BMJ
13 Feb COPD: Editorial Regarding Earlier Diagnosis by Primary Care
MedicalResearch.com: Interview with:
Professor Chris van Weel
Emeritus Professor of Family Medicine/General Practice
Radboud University Nijmegen, The Netherlands
Professor of Primary Health Care Research, Australian National University, Canberra
Background from Professor Chris van Weel
Thank you for the opportunity to respond to your questions. My paper was a commentary to the study of Jones and colleagues, Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort looking at the implications of the study findings.
MedicalResearch.com: What are the main findings of the study?
Answer: Jones and colleagues reported that in the UK, there are many missed opportunities to diagnose COPD. My comments are that this is not a unique UK problem, but a universal one: under-diagnosis or late diagnosis of COPD is a universal problem in most if not all countries in the world.
To understand it, it is important to analyse more in-depth the diagnostic challenge in primary care, for general practitioners(GP)/family physicians (FP). The paper of Jones highlights this diagnostic problem - symptoms of COPD are initially insidious and may fluctuate over time. And from my earlier research it is also clear that patients 'adept' their daily activities (less physical activities) and therefore may underplay or even become unaware of, their symptoms.
At the same time, this is a problem for the physician, when encountering these symptoms. As I highlighted in my commentary, GPs/FPs have to pay attention to other possible diseases that might cause these symptoms: pneumonia, heart failure, lung cancer. The 'low key symptoms' and the need of applying a broad diagnostic scope together cause what Jones and his colleagues called the 'missed opportunities' to diagnose COPD.
13 Feb Annual Mammograms Did Not Save Lives in 25 Year Study
MedicalResearch.com Interview with:
Anthony Miller, MD
Director, Canadian National Breast Screening Study
Professor Emeritus, Dalla Lana School of Public Health
University of Toronto
MedicalResearch.com: What are the main findings of the study?
Prof. Miller: The study involved 89,835 women aged 40 to 59. All underwent an annual physical breast examination, while half were randomly assigned to undergo annual mammograms for five years, beginning in 1980.
During the five-year screening period, 666 invasive breast cancers were diagnosed in the mammography arm and 524 in the controls. Over the 25 year follow-up 180 women in the mammography arm and 171 women in the control arm died of breast cancer. The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 (95% CI: 0.85 – 1.30). The findings for women aged 40-49 and aged 50-59 were almost identical.
After 15 years of follow-up an excess of 106 cancers was observed in the mammography arm, attributable to over-diagnosis, i.e. 22% of screen-detected invasive breast cancers, half of those detected by mammography alone. This represents one over-diagnosed breast cancer for every 424 women screened by mammography.
By 2005, 3,250 of the 44,925 women in the mammography arm of the study were diagnosed with breast cancer, and 500 had died of it. The control group of 44,910 women had 3,133 breast cancer diagnoses and 505 breast cancer deaths.
We conclude that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.
13 Feb EHR: Electronic Health Records and Cost Challenges to Implementation
MedicalResearch.com Interview with;
Dr Sarah Slight, School of Medicine
Pharmacy and Health, Wolfson Research Institute
University of Durham, United Kingdom.
MedicalResearch.com: What are the main findings of the study?
Dr. Slight: Our study identified four main cost categories associated with the implementation of EHR systems, namely: infrastructure (e.g., hardware and software), personnel (e.g., project management and training teams), estates / facilities (e.g., furniture and fittings), and other (e.g., consumables and training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure, diverse training approaches for staff, and different software applications to integrate with the new system.
13 Feb Tobacco Appeal Would Be Reduced By Standarized Packaging
MedicalResearch.com Interview with:
Dr Jenny L Hatchard
University of Bath and UK Centre for Tobacco and Alcohol Studies
MedicalResearch.com: What are the main findings of the study?
Dr. Hatchard: Our study found that global tobacco companies’ claims that standardised packaging ‘won’t work’ should be viewed sceptically.
The aim of standardised packaging, with no logos, brand imagery, symbols, or promotional text, is to restrict the already limited opportunities that tobacco companies have to market their products, and deter people from starting smoking. It was introduced in Australia in 2012 and the UK Government is currently considering following suit.
We analysed the evidence cited by four global tobacco companies in their lengthy responses (1521 pages in total) to a recent UK Government consultation on standardised packaging for cigarettes.
13 Feb Acupuncture Needles May Have Quality Control Issues
MedicalResearch.com Interview with:
Professor Yi Min Xie, FTSE, FIEAust
Director, Centre for Innovative Structures and Materials
Deputy Head of School, Research & Innovation
School of Civil, Environmental and Chemical Engineering
Royal Melbourne Institute of Technology (RMIT University)
Melbourne 3001, Victoria Australia
MedicalResearch.com: What are the main findings of the study?
