Electronic Decision Support Facilitates Home Discharge of Some PE Patients From ER

Dr-David R Vinson

Dr. Vinson

MedicalResearch.com Interview with:
David R. Vinson, MD
Department of Emergency Medicine
Kaiser Permanente Sacramento Medical Center Sacramento, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: At least one-third of emergency department (ED) patients with acute blood clots in the lung, or pulmonary embolism (PE), are eligible for expedited discharged to home, either directly from the ED or after a short (<24 hour) period of observation. Yet in in most hospitals in the U.S. and around the world nearly all ED patients with acute PE are hospitalized. These unnecessary hospitalizations are a poor use of health care resources, tie up inpatient beds, and expose patients to the cost, inconvenience, and risk of inpatient care. The better-performing medical centers have two characteristics in common: they help their physicians identify which PE patients are candidates for outpatient care and they facilitate timely post-discharge follow-up. At Kaiser Permanente Northern California (KPNC), we have had the follow-up system in place for some time, but didn’t have a way to help our physicians sort out which patients with acute PE would benefit from home management.

To correct this, we designed a secure, web-based clinical decision support system that was integrated with the electronic health record. When activated, it presented to the emergency physician the validated PE Severity Index, which uses patient demographics, vital signs, examination findings, and past medical history to classify patients into different risk strata, correlated with eligibility for home care. To make use of the PE Severity Index easier and more streamlined for the physician, the tool drew in information from the patient’s comprehensive medical records to accurately auto-populate the PE Severity Index. The tool then calculated for the physician the patient’s risk score and estimated 30-day mortality, and also offered a site-of-care recommendation, for example, “outpatient management is often possible.” The tool also reminded the physician of relative contraindications to outpatient management. At the time, only 10 EDs in KPNC had an on-site physician researcher, who for this study served as physician educator, study promotor, and enrollment auditor to provide physician-specific feedback. These 10 EDs functioned as the intervention sites, while the other 11 EDs within KPNC served as concurrent controls. Our primary outcome was the percentage of eligible ED patients with acute PE who had an expedited discharge to home, as defined above.

During the 16-month study period (8-month pre-intervention and 8-months post-intervention), we cared for 1,703 eligible ED patients with acute PE. Adjusted home discharge increased at intervention sites from 17% to 28%, a greater than 60% relative increase. There were no changes in home discharge observed at the control sites (about 15% throughout the 16-month study). The increase in home discharge was not associated with an increase in short-term return visits or major complications.  Continue reading

Disparities Remain But Blacks Experience Greatest All-Cause Mortality Reductions

MedicalResearch.com Interview with:

Katie Hastings MPH Stanford Medicine 

Kate Hastings

Katie Hastings MPH
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart disease has been the leading cause of death since the early 1900s, but recent data has suggested cancer will surpass heart disease in the upcoming decades. To date, this is the first study to examine the transition from heart disease to cancer mortality as the leading cause of death by U.S. county and sociodemographic characteristics using national mortality records from 2003 to 2015.

Our main findings are:

  • Epidemiologic transition is occurring earlier in high compared to low income U.S. counties, and occurs earlier for Asian Americans, Hispanics, and NHWs compared to blacks and American Indians/Alaska Natives.
  • Data may suggest that this shift arises from larger reductions in heart disease than cancer mortality over the study period, particularly in the highest income counties.
  • Continued disparities in heart disease and cancer mortality between blacks and other racial/ethnic groups, even in the highest income quintiles. While blacks continue to have the highest overall mortality than any other group, we do show this population experienced the greatest overall improvements in mortality (i.e. mortality rate reductions over time) for all-cause, heart disease, and cancer compared to all other racial/ethnic groups (except for heart disease in Hispanics). 

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Biomarkers Suggest Intensive Blood Pressure Treatment Does Not Cause True Kidney Damage in CKD Patients

MedicalResearch.com Interview with:

Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu/) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center

Dr. Shlipak

Michael G. Shlipak, MD, MPH
Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu)
Professor of Medicine, Epidemiology & Biostatistics
University of California, San Francisco
Associate Chief of Medicine for Research Development
San Francisco VA Medical Center

MedicalResearch.com: What is the background for this study?

  • Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
  • The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
  • Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
  • In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
  • In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
  • In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group. 

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Opioid Prescriptions Drop After 2016 CDC Guidelines Released

MedicalResearch.com Interview with:

Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC

Dr. Gery Guy

Gery P. Guy Jr., PhD, MPH
Senior Health Economist
Division of Unintentional Injury
CDC

MedicalResearch.com: What is the background for this study?

