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Annals Internal Medicine, Author Interviews, Heart Disease / 25.02.2015

Andrew Paul DeFilippis, MD, MSc Assistant Professor of Medicine University of Louisville Director, Cardiovascular Disease Prevention Medical Director, Cardiovascular Intensive Care Unit Adjunct Assistant Professor of Medicine Johns Hopkins University of Louisville Jewish Hospital Rudd Heart & Lung Center Louisville, KY MedicalResearch.com Interview with: Andrew Paul DeFilippis, MD, MSc Assistant Professor of Medicine University of Louisville Director, Cardiovascular Disease Prevention Medical Director, Cardiovascular Intensive Care Unit Adjunct Assistant Professor of Medicine Johns Hopkins University of Louisville Jewish Hospital Rudd Heart & Lung Center Louisville, KY Michael Joseph Blaha, MD MPH Director of Clinical Research Ciccarone Center for the Prevention of Heart Disease Assistant Professor of Medicine John HopkinsMichael Joseph Blaha, MD MPH Director of Clinical Research Ciccarone Center for the Prevention of Heart Disease Assistant Professor of Medicine John Hopkins MedicalResearch: What is the background for this study? Response: Atherosclerotic cardiovascular disease is the leading cause of death worldwide. While multiple therapies are available to prevent this common disease, accurate risk assessment is essential to effectively balance the risks and benefits of therapy in primary prevention. For more than a decade, national guidelines have recommended the use of an objective risk assessment tool based on the Framingham Risk Score (FRS) to guide therapy in primary prevention. Recently, the American Heart Association (AHA) and the American College of Cardiology (ACC) developed a new risk score to guide cardiovascular risk-reducing therapy. We had two main objectives in our study: 1) To compare the performance of the new AHA-ACC risk score with four other commonly used risk scores in a MODERN DAY gender balanced multi-ethnic population. 2) To explore how the use of modern day preventive therapy (aspirin, statins, BP meds and revascularization) impact the performance of the AHA-ACC score. MedicalResearch: What are the main findings? Response:  We found that the new AHA-ACC atherosclerotic cardiovascular disease (ASCVD) risk score and three Framingham-based risk scores, all derived from cohorts’ decade’s old, overestimated cardiovascular events by 25 – 115%, while the Reynolds Risk score, derived from more modern cohorts, accurately predicted the overall event rate in a modern, multi-ethnic cohort free of baseline clinical cardiovascular disease. Overestimation was noted throughout the continuum of risk and does not appear to be secondary to missed events or use of preventive therapies. (more…)
Annals Internal Medicine, Author Interviews, Infections / 17.02.2015

Robert M Centor, MD, MACP Chair ACP Board of Regents Regional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801 Professor, General Internal Medicine UAB Birmingham, AL 35294-3407MedicalResearch.com Interview with: Robert M Centor, MD, MACP Chair ACP Board of Regents Regional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801 Professor, General Internal Medicine UAB Birmingham, AL 35294-3407 Medical Research: What is the background for this study? What are the main findings? Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis.  This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess).  The organism also causes around 80% of the Lemierre Syndrome.  We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis.  The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis. (more…)
Annals Internal Medicine, Author Interviews, Lung Cancer, NIH, Radiology / 13.02.2015

MedicalResearch.com Interview with: Paul F. Pinsky, PhD MPH Acting Chief Early Detection Research Group National Cancer Institute Bethesda, MD, 20892 Medical Research: What is the background for this study? What are the main findings? Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial . The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens. (more…)
Annals Internal Medicine, Author Interviews, End of Life Care / 07.02.2015