Professor Yi Min Xie: This study examined acupuncture needles of two of the most popular brands in the world. Significant surface irregularities and defects at needle tips were found, especially of needles from one of the two brands. The main conclusion of the study was that acupuncture needle manufacturers, including the well established ones, should review and improve their quality control procedures for the fabrication of acupuncture needles.
05 Feb Most Drugs Have Ingredients That Come From Animals
MedicalResearch.com Interview with: Kinesh Patel, Research Fellow Wolfson Unit for Endoscopy St Mark’s Hospital, Harrow HA1 3UJ, UK MedicalResearch.com: What are the main findings of the study? Dr. Patel: Most drugs prescribed in primary care have ingredients that come from animals, but the animals they come from is not always clear and whether the drugs are suitable for vegetarians is difficult to find out conclusively, even after looking at information available on packets, information leaflets and on the internet.26 Jan Total Hip Replacements: Failure rate of Cemented vs Uncemented
MedicalResearch.com Interview with: Keijo T Mäkelä Associate professor Department of Orthopaedics and Traumatology Turku University Hospital, Rauhankatu Turku, FI-20100, Finland MedicalResearch.com: What are the main findings of the study? Answer: • The implant survival of cemented total hip replacement was higher than that of uncemented total hip replacement in patients aged 65 years and older in our multinational register study with a comprehensive patient population. • The proportion of uncemented total hip replacement is rapidly increasing in Nordic countries. The increased use of uncemented total hip replacement group is not supported by these data.25 Jan Hormone Replacement Therapy Found Protective of Hip, Knee Joint Replacements
MedicalResearch.com Interview with:
Professor Nigel Arden
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
Botnar Research Centre
Oxford OX3 7LD
MedicalResearch.com: What are the main findings of the study?
Professor Arden: We found that in a cohort of women who had used hormone replacement therapy (HRT) and underwent knee or hip replacement their risk of implant revision was reduced by about 40% compared to non-users of HRT.
22 Jan Bereavement During Pregnancy, Early Childhood and Psychosis Risk
MedicalResearch.com Interview with: Prof. Kathryn M Abel Professor of Psychiatry & Honorary Consultant Psychiatrist University of Manchester and Honorary Senior Lecturer at the Institute of Psychiatry, London. MedicalResearch.com: What are the main findings of the study? Answer: The main study findings were that exposure of a mother to a severe psychological stress of losing a close family member up to either 6 months before conception or at any time during pregnancy did not increase risk of subsequent psychotic illness in the offspring. Secondly, we found during childhood, if a close family member died then, especially a sibling of the child or one of their parents, these children were at slightly increased risk of developing a psychotic illness later in life. This was most likely to happen following a sudden death especially suicide and in particular following suicide a psychotic mood disorder was more likely than other kinds of psychosis such as schizophrenia (although the risk of schizophrenia was also increased following suicide). This effect was not accounted for by having a family history of a psychotic illness or suicide.16 Jan SSRIs During Late Pregnacy and Infant Pulmonary Hypertension
MedicalResearch.com Interview with:
Sophie Grigoriadis, MD, MA, PhD, FRCPC
Head, Women's Mood and Anxiety Clinic: Reproductive Transitions,
Fellowship Director, Sunnybrook Health Sciences Centre,
Scientist, Sunnybrook Research Institute
Adjunct Scientist, Women's College Research Institute,
Associate Professor, Faculty of Medicine, University of Toronto
MedicalResearch.com: What are the main findings of the study?
Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy (but not early) are at risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains high in the lungs following birth and which results in breathing difficulties. The symptoms can range from mild to severe, but the condition can be managed successfully typically after SSRI exposure. It is important to note that the baseline risk for PPHN in the general population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy (increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to 351 women would have to be treated with an SSRI during late pregnancy in order to result in 1 additional case of PPHN.
16 Jan Adverse Events Reporting: Room for Improvement
MedicalResearch.com Interview with:
Sunita Vohra MD MSc FRCPC FCAHS
Director, CARE Program
Director, PedCAM Network, AIHS Health Scholar
Professor, Dept of Pediatrics Faculty of Medicine & Dentistry
University of Alberta
Edmonton Continuing Care Centre, Edmonton, Alberta Canada
MedicalResearch.com: What are the main findings of the study?
Dr. Vohra: Our main findings were: (i) relative to how often systematic reviews
evaluate the effectiveness of health interventions, the systematic review
of harms is quite neglected; and (ii) even when systematic reviews do aim
to evaluate harms, there is considerable room for improvement in reporting.
