cohorts, we examined the risk of incident myocardial infarction (MI) associated with atrial fibrillation (AF). Overall, AF was associated with almost double the risk of MI. When we adjusted for common cardiovascular risk factors and potential confounders, the risk remained significantly high; about 70% increased risk. When we looked at women, men, blacks, and whites separately,  we found significant differences between races and sex.  AF in women and blacks was associated with more than double the risk of MI. This compares to less than 50% increased risk of heart attack associated with AF in men and whites . So AF is basically bad for all, but the risk of MI associated with AF is more pronounced in women and blacks.
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Donated Kidneys May Serve as Scaffolding to Grow New Kidneys for Kidney Failure Patients

MedicalResearch.com eInterview with Dr. Giuseppe Orlando, M.D., Ph.D.  Instructor, General Surgery Specialty Areas: Transplant Urology, Kidney Transplantation, Pancreas Transplantation, Transplant Immunology, Transplant Immunosuppression, Transplant Surgery Wake Forest Baptist Medical Center Medical Center Boulevard, Winston-Salem, NC 27157.MedicalResearch.com eInterview with Dr. Giuseppe Orlando, M.D., Ph.D.

Instructor, General Surgery
Specialty Areas: Transplant Urology, Kidney Transplantation, Pancreas Transplantation, Transplant Immunology, Transplant Immunosuppression, Transplant Surgery
Wake Forest Baptist Medical Center
Medical Center Boulevard, Winston-Salem, NC 27157.

MedicalResearch.com:  What are the main findings of the study?

Dr. Orlando: Our study shows that we can use discarded kidneys from deceased human donors as platform for kidney regeneration investigations. As of now, we are using porcine models, after having developed smaller scale models (mainly in rodents, as it normally occurs in health science ie we need to provide the proof of concept in small animals before scaling up to larger animals which, for obvious reasons, are clinically more relevant). In regenerative medicine we know that cells do not survive if they are not seeded on supporting platforms which we call “scaffolds”. There are several types of scaffolds, but probably the most effective are the ones that we can produce from animal/human organs. Basically, every organ consists of a cellular component which is endowed within the framework of the so-called extracellular matrix. When we strip cells out of an organ, what remains is the acellular extracellular matrix. Quite strikingly, the acellular organ in question maintains the same shape and volume that it had before stripping. What counts is that the so-obtained scaffold contains most information that cells require to grow, be viable and exert their function. It looks like this happens also for discarded human kidneys which may represent the most promising platform for our research
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Study: Cancer of the Appendix is Different than Colon Cancer

WINSTON-SALEM, N.C. – March 7, 2012 – Researchers at Wake Forest Baptist Medical Center have demonstrated that cancer of the appendix is different than colon cancer, a distinction that could lead to more effective treatments for both diseases.

The study by Edward A. Levine, M.D., professor of surgery and chief of the surgical oncology service at Wake Forest Baptist, is the result of gene analysis of cases covering a 10-year period. It appears in the early online edition of the April issue of the Journal of the American College of Surgeons.

Cancer of the appendix, which is part of the colon, affects approximately 2,500 people in the United States annually and has the propensity to spread throughout the peritoneal cavity, the space within the abdomen that contains the intestines, stomach and liver.

“Our treatment program, which was the catalyst for this research, is one of the largest worldwide and consists of aggressive surgery coupled with heated chemotherapy placed directly into the abdominal cavity at the time of surgery,” Levine said. “Given the uncertainty of predicting outcomes in patients with disseminated appendiceal cancer, we sought to use the tools of gene expression profiling to better understand these rare malignancies at a molecular level in order to better predict oncologic outcomes. We’ve looked at the genes that make these cancers tick, and we actually started to pick them apart for the first time.”

For the study, the researchers examined tumor samples from Wake Forest Baptist’s tissue bank for patterns of expression of different genes.

“By looking at these genetic signatures, we found that the genes active in cancer of the colon and those active in cancer of the appendix are very different,” Levine said. “For years, however, cancer of the appendix, which is part of the colon, has been treated with the same chemotherapy treatment used for colon cancer. This study shows that we need a fresh approach to how we treat appendix cancer.”

This research, which was done in collaboration with Duke University, was supported, in part, by a grant from Golfers Against Cancer. Co-authors include Perry Shen, M.D., and John Stewart, M.D., both of Wake Forest Baptist, and David Hsu, M.D., and Trey Blazer, M.D., both of Duke University.