Response: In response to the increasing harms and adverse outcomes from prescription opioids, the CDC released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. The CDC Guideline recommends evidence-based practices for opioid use for patients age 18 years and older in primary care settings in treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

This report analyzed the temporal changes in opioid prescribing following the release of the CDC Guideline.

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Pregabalin Linked To Increased Risk for Opioid-Related Deaths

MedicalResearch.com Interview with:

Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada

Tara Gomes

Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada 

MedicalResearch.com: What is the background for this study?

Response: Pregabalin is a medication increasingly being prescribed to manage pain, however there is emerging evidence that this drug may increase one’s risk of opioid overdose when prescribed with opioids.

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Diabetes: Microvascular Complications Markedly Decreased After Bariatric Surgery

MedicalResearch.com Interview with:

David Arterburn, MD, MPH Kaiser Permanente Washington Health Research Institute Seattle, WA 

Dr. Arterburn

David Arterburn, MD, MPH
Kaiser Permanente Washington Health Research Institute
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More than 9 percent of adult Americans—about 30 million people—are estimated to have type 2 diabetes, according to the American Diabetes Association. The disease tends to worsen over time, with blood sugar levels rising along with the risks of developing large blood vessel (macrovascular) complications like heart attack and stroke, as well as small blood vessel (microvascular) complications affecting the nerves of the feet and hands (neuropathy), kidneys (nephropathy), and eyes (retinopathy).

Among more than 4000 patients who underwent bariatric surgery, the 5-year incidence of microvascular disease — including neuropathy, nephropathy, and retinopathy — was nearly 60% lower than that of 11,000 matched nonsurgical control patients receiving usual diabetes care.  Continue reading

Hepatitis C Treatment After Kidney Transplant May Extend Lives and Decrease Costs

MedicalResearch.com Interview with:

Mark H. Eckman, MD Posey Professor of Clinical Medicine Director, Division of General Internal Medicine Director, Center for Clinical Effectiveness University of Cincinnati Medical Center Cincinnati, OH

Dr. Eckman

Mark H. Eckman, MD
Posey Professor of Clinical Medicine
Director, Division of General Internal Medicine
Director, Center for Clinical Effectiveness
University of Cincinnati Medical Center
Cincinnati, OH 

MedicalResearch.com: What is the background for this study?

Response: People who are infected with hepatitis C virus and have kidney failure need a kidney transplant.

Recent studies have found that it is possible to transplant kidneys from donors who are infected with hepatitis C virus into patients who need a transplant and are already infected with the virus. In addition, drugs are available to cure most patients of hepatitis C virus, including those who have kidney failure. Infected patients who need a kidney transplant have 2 options. One option is to receive an infected kidney and then use drugs after the transplant to cure themselves and the transplanted kidney of the virus. Another option is to use the drugs first to get rid of the virus and then to receive a kidney from a donor who does not have hepatitis C virus infection.

For the more than 500,000 patients receiving dialysis for end-stage renal disease (ESRD), less than 4% receive kidney transplants. Because of the limited organ availability, hemodialysis is the final treatment for most patients with ESRD. Of the 10% or so of U.S. patients receiving dialysis who are infected with the hepatitis C virus (HCV), some are willing to accept HCV-infected kidneys, in part, because the wait times for such kidneys are shorter than those for HCV-uninfected kidneys. Because the yearly mortality rate for patients receiving hemodialysis is so high, between 4% and 16%, reducing the time to kidney transplant can have a dramatic effect on both survival and quality of life.

Because it may not be possible to do this type of research with actual people, we created a model that allowed us to estimate possible outcomes without using actual people.

The model was a computer program that combined the best available information to approximate what might happen to participants in a real-world clinical trial. Continue reading

Cardiovascular Risks of Hormone Therapy in Transgender Individuals

MedicalResearch.com Interview with:

Michael Goodman, MD, MPH Professor of Epidemiology Director, MD/MPH program Emory University School of Public Health Atlanta, GA  30322

Dr. Goodman

Michael Goodman, MD, MPH
Professor of Epidemiology
Director, MD/MPH program
Emory University School of Public Health
Atlanta, GA  30322

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There is a concern that hormone therapy may be associated with higher risk of certain cardiovascular problems such as heart attacks, stroke and formation of blood clots (“venous thromboembolism”).