Adam E. Singer, MPhil, Pardee RAND Graduate School, RAND Corporation Santa Monica, CAMedicalResearch.com Interview with: Adam E. Singer, MPhil Pardee RAND Graduate School, RAND Corporation Santa Monica, CA MedicalResearch: What is the background for this study? What are the main findings? Response: In 1997, the Institute of Medicine (IOM) released a seminal report on the state of end-of-life care in the US that called for major changes in the organization and delivery of end-of-life care. Many of the IOM’s indictments have ostensibly been addressed since that time through the expansion of palliative care and hospice, along with a greater focus on symptom management in both policy and practice. This study was designed to ask whether end-of-life symptoms have become less prevalent from 1998 to 2010 for the population as a whole and also for subgroups that died suddenly or had cancer, congestive heart failure (CHF), chronic lung disease, or frailty. The study found that many alarming symptoms were common in the last year of life and affected more people from 1998 to 2010. For example, in the whole population, pain affected 54% in 1998 and 61% in 2010 (a 12% increase). Depression affected 45% in 1998 and 57% in 2010 (a 27% increase). Periodic confusion affected 41% in 1998 and 54% in 2010 (a 31% increase). Depression and periodic confusion also became more prevalent in subgroups with CHF and/or chronic lung disease and frailty. In addition, nearly all other symptoms in the whole population and in each of the subgroups trended toward increases in prevalence from 1998 to 2010, although most of these trends did not reach statistical significance. The one exception is that there were no significant changes in the subgroup with cancer. (more…)
Annals Internal Medicine, Author Interviews, Supplements / 02.02.2015

MedicalResearch.com Interview with: Emanuele Cereda, MD, PhD Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Federico D’Andrea MD SCDO Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy MedicalResearch: What is the background for this study? What are the main findings? Response: Pressure ulcers (PUs) represent an important indicator of patient safety and quality of care. They negatively affect patient quality of life and increase healthcare costs. PUs are closely linked to malnutrition as it contributes not only to their development but also to impaired healing. It's also a sign of neglect if the patient is in a nursing home so you may want to contact someone like this nursing home neglect lawyer if you are worried that your loved one is being mistreated. Pressure ulcers patients are frequently unable to meet energy requirements through spontaneous feeding and nutritional support becomes essential. International guidelines currently recommend nutritional assessment and nutritional support as most Pressure ulcers patients can take advantage from adequate supply of proteins and calories. Beside, recent studies have suggested that additional provision of larger amount of some nutrients putatively involved in wound healing - arginine, zinc and antioxidants - may be of additional benefit. The OEST study has specifically investigated the role of these nutrients and has demonstrated that supplementation of malnourished Pressure ulcers patients with an oral nutritional formula enriched with arginine, zinc and antioxidants improves Pressure ulcers healing, independently of the adequate supply of proteins and calories. (more…)
Annals Internal Medicine, Author Interviews, Exercise - Fitness, Lifestyle & Health / 20.01.2015

David Alter, MD, PhD FRCPC Senior Scientist Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation InstituteMedicalResearch.com Interview with: David Alter, MD, PhD FRCPC Senior Scientist Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation Institute   Medical Research: What is the background for this study? What are the main findings? Dr. Alter: We knew going into the study that exercise was an important lifestyle factor that improved health. We also knew from studies that sedentary time was associated with deleterious health-effects. What we didn’t know was whether the health-outcome effects of sedentary time and exercise were really one and the same (i.e., albeit opposite ends of the same spectrum) or alternatively, whether the health effects of each were independent of one another.  We explored over 9000 published studies to quantify the health-outcome effects associated with sedentary behaviour and extracted only those which took into account both sedentary time and exercise. We found a consistent association between sedentary time and a host of health outcomes independent of exercise. Specifically, after controlling for an individual’s exercising behaviour, sitting-time was associated with a 15-20% higher risk of death, heart-disease, death from heart disease, cancer-incidence, and death from cancer. Sitting time was also independently  associated with a marked (i.e., 90% increase) in the risk for diabetes after controlling for exercise. In short, sedentary times and exercise are each independently associated with health outcomes. We hypothesize that the two may have different mechanism, and may require different therapeutic strategies. But, the health-outcome implications of both are each important in their own right. (more…)
Annals Internal Medicine, Author Interviews, Colon Cancer, Race/Ethnic Diversity, University of Pennsylvania / 30.12.2014