15 Jan Dietary Fiber Intake and Cardiovascular Risk
MedicalResearch.com Interview with:
Prof. Victoria J Burley
Senior Lecturer in Nutritional Epidemiology
School of Food Science and Nutrition
University of Leeds
Biostatistics, University of Leeds, UK
MedicalResearch.com: What are the main findings of the study?
Prof. Burley: Although it’s been suggested for a long time that foods rich in dietary fiber may protect individuals from having a heart attack or stroke because they lower some of the risk factors for these diseases, trying to determine how much dietary fibre might be beneficial and whether these benefits are apparent in all populations around the world has been less easy to research. Our research at the University of Leeds has pooled the results of published large-scale follow-up studies and has demonstrated a consistent lowering of risk of cardiovascular and coronary heart disease with increasing dietary fiber intake. This dose-response trend suggests that even small additional increments in intake may be beneficial in the long term.
31 Dec Hospital Readmissions: Many Caused by Co-Morbid Diseases, Infections
Posted at 11:23h
in Author Interviews, BMJ, Brigham & Women's - Harvard, Hospital Readmissions, Medical Research Centers
MedicalResearch.com Interview with:
Dr. Jacques Donzé MD PhD
Research Associate
Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital
Harvard Medical School, Boston, MA 02115,
MedicalResearch.com: What are the main findings of the study?
Dr. Donzé: In a large retrospective cohort study, we identified the primary diagnoses of 30-day potentially avoidable readmissions in medical patients according to the most common comorbidities. Interestingly, almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. Patients with cancer, heart failure, and chronic kidney disease had a significantly higher risk of potentially avoidable readmission than those without those comorbidities. Also, when readmitted, patients with chronic kidney disease had a 20% higher risk of having the readmission be potentially avoidable.
06 Dec Probiotics Ineffective in Preventing Childhood Asthma
MedicalResearch.com Interview with:
Dr. Meghan Azad, PhD
Banting Postdoctoral Fellow
Department of Pediatrics
University of Alberta
MedicalResearch.com: What are the main findings of the study?
Dr. Azad: In this study, our goal was to evaluate the clinical evidence for using probiotics (live "healthy bacteria") to prevent childhood asthma. We reviewed the results of 20 clinical trials involving over 4000 infants, where probiotics were administered during pregnancy or the first year of life, and found no evidence to support the use of probiotics for asthma prevention. Children receiving probiotics were just as likely to develop asthma as children receiving placebo. Similarly, there was no effect of probiotic supplementation on the development of wheezing.
24 Nov Venous Thromboembolism: Risk of First Blood Clots in Hospitalized Pregancy Women
MedicalResearch.com Interview with: Alyshah Abdul Sultan, doctorate student Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, Nottingham NG5 1PB, UK MedicalResearch.com: What are the main findings of the study? Answer: Overall, we found that hospitalisation during pregnancy was associated with an excess risk of 16.6 cases per 1,000 person-years compared with time outside hospital (17.5-fold increase in risk). There was also an excess risk of 5.8 cases per 1,000 person years in the 28 days after discharge with VTE events more likely to occur in the third trimester of pregnancy and in women aged 35 years and over.21 Nov Hospital Readmissions: Best US Hospitals Reduce Globally
MedicalResearch.com Interview with:
Kumar Dharmarajan MD MBA
Fellow in Cardiovascular Medicine
Columbia University Medical Center
MedicalResearch.com: What were the main findings of the study
Dr. Dharmarajan: In the United States, 1 in 5 older patients is readmitted to the
hospital within 30 days of hospital discharge. However, there is great
variation in rates of 30-day readmission across hospitals, and we do
not know why some hospitals are able to achieve much lower readmission
rates than others.
We therefore wondered whether top performing hospitals with low 30-day
readmission rates are systematically better at preventing readmissions
from particular conditions or time periods after discharge. For
example, are hospitals with low 30-day readmission rates after
hospitalization for heart failure especially good at preventing
readmissions due to recurrent heart failure or possible complications
of treatment? Similarly, are top performing hospitals especially good
at preventing readmissions that occur very soon after discharge, which
may signify poor transitional care as the patient moves form the
hospital back home?
04 Nov Non-Publication of Medical Research Remains an Issue
MedicalResearch.com Interview with:
Dr. Christopher Jones MD
Attending Physician
Department of Emergency Medicine,
Cooper Medical School of Rowan University
One Cooper Plaza, Camden, NJ 08103, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Jones: We identified a group of 585 clinical trials with at least 500 participants which had been prospectively registered with ClinicalTrials.gov and completed prior to 2009. Following an extensive search of the medical literature, we were unable to identify published manuscripts for 171 (29%) of these studies. For these unpublished studies we also determined whether results were available in the ClinicalTrials.gov results database, and we found that 133 studies had no results available either in the published literature or on ClinicalTrials.gov.