To study this concern we examined data on 4,960 transgender and gender non-conforming people enrolled in Kaiser Permanente health systems in Georgia, Northern California, and Southern California. They were matched to 48,686 cisgender men and 48,775 cisgender women.  Below are the main findings

  • Rates of venous thromboembolism in all transwomen were approximately twice as high as the rates among cisgender men or cisgender women. The data for stroke and myocardial infarction demonstrated little difference between transwomen and cisgender men, but 80% to 90% higher rates among transwomen compared to cisgender women.
  • When the analyses focused specifically on transwomen who started therapy with female hormone estrogen at Kaiser Permanente, the incidence of both venous thromboembolism and stroke was more clearly elevated relative to either reference group.  There was evidence that incidence of both of these conditions among transwomen was particularly increased two to six years after estrogen initiation. By contrast, the association between estrogen therapy and myocardial infarction was less evident due to relatively few observed events.
  • Transmen did not appear to have significantly higher rates of venous thromboembolism, ischemic stroke, or myocardial infarction than their non-transgender counterparts, but this group was rather young and included a relatively small proportion of participants who initiated their hormone therapy during the study.

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Women With History of Preeclampsia or Gestational Hypertension Have Increased Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Jennifer J. Stuart, ScD Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology  Department of Epidemiology Harvard T.H. Chan School of Public Health  Division of Women's Health Brigham and Women's Hospital and Harvard Medical School

Dr. Stuart

Jennifer J. Stuart, ScD
Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Division of Women’s Health
Brigham and Women’s Hospital and Harvard Medical School

 MedicalResearch.com: What is the background for this study?

Response: Preeclampsia and gestational hypertension are common pregnancy complications involving high blood pressure that develops for the first time during pregnancy and returns to normal after delivery. Approximately 10 to 15% of all women who have given birth have a history of either preeclampsia or gestational hypertension. Previous studies have shown that women with a history of high blood pressure in pregnancy are more likely to develop cardiovascular disease events like heart attack and stroke later in life when compared to women with normal blood pressure in pregnancy. However, what is less clear is to what extent these women are more likely to develop chronic hypertension, diabetes, and high cholesterol and when these risk factors begin to emerge after pregnancy.

We examined this question in a cohort of nearly 60,000 American women who we were able to follow for up to 50 years after their first pregnancy. Previous studies have been limited by small numbers, short follow-up, or a lack of information on shared risk factors, such as pre-pregnancy body mass index, smoking, and family history. This research was conducted within the Nurses’ Health Study II, which collected data on these pre-pregnancy factors in tens of thousands of women over several decades.

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Small Renal Cancers: For Select Older Patients, Percutaneous Ablation May Be As Effective and Safer

MedicalResearch.com Interview with:

Adam Talenfeld, M.D Assistant Professor of Radiology Weill Cornell Medical College Assistant Attending Radiologist New York-Presbyterian Hospital. 

Dr. Talenfeld

Adam Talenfeld, M.D
Assistant Professor of Radiology
Weill Cornell Medical College
Assistant Attending Radiologist
New York-Presbyterian Hospital.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy.

Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers.

We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications. Continue reading

Most Patients Who Survive Overdose Do Not Receive FDA Approved Medications for Opioid Use Disorder

MedicalResearch.com Interview with:

Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston University School of Medicine Boston MA

Dr. Larochelle


Marc R. Larochelle, MD, MPH

Assistant Professor of Medicine
Boston University School of Medicine
Boston MD 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this study we examined more than 17,000 individuals who survived an opioid overdose in Massachusetts between 2012 and 2014.

We were interested in identifying how many went on to receive one of the three FDA-approved medications for opioid use disorder (MOUD), and whether or not they were associated with mortality.

We found that only 3 in 10 received MOUD and that receipt of buprenorphine and methadone were associated with 40-60% reduction in all-cause and opioid-related mortality.

We found no association between naltrexone and mortality though the confidence of this conclusion is limited by the small number who received naltrexone in this cohort.

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Long Term HIV Viral Suppression Reduces But Does Not Eliminate Elevated Cancer Risk

MedicalResearch.com Interview with:

Lesley S. Park, PhD, MPH Instructor, Medicine- Primary Care and Population Health BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

Dr. Lesley Park

Lesley S. Park, PhD, MPH
Instructor, Medicine- Primary Care and Population Health
BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship
Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As the population of persons living with HIV/AIDS is aging, the overall burden of cancer is substantial and increasing; however, we have much to learn about the potential cancer prevention benefits of antiretroviral treatment (ART).