Jeffrey H. Silber, M.D., Ph.D. The Nancy Abramson Wolfson Endowed Chair in Health Services Research Director, Center for Outcomes Research The Children's Hospital of Philadelphia Professor of Pediatrics, Anesthesiology & Critical Care The Perelman School of Medicine Professor of Health Care Management, The Wharton SchoolMedicalResearch.com Interview with: Jeffrey H. Silber, M.D., Ph.D. The Nancy Abramson Wolfson Endowed Chair in Health Services Research Director, Center for Outcomes Research The Children's Hospital of Philadelphia Professor of Pediatrics, Anesthesiology & Critical Care The Perelman School of Medicine Professor of Health Care Management, The Wharton School The University of Pennsylvania  Philadelphia, PA 19104 Medical Research: What is the background for this study? What are the main findings? Response: Differences in colon cancer survival by race is a well recognized problem among Medicare beneficiaries. We wanted to determine to what extent the racial disparity in survival is due to a racial disparity in presentation characteristics at diagnosis (such as advanced stage and the presence of chronic diseases) versus a disparity in subsequent treatment by surgeons and oncologists. To answer this question, we compared black colon cancer patients to three matched white groups: (1) “Demographics” match controlling age, sex, diagnosis year, and Survey, Epidemiology, and End Results (SEER) site; (2) “Presentation” match controlling demographics plus comorbidities and tumor characteristics including stage and grade; and (3) “Treatment” match including presentation variables plus details of surgery, radiation and chemotherapy. We studied Medicare patients 65 years of age and older diagnosed between 1991-2005 in the SEER-Medicare database. There were 7,677 black patients and 3 sets of 7,677 matched white controls. We found that difference in 5-year survival (black-white) was 9.9% in the demographics match. This disparity remained unchanged between 1991-2005. After matching on presentation characteristics, this difference fell to 4.9%. Finally, after additionally matching on treatment, this same difference hardly changed, moving to only 4.3%. So the disparity in survival attributed to treatment differences comprised only an absolute 0.6% of the overall 9.9% survival disparity. (more…)
Annals Internal Medicine, Author Interviews, Breast Cancer, Radiology / 09.12.2014

Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch.com Interview with:  Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch: What is the background for this study? Dr. Sprague: Mammographic breast density refers to the appearance of breast tissue on a mammogram.  High breast density means that there is a greater amount of glandular tissue and connective tissue, which appears white on a mammogram.  It is more difficult to detect breast cancer on a mammogram when there is greater breast density.  It has also been shown that women with dense breasts are at a higher risk of developing breast cancer.  Because of these two factors, women with dense breasts have a greater chance of developing breast cancer after a normal screening mammogram than women whose breasts are not dense.  Many states have now passed laws that require mammography facilities to inform women with dense breasts so that they are aware of this.  Similar legislation is now under consideration at the national level.  More than 40% of women undergoing mammography screening have dense breasts. Researchers are trying to determine whether supplemental breast cancer screening with other tools would improve outcomes for women with dense breasts.  One possible approach is to use ultrasound imaging to screen for breast cancer in women with dense breasts after they have had a normal mammogram.  We wanted to estimate the benefits, harms, and cost-effectiveness of this approach compared to mammography screening only.  No randomized trials or observational studies have assessed long term outcomes after ultrasound screening for women with dense breasts, but we have short term data on how often cancer is diagnosed by ultrasound screening and how often false positive exams occur.  We used computer simulation modeling to estimate long term outcomes by combining the currently available data on mammography and ultrasound screening with the best available data on breast cancer risk and survival. (more…)
Annals Internal Medicine, Author Interviews, Hospital Readmissions / 02.12.2014

Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705MedicalResearch.com Interview with: Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kind: By way of background: Socioeconomic disadvantage is a complex theoretical concept which describes the state of being challenged by low income, limited education and substandard living conditions for both the person and his or her neighborhood or social network. It is plausible that disadvantage would influence rehospitalization because vulnerable patients depend upon their neighborhood supports for stability, generally, and these needs are likely to be increased after a hospitalization. Yet, it is difficult to assess socioeconomic disadvantage during clinical encounters, yet the ADI provides an option for beginning such a discussion. ADI or Area Deprivation Index is a composite measure of neighborhood disadvantage, similar to other geographic measures of disadvantage employed in other countries for resource planning and health policy development. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, McGill / 18.11.2014

MedicalResearch.com Interview with: Todd Lee MD MPH FRCPC Consultant in Internal Medicine and Infectious Diseases Assistant Professor of Medicine, McGill University Director, General Internal Medicine Consultation Service, Chief of Service, 6 Medical Clinical Teaching Unit, McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs.  Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use.  Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy.  Sometimes this means that no antibiotics should be given. In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions. Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship".  This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist.  These audits were performed by our senior resident physicians in the context of providing their routine clinical care.  We also provided local antibiotic guidelines and regular educational sessions once a rotation. We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority.  We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested. Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, NIH / 05.11.2014

MedicalResearch.com Interview with: Anita Kohli, MS, MD Clinician Investigator, Clinical Monitoring Research Program (CMRP) Leidos Biomedical Research, Inc. formerly SAIC-Frederick, Inc. National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Dr. Kohli: We previously treated 60 patients with sofosbuvir and ribavirin for 24 weeks. Patients who relapsed after treatment were offered re-treatment with another regimen of directly acting antivirals alone. 13 patients who relapsed were treated with sofosbuvir and ledipasvir for 12 weeks. All patients achieved SVR12. This is the first report of re-treating patients who failed a regimen including sofosbuvir with another regimen incorporating this same antiviral. (more…)
Annals Internal Medicine, Author Interviews, Ebola, Yale / 30.10.2014

Dr. Dan YasminMedicalResearch.com Interview with: Dan Yamin PhD Postdoctoral Associate Yale School of Public Health New Haven, CT 06520   Medical Research: What is the background for this study? Dr. Yamin: With limited resources, West Africa is currently overwhelmed by the most devastating Ebola epidemic known to date. In our research, we seek to address two questions:
  • 1) who is mostly responsible for transmission? and 2) what intervention programs should be applied to contain the current Ebola outbreak?
(more…)
Annals Internal Medicine, Author Interviews, Heart Disease / 10.10.2014

Joseph A. Ladapo, MD, PhD New York University School of Medicine Department of Population Health New York, NY 10016MedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD New York University School of Medicine Department of Population Health New York, NY 10016 Medical Research: What are the main findings of the study? Dr. Ladapo: We showed that the use of cardiac stress testing has risen briskly over the past two decades, with the use of imaging growing particularly rapidly. We also showed that national growth in cardiac stress test use can largely be explained by population and provider characteristics, but the use of imaging cannot. Importantly, nearly one third of cardiac stress tests with imaging tests were probably inappropriate, because they were performed in patients who rarely benefit from imaging. These tests--about 1 million each year--are associated with about half a billion dollars in healthcare costs annually and lead to about 500 people developing cancer in their lifetime because of radiation they received during that cardiac stress test. (more…)
Annals Internal Medicine, Author Interviews, Pain Research / 16.09.2014