Our study is the first to examine the effects of prolonged periods of viral suppression and potential cancer prevention benefits. While prior randomized clinical trials (RCTs) and observational studies have examined viral suppression and cancer risk, they mostly were limited to small numbers of cancer outcomes or were only focused on few specific cancer types.

Our study demonstrated a benefit of the prevention of cancer development in AIDS-defining cancers (non-Hodgkin lymphoma, Kaposi sarcoma), which was expected, but also in some non-AIDS-defining cancer types (lung, larynx, melanoma, leukemia).  Continue reading

Physician MOC Status Linked To Better Diabetes Performance Measure

MedicalResearch.com Interview with:
Bradley Gray, PhD
Senior Health Services Researcher
American Board of Internal Medicine

MedicalResearch.com: What is the background for this study?

Response: This study is part of an ongoing effort to improve and validate ABIM’s MOC process through the use of real data that is ongoing here at ABIM.

MedicalResearch.com: What are the main findings? 

Response: The paper examines the association between MOC status and a set of HEDIS process quality measures for internists twenty years past the time they initially certified. An example of one HEDIS performance measure we looked at was percentage of patients with diabetes that had twice annual HbA1c testing. The key findings of the paper are that physicians who maintained their certification had better scores on 5 of 6 HEDIS performance measures than similar physicians who did not maintain their certification.

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Lack of Dialysis Access for Undocumented Immigrants Stresses Patients and Providers

MedicalResearch.com Interview with:

Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center

Dr. Cervantes

Lilia Cervantes, M.D.
Internal Medicine, Hospitalist
Denver Health and Hospital Authority
Assistant Professor, Division of General Internal Medicine
Founder, Healthcare Interest Program and Health Equity Lecture Series
at Denver Health
University of Colorado Health Sciences Center

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis.

This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  Continue reading

Amyloid Biomarker Predictive of Mortality in Non-STEMI Heart Attack

MedicalResearch.com Interview with:

Prof. Dr. med. Konstantinos Stellos,MD, FAHA, FESC Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle upon Tyne United Kingdom

Prof. Stellos

Prof. Dr. med. Konstantinos Stellos,MD, FAHA, FESC
Cardiovascular Research Centre, Institute of Genetic Medicine
Newcastle upon Tyne
United Kingdom

MedicalResearch.com: What is the background for this study?

 

Response: Risk stratification of patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains a major challenge in clinical cardiology. Risk stratification is important to identify patients at high risk, to whom an early coronary intervention with optimal adjunctive medical therapy shall be applied to reduce that risk. Conversely, it is equally important to identify patients at low risk, to whom a potentially hazardous invasive therapy or a multi-drug administration shall be avoided. Current ACC/AHA and ESC guidelines agree in a standardized approach that uses Global Registry of Acute Coronary Events (GRACE) score, a well validated scoring system, to calculate a patient’s risk and guide triage and management decisions.

Amyloid-β (Aβ) 1-40 and 1-42 peptides (Aβ40 and Aβ42), are proteolytic fragments of a larger protein, the amyloid precursor protein (APP) cleaved by β- and γ-secretases, found in typical brain amyloid deposits in Alzheimer’s disease. Many lines of evidence support a role of Aβ40 in cardiovascular disease as a peptide with pro-inflammatory and pro-thrombotic properties. Most cardiovascular risk factors seem to affect APP metabolism and thus, Aβ production and its soluble circulating APP770 isoform are elevated in patients with ACS_ENREF_15, suggesting a role for Aβ40 in the triggering and outcome of ACS in stable CAD patients. Although vascular inflammation is considered as a hallmark in the pathophysiologic pathways of coronary artery disease (CAD) and novel mechanisms are continuously recognized in its pathogenesis, no inflammatory marker is currently recommended for risk stratification of patients with NSTE-ACS individually or as a component of the GRACE score. This may partly explain the moderate discriminative ability of GRACE score in some studies, especially in older patients and those after early percutaneous coronary intervention (PCI).

In this retrospective study, we used data from two independent prospective cohorts, the Heidelberg study (n=1,145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation, n=734) study and determined the clinical prognostic and reclassification value of baseline circulating Aβ40 levels in the prediction of mortality over the GRACE risk score in patients with NSTE-ACS across a median follow-up of 21.9 ( Heidelberg cohort) and 24.9 months (APACE cohort), respectively.

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Double-Edge Sword of Drug Epidemic

MedicalResearch.com Interview with:
Christine Marie Durand, M.D
.
Assistant Professor of Medicine
Johns Hopkins Medicine 

MedicalResearch.com: What is the background for this study

Response: Most Americans know that the United States faces an epidemic of deaths due to drug overdose.  And many are also aware that there is a critical shortage of organs available for transplant.  Perhaps less widely known is that today, more than 1 in every 8 deceased organ donors died from a drug overdose.  The objective of our study was to look at the outcomes of patients who received transplants with organs donated after an overdose.

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LOUD Outdoor Concerts Lead To Temporary Hearing Loss, esp in Men

Christine Marie Durand, M.D. Assistant Professor of Medicine Johns Hopkins Medicine MedicalResearch.com Interview with:
Dr. Véronique J. C. Kraaijenga
 MD
Department of Otorhinolaryngology–Head and Neck Surgery
Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands


MedicalResearch.com: What is the background for this study?

Response: During the past two decades, the frequency of hearing loss among young people has increased and going to music concerts, clubs and festivals may part of the reason. Noise-induced hearing loss because of recreational noise exposure is reduced by using earplugs.

Our study evaluated 51 adults who attended an outdoor music festival in Amsterdam, the Netherlands, in September 2015. The study measured music festival visit for 4.5 hours (intervention); temporary hearing loss (outcome).

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Since Semi-Automatic Rifles Outlawed, Australia Has Had Zero Mass Shootings

MedicalResearch.com Interview with:

Simon Chapman AO PhD FASSA Hon FFPH (UK) Emeritus Professor in the School Public Health University of Sydney

Prof. Chapman

Simon Chapman AO PhD FASSA Hon FFPH (UK)
Emeritus Professor in the School Public Health
University of Sydney

MedicalResearch.com: What is the background for this study?

Response: Since major gun law reforms in 1996, Australian has seen zero mass shootings (five or more deaths, not including the perpetrator).The law reforms outlawed semi-automatic rifles, those often favored by mass killers.

In the 18 years prior to the reforms, Australia experienced 13 mass shootings. The National Rifle Association and others have suggested that the 22 year absence of mass shootings may simply reflect that these events are rare and statistically unlikely to occur regardless of any policy.

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Hand Osteoarthritis: Hydroxychloroquine No More Effective Than Placebo

MedicalResearch.com Interview with:
Dr Sarah Kingsbury PhD
Osteoarthritis Strategic Lead
Deputy Section Head, Musculoskeletal Medicine and Imaging
Leeds Institute of Rheumatic and Musculoskeletal Medicine
University of Leeds

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoarthritis of the hand is a painful and disabling condition, estimated to effect up to 31 per cent of people aged over 70. It can stop people from carrying out everyday activities and can limit their quality of life. The first-line pharmacological treatments for hand osteoarthritis, including paracetamol and non-steroidal anti-inflammatory drugs, are often not effective and are associated with side effects. Doctors have used hydroxychloroquine, an established treatment for rheumatoid arthritis, as an off-label alternative, supported by increasing evidence that inflammation is a factor in osteoarthritis. Until now, there has not been a large-scale study into whether using hydroxychloroquine works.

HERO was a 12 month randomised, double-blind, placebo controlled, pragmatic trial, designed with a view to replicate anecdotal reports of hydroxychloroquine use in clinical practice, and  powered to detect a moderate effect equivalent to that for NSAIDs in this population. The study involved 248 patients at 13 NHS hospitals in England: all had the condition for at least 5 years, had changes to the joints in their hands consistent with osteoarthritis and reported moderate to severe pain on at least half of the days in the previous three months to the study commencing.

Participants were randomised 1:1 to either hydroxychloroquine or placebo and followed up at 3 monthly intervals for 12 months. The study found that patients initially reported a small reduction in the severity of pain before the improvement plateaued. However, a similar amount of change was seen in both the group receiving hydroxychloroquine medication and the group taking the placebo.

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HOT Tea Raises Risk of Esophageal Cancer

MedicalResearch.com Interview with:
“Hot tea #steam” by Thomas Ricker is licensed under CC BY 2.0Jun / 吕筠

Professor, Department of Epidemiology & Biostatistics
School of Public Health, Peking University Health Science Center
Beijing 100191 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Esophageal cancer (EC) remains a global concern because of its increasing incidence and persistently poor survival. It poses a bigger threat to less developed regions and men.