Gert Bronfort, DC, PhD Professor, Integrative Health and Wellbeing Research Program Center for Spirituality & Healing University of MinnesotaMedicalResearch.com Interview with: Gert Bronfort, DC, PhD Professor, Integrative Health and Wellbeing Research Program Center for Spirituality & Healing University of Minnesota Medical Research: What are the main findings of the study? Were any of the findings unexpected? Dr. Bronfort: Our study found that spinal manipulative therapy  SMT coupled with home exercise and advice (HEA) appears to be helpful compared to home exercise and advice alone (especially in the short term) for patients with sub-acute and chronic back-related leg pain (BRLP). BRLP was defined as radiating pain originating from the lumbar spine, which travels into the proximal or distal lower extremity, with or without neurological signs. Patients with progressive neurological deficits, cauda equina syndrome, spinal fracture, and other potentially serious causes of BRLP (and often candidates for surgery) were EXCLUDED. There were a few things we did find to be quite interesting. First, it is notable that the spinal manipulative therapy & home exercise and advice group experienced less self-reported medication use after one year than the  home exercise and advice alone group (SMT&HEA was 2.6 times more likely to experience fewer medication days than HEA alone at 1 year). Given the growing concerns of overuse of pain medications (and the potential for adverse events and addiction), this is a finding that has important public health consequence. Another interesting and important finding is that the adverse events observed in this study were only mild to moderate and self-limiting. No serious adverse events occurred that were related to the study interventions. Mild to moderate adverse events (e.g. temporary aggravation of pain, muscle soreness, etc.) were reported by 30% of the patients in the SMT&HEA group, and 42% in the HEA group. This is important as few studies have systematically recorded the side effects and adverse events related to SMT&HEA and HEA alone; this is one of the first, larger clinical trials to do so. These findings are especially notable because SMT is often not recommended for patients with leg symptoms because of safety concerns (which might be related to the previous absence of robust scientific data to support its use). Finally, while an advantage of SMT& HEA versus HEA was found (especially in the short term), we do find the findings of the HEA alone group to also be of interest. Almost half of the HEA patients experienced a 50% reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks). That’s an important improvement and warrants future investigation. Self-management strategies (like home exercise) that emphasize the importance of movement and fitness, restoration of normal activities, and allow patients to care for themselves embrace important principles for promoting overall health and wellbeing that could have a big impact if routinely put into practice. (more…)
Annals Internal Medicine, Author Interviews, Orthopedics, UCLA / 09.09.2014

Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles UCLA Medicine/GIM Los Angeles, CA 90024MedicalResearch.com Interview with: Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles   Medical Research: What are the main findings of the study? Dr. Crandall: 1.        We found high-strength evidence that several medications decrease fracture risk when used by persons with bone density in the osteoporotic range and/or with pre-existing hip or vertebral fracture.  While many of the medications (alendronate, risedronate, zoledronic acid, ibandronate, denosumab, teriparatide, and raloxifene) reduce vertebral fractures, a reduction in the risk of hip fracture is not demonstrated for all of the medications.  In particular, hip fracture reduction is only demonstrated for alendronate, risedronate, zoledronic acid, and denosumab.  Unfortunately, due to a lack of head-to-head trials, the comparative effectiveness of the medications is unclear. 2.       The adverse effects of the medications vary.  For example, raloxifene is associated with an increased risk of thromboembolic events, whereas denosumab and the bisphosphonate medications have been associated with increased risk of osteonecrosis of the jaw and atypical subtrochanteric femoral fractures. (more…)
Annals Internal Medicine, Author Interviews, Diabetes / 04.09.2014

Andy Menke PhD Department of Epidemiology, Tulane University School of Medicine New Orleans, LouisianaMedicalResearch.com Interview with Andy Menke PhD Department of Epidemiology, Tulane University School of Medicine New Orleans, Louisiana Medical Research: What are the main findings of the study? Dr. Menke: The prevalence of diabetes increased more in men than women between 1976 and 2010 in the US, from 4.7% to 11.2% in men and from 5.7% to 8.7% in women. Changes over time in the distribution of age, race/ethnicity, and obesity in the population explained all of the increase in women and only half of the increase in men. (more…)
Annals Internal Medicine, Author Interviews, Weight Research / 02.09.2014

MedicalResearch.com Interview with: Tian Hu, MD, MS Research Fellow ​Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112 Medical Research: What are the main findings of the study? Dr. Hu: Participants on the low-carbohydrate diet lost more weight than those on the low-fat diet at 3, 6, and 12 months. At 12 months, those in the low-carbohydrate group lost an average of almost 8 pounds more than those in the low-fat group. Participants on the low-carbohydrate diet lost more fat mass and did not lose lean mass (muscle) compared to those on the low-fat diet. Overall, bad cholesterol (low-density lipoprotein cholesterol) that is a predictor of risk for cardiovascular disease decreased on both diets, but good cholesterol (high-density lipoprotein cholesterol) increased more in the low-carbohydrate group. Physical activity was similar in the groups throughout the study, suggesting that the greater weight loss among participants in the low-carbohydrate group was not because they exercised more. When we evaluated the black and white participants separately, the results were similar. (more…)
Annals Internal Medicine, Author Interviews, Colon Cancer, Erasmus / 18.08.2014

Frank van Hees, MSc Researcher, Department of Public Health, Erasmus MC Rotterdam, The NetherlandsMedicalResearch.com Interview with: Frank van Hees, MSc Researcher, Department of Public Health, Erasmus MC Rotterdam, The Netherlands Medical Research:   What are the main findings of the study? Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Menopause / 03.08.2014

S. Mitchell Harman, M.D., Ph.D. CAPT US Public Health Service, retired Professor, Clinical Medicine, U of AZ College of Medicine Interim Chief, Dept. of Internal Medicine Chair, IRB Subcommitee Phoenix VA Health Care System Phoenix, AZ 85012-1892MedicalResearch.com Interview with: S. Mitchell Harman, M.D., Ph.D. CAPT US Public Health Service, retired Professor, Clinical Medicine, U of AZ College of Medicine Interim Chief, Dept. of Internal Medicine Chair, IRB Subcommitee Phoenix VA Health Care System Phoenix, AZ 85012-1892 Medical Research: What are the main findings of the study? Dr. Harman: The major findings are: 1.       Neither transdermal nor oral estrogen treatment significantly accelerates or decelerates rate of change of carotid artery intimal medial thickness (CIMT) in healthy recently menopausal women. 2.       Both estrogen treatments have some potentially beneficial effects on markers of CVD risk, but these differ depending on the route of estrogen delivery with improvements in LDL and HDL cholesterol seen with oral, and reduced insulin resistance with transdermal. 3.       No significant effects were observed on rate of accumulation of coronary artery calcium. 4.       Women reported significant relief of vasomotor (hot flush) symptoms with both estrogen treatments (more…)
Annals Internal Medicine, Author Interviews, Herpes Viruses, HIV / 01.07.2014

Connie Celum, MD, MPH Professor of Global Health and Medicine Director, International Clinical Research Center University of Washington Harborview Medical Center Seattle WA 98104MedicalResearch.com: Interview with Connie Celum, MD, MPH Professor of Global Health and Medicine Director, International Clinical Research Center University of Washington Harborview Medical Center Seattle WA  98104 MedicalResearch: What are the main findings of the study? Dr. Celum: We conducted a randomized, double blind study of daily oral tenofovir and tenofovir combined with emtricitabine (FTC) as oral pre-exposure prophylaxis (PrEP) for HIV among HIV serodiscordant couples (in which onepartner had HIV and the other partner did not) in Kenya and Uganda. Because of recent studies showing that tenofovir gel could reduce the chances of becoming HSV-2 infected, we studied the subset of HIV-uninfected partners who did not have HSV-2 and compared the rates who became HSV-2 infected during follow-up among those  who received oral pre-exposure prophylaxis versus those who received placebo.  We found that oral pre-exposure prophylaxis reduced HSV-2 acquisition by 30%. (more…)
Annals Internal Medicine, Author Interviews, Electronic Records, Outcomes & Safety / 05.06.2014

Lisa M. Kern, MD, MPH, FACP Associate Professor of Healthcare Policy and Research and of Medicine Associate Director for Research, Center for Healthcare Informatics and Policy Deputy Director, Health Information Technology Evaluation Collaborative Weill Cornell Medical College New York, NY 10065MedicalResearch.com Interview with: Lisa M. Kern, MD, MPH, FACP Associate Professor of Healthcare Policy and Research and of Medicine Associate Director for Research, Center for Healthcare Informatics and Policy Deputy Director, Health Information Technology Evaluation Collaborative Weill Cornell Medical College New York, NY 10065 MedicalResearch: What are the main findings of the study? Dr. Kern: We found that primary care physicians participating in Patient-Centered Medical Homes (PCMHs) improved their quality of care over time at a significantly higher rate than their non-PCMH peers. (more…)
Annals Internal Medicine, General Medicine, Hospital Readmissions / 04.06.2014