Tea is one of the most common beverages worldwide and usually consumed at elevated temperature. Existing evidence remains inconclusive as to the association between tea consumption and EC risk. Tea consumers, especially in Chinese men, are more likely to smoke and drink alcohol. Tobacco smoking and alcohol consumption, as well as the chemical compounds and adverse thermal effect of high-temperature tea, considerably complicate the association between tea consumption and esophageal cancer risk.

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What Are The Health Risks To Living Kidney Donors?

Emanuele Di Angelantonio MPhl Department of Public Health and Primary Care School of Clinical Medicine University of Cambridge 

Emanuele Di Angelantonio

MedicalResearch.com Interview with:
Emanuele Di Angelantonio MPhl

Department of Public Health and Primary Care
School of Clinical Medicine
University of Cambridge 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This systematic review supports and expands previous research suggesting that living kidney donors have no increased risk for several major chronic diseases, with the exception of end stage renal disease. Female donors seem to be at increased risk for preeclampsia. Furthermore, there was no evidence that living kidney donors had higher risk for mortality, cardiovascular disease, or type 2 diabetes, or reduced quality of life. –

MedicalResearch.com: What should readers take away from your report?

Response: This study highlights the low but real risks of living kidney donation and emphasise the importance of careful assessment and counseling for all living kidney donors. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: While this systematic review and meta-analysis provide some important answers, the field is still a long way from offering precise risk estimates to prospective donors.  

No disclosures 

Citations:

O’Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, et al. Mid- and Long-Term Health Risks in Living Kidney DonorsA Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 30 January 2018] doi: 10.7326/M17-1235

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Insufficient Evidence To Determine Cardiovascular Risks of Marijuana

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant (Cannabis sativa)

MedicalResearch.com Interview with:
Divya Ravi, MD, MPH

The Wright Center for Graduate Medical Education
Scranton, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is evidence to suggest that Marijuana can bring about changes at the tissue level and has the ability to potentiate vascular disease, in ways similar to tobacco.  With change in legalization and increase usage trends, we conducted this review to examine the known effects of marijuana on cardiovascular outcomes and risk factors, given that cardiovascular disease remains the greatest cause of morbidity and mortality worldwide.

Our review found insufficient evidence to draw meaningful conclusions that marijuana use is associated with cardiovascular risk factors and outcomes. The few studies that suggested a possible benefit from marijuana use, were cross-sectional, and were contradicted by more robust longitudinal studies that reported potential harmful effects.

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Statins: Large Disparity Between US/Canadian/UK and European Guidelines

MedicalResearch.com Interview with:

Borge G. Nordestgaard,

Borge G. Nordestgaard

Børge G. Nordestgaard, MD, DMSc
Department of Clinical Biochemistry
Herlev and Gentofte Hospital, Copenhagen University Hospital
Herlev, Denmark

MedicalResearch.com: What is the background for this study?

Response: Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease  — the American College of Cardiology/American Heart Association (ACC/AHA) in 2013, the United Kingdom’s National Institute for Health and Care Excellence (NICE) in 2014, and in 2016 the Canadian Cardiovascular Society (CCS), the US Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). We applied these five guidelines to a contemporary study cohort of 45,750 40-75 year olds from the Copenhagen General Population Study.

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Viral Vector Delivered Gene Therapy That Reversed Diabetes in Mice

MedicalResearch.com Interview with:
Xiangwei Xiao, M.D., Ph.D.
Assistant Professor of Department of Surgery,
Children’s Hospital of Pittsburgh
University of Pittsburgh School of Medicine,
Pittsburgh, PA

MedicalResearch.com: What is the background for this study?

Response: Diabetes is a prevalent chronic disease characterized by persistently high blood glucose. Diabetes has two main subtypes, type 1 diabetes and type 2 diabetes. In type 1 diabetes, the immune system attacks and destroys insulin-producing beta cells in the pancreas, resulting in high blood levels of glucose. In type 2 diabetes, the beta cells do not produce enough insulin or the body is not able to use insulin effectively.

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Not Clear That Physical Activity Programs Reduce Cognitive Decline

MedicalResearch.com Interview with:
“Exercise” by Diabetes Education Events is licensed under CC BY 2.0
Michelle Brasure, MSPH, PhD, MLIS
Evidence-based Practice Center
School of Public Health
University of Minnesota 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We conducted a large systematic review to assess the evidence relating to interventions to prevent cognitive decline and dementia. We included experimental studies with follow up times of at least six months. This paper analyzes the physical activity interventions; other papers in this issue address other types of interventions.

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