Cindy Feltner, MD, MPH Assistant Professor, Division of General Medicine University of North Carolina--Chapel Hill RTI- UNC Evidence-based Practice CenterMedicalResearch.com Interview with: Cindy Feltner, MD, MPH Assistant Professor, Division of General Medicine University of North Carolina--Chapel Hill RTI- UNC Evidence-based Practice Center MedicalResearch: What are the main findings of the study? Dr. Feltner: We conducted a systematic review and meta-analysis to assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with heart failure. We included a broad range of intervention types applicable to adults transitioning from hospital to home that aimed to prevent readmissions. Although 30-day readmissions are the focus of quality measures, we also included readmissions measured over 3 to 6 months because these are common, costly, and potentially preventable. Forty-seven trials were included, most enrolled adults with moderate to severe heart failure and a mean age of 70 years. We found that interventions providing multiple home visits soon after hospital discharge can reduce 30-day readmission rates. Both home-visiting programs and multidisciplinary heart failure clinics visits can improve mortality and reduce all-cause readmission in the six months after hospitalization. Telephone support interventions do not appear to reduce all-cause readmission, but can improve survival and reduce readmission related to heart failure. Programs focused on telemonitoring or providing education only did not appear to reduce readmission or improve survival. (more…)
Annals Internal Medicine, Author Interviews, Colon Cancer, Erasmus, Sloan Kettering / 03.06.2014

MedicalResearch.com Interview with: Frank van Hees MSc Erasmus University Medical Center Rotterdam, the Netherlands and Ann G. Zauber PhD Memorial Sloan Kettering Cancer Center, New York MedicalResearch: What are the main findings of the study? Answer: The main finding of our study is that colorectal cancer screening of individuals without previous screening is worthwhile well beyond age 75, which is the recommended age to stop screening in individuals with an adequate screening history. The exact age up to which screening should be considered in unscreened elderly depends on an individual's health status: in healthy individuals screening remains worthwhile up to age 86, whereas in individuals with a severe illness, such as heart failure, screening remains worthwhile up to age 80. (more…)
Annals Internal Medicine, Author Interviews, Cancer Research, University of Pittsburgh / 30.05.2014

Yael Schenker, MD, MAS Assistant Professor Division of General Internal Medicine Section of Palliative Care and Medical Ethics University of Pittsburgh Pittsburgh, PA 15213 MedicalResearch.com Interview with: Yael Schenker, MD, MAS Assistant Professor Division of General Internal Medicine Section of Palliative Care and Medical Ethics University of Pittsburgh Pittsburgh, PA  15213 MedicalResearch: What are the main findings of the study?  Dr. Schenker: We analyzed the content of cancer center advertisements placed in top TV and magazine media markets in 2012.  Out of 1427 advertisements that met our initial search criteria, we found 409 unique advertisements that promoted clinical services at 102 cancer centers across the country.  These advertisements promoted cancer treatments (88%) more often than cancer screening (18%) or supportive services (13%).  Provision of information about clinical services was scant. For example, 27% of advertisements mentioned a benefit of advertised services and 2% quantified these benefits.  2% mentioned a risk of advertised services and no advertisements quantified these risks.  5% mentioned costs or insurance coverage and no advertisements mentioned availability under specific insurance plans.  In contrast, use of emotional appeals was frequent (85%).  Emotional appeals commonly evoked hope for survival, focused on treatment advances, used fighting language, and/or evoked fear.  Nearly half of all advertisements included patient testimonials, overwhelmingly focused on stories about survival or cure.  Only 15% of testimonials included a disclaimer (for example, “most patients do not experience these results”) and none described the outcome that a typical patient may expect. (more…)
Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, OBGYNE, Vaccine Studies / 29.05.2014

Ai Kubo, MPH PhD Kaiser Permanente Division of Research 2000 Broadway Oakland, CA 94612MedicalResearch.com Interview with: Ai Kubo, MPH PhD Kaiser Permanente Division of Research 2000 Broadway Oakland, CA 94612 MedicalResearch: What are the main findings of the study? Dr. Kubo: The main findings of the study are three folds: 1)  The CDC guideline works for the majority of infants in preventing vertical transmission, if the immunizations are done according to the recommended schedule. 2) It takes an organized effort to case-manage each mother-infant pairs in order to achieve almost complete immunization rates and very low transmission rates. 3) Highest risk group was mothers with extremely high viral load and e-antigen positivity.  This group of women may benefit from additional therapy to prevent the vertical transmission. However, for others, the risk of transmission is extremely low as long as the infants are immunized according to the guideline. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, Health Care Systems / 07.05.2014

MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard School of Public Health / Brigham & Women's Hospital Boston, MA 02115MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard School of Public Health / Brigham & Women's Hospital Boston, MA 02115   MedicalResearch.com: What are the main findings of the study? Dr. Sommers: We find that over the first four years since Massachusetts' 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period.  We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health.  Overall, we estimate that the health reform law prevented over 320 deaths per year in the state - or one life saved per 830 adults gaining health insurance.  Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease.  We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities. (more…)
Annals Internal Medicine, Author Interviews / 14.04.2014

Sharon K. Inouye, MD, MPH Professor of Medicine, Harvard Medical School Director, Aging Brain Center, Institute for Aging Research Hebrew SeniorLife both in Boston, MAMedicalResearch.com Interview with: Sharon K. Inouye, MD, MPH Professor of Medicine, Harvard Medical School Director, Aging Brain Center, Institute for Aging Research Hebrew SeniorLife both in Boston, MA Study Co- Authors Cyrus Kosar, Douglas Tommet, Eva Schmitt, Margaret Puelle, Jane Saczynski, Edward Marcantonio and Richard Jones.  MedicalResearch.com: What are the main findings of the study?  Dr. Inouye: In this study, we developed and validated a new scoring system for delirium severity.  Delirium (acute confusional state) is a common and morbid complication of hospitalization for older persons, which often goes undetected.  Our new scoring system indicates that the severity of delirium is directly related to hospital outcomes, such as length of stay, nursing home placement, death, and healthcare costs. (more…)
Annals Internal Medicine, Author Interviews, Compliance, Cost of Health Care, McGill, Pharmacology / 09.04.2014

Robyn Tamblyn BScN Msc PhD James McGill Chair Departments of Medicine and Epidemiology and Biostatistics McGill University Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research MedicalResearch.com Interview with: Robyn Tamblyn BScN Msc PhD James McGill Chair Departments of Medicine and Epidemiology and Biostatistics McGill University and Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research MedicalResearch.com: What are the main findings of the study? Dr. Tamblyn: Higher drug costs are associated with a higher probability of primary non-adherence, whereas better follow-up by the prescribing physician, and a policy to provide medication at no cost for the very poor increase the likelihood of adherence (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Lipids, Nutrition / 17.03.2014

Rajiv Chowdhury MD, PhD Cardiovascular Epidemiologist Department of Public Health and Primary Care University of CambridgeMedicalResearch.com Interview with: Rajiv Chowdhury MD, PhD Cardiovascular Epidemiologist Department of Public Health and Primary Care University of Cambridge MedicalResearch.com: What are the main findings of the study? Dr. Chowdhury: Total saturated fatty acid, whether measured as a dietary intake variable or in the bloodstream as a biomarker, was not associated with coronary disease risk in combining all available prospective observational studies. Similarly, there were non-significant overall associations in the prospective studies that involved assessments of total monounsaturated fatty acids, long-chain omega-3 and omega-6 polyunsaturated fatty acids. However, we found diversity in the observational associations between specific circulating long-chain omega-3 and omega-6 fatty acids with coronary risk, with some evidence that circulating levels of eicosapentaenoic and docosahexaenoic acids (ie, the two main types of long-chain omega-3 polyunsaturated fatty acids), and arachidonic acid are each associated with lower coronary risk. Similarly, within saturated fatty acids, there were positive, however, non-significant associations observed for circulating blood composition of palmitic and stearic acids (found largely in palm oil and animal fats, respectively), whereas circulating margaric acid (a milk fat) had a significant inverse association. Additionally, when we investigated the randomised controlled trials that reported on the effects of omega-3 and omega-6 fatty acids on reducing coronary outcomes, there was no significant overall association observed. (more…)