02 Nov How much would Sugary Drink Tax Reduce Obesity?
MedicalResearch.com Interview with: Adam D M Briggs Academic Clinical Fellow British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK MedicalResearch.com: What are the main findings of the study? Answer: For the first time this study estimates the impact of a sugary drinks tax in the UK on obesity. We estimate the tax would reduce the number of adults with obesity by around 180,000 or just over 1% of all adults who are obese, and the number of adults who are either overweight or obese by 285,000. The greatest reductions are seen in young adults. We also estimate that the effects of the tax will be similar across all income groups.02 Nov Diabetes: Renoprotective Effects of ACE Inhibitors
MedicalResearch.com Interview with: Hon-Yen Wu, Lecturer Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan MedicalResearch.com: What are the main findings...
18 Oct Antipsychotics: Financial Incentives to Improve Medication Adherence
MedicalResearch.com Interview with
Professor Stefan Priebe, Dipl.-Psych., Dr. med. habil., FRCPsych
Unit for Social and Community Psychiatry
WHO Collaborating Centre for Mental Health Services Development
Queen Mary, University of London
MedicalResearch.com: What are the main findings of the study?
Answer: Offering modest financial incentives can help patients to achieve better adherence to anti-psychotic maintenance medication.
13 Oct Suicide: Bereavement Course in Close Relatives and Spouses
MedicalResearch.com Interview with:
Marieke de Groot, PhD
Senior Researcher
University of Groningen/University Medical Center Groningen
VU University Amsterdam, department of Clinical Psychology
The EMGO Institute for Health and Care Research (EMGO+)
MedicalResearch.com: What are the main findings of the study?
Answer: We investigated the long term course of bereavement through suicide in a community-based sample of 153 first-degree relatives and spouses of 74 suicide cases. Outcome measures were complicated grief, depression and suicide ideation. We found that outcomes are mutually strongly associated over the 8-10 years course. A history of attempted suicide predicts a increased risk of suicide ideation during the bereavement course. Depression is more likely predicted by factors generally associated with a increased risk of depression such as female gender and low mastery, whereas complicated grief is more likely predicted by the trauma of losing a child due to suicide. No significant associations were found between outcomes and the use of help resources except for mutual (or peer) support, which is associated with a increased risk of complicated grief. Time is the only factor (included in this study) predicting decrease of the risk of depression and complicated grief.
04 Oct Suicide: Impact of 2008 Global Economic Crisis
MedicalResearch.com Interview with:
Shu-Sen Chang, MD, MSc, PhD
Research Assistant Professor
HKJC Centre for Suicide Research and Prevention
The University of Hong Kong
2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road Pokfulam, Hong Kong
MedicalResearch.com: What are the main findings of the study?
Dr. Chang: The study shows a marked increase in suicide in 2009 following the 2008 global economic crisis, particularly in men in the 27 European and 18 American countries included in the study. There were estimated approximately 5000 excess suicides across all 54 study countries in 2009. The largest increase in Europe was seen in 15-24 year old men and in 45-64 year old men in America.
03 Oct Rheumatoid Arthritis: Fish Oil and Symptomatic Benefit
MedicalResearch.com Interview with A/Prof Susanna M Proudman MB BS (Hons) FRACP Discipline of Medicine, University of Adelaide Senior Consultant in Rheumatology Royal Adelaide Hospital North Terrace, Adelaide, 5000 MedicalResearch.com: What are the main findings of the study? Answer: In patients with early DMARD-naïve rheumatoid arthritis (RA), fish oil (delivering an average daily dose of 3.7 g dose of omega-3 fats) was associated with benefits additional to those achieved by combination treat-to-target DMARDs with similar methotrexate use. These included significantly reduced risk of triple DMARD failure, defined as needing the addition of leflunomide, and a higher rate of ACR remission. Because a structured treatment algorithm that was responsive to disease activity and tolerance was used, drug use could be used as an outcome measure for the effects of fish oil. This is one of the novel features of this study as the study design allows for a RCT to be performed on a background of treat-to-target therapy for early RA.19 Sep Cancer Screening Trials: Weighing the Harms
MedicalResearch.com Interview with: Bruno Heleno, PhD fellow Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark MedicalResearch.com: What are the main findings of the study? Answer: In a literature review of cancer screening trials of a wide range of screening interventions, we found that trials seldom report the information necessary to weigh benefits against harms.30 Aug Rheumatoid Arthritis: Nurse-Led Care Effectiveness and Patient Satisfaction
MedicalResearch.com Interview with: Mwidimi Ndosi, PhD, MSc, BSc (Hons), RN. Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN) Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds England MedicalResearch.com: What are the main findings of the study? Answer: The aims of this study was to determine the clinical and cost-effectiveness of nurse-led care for people with rheumatoid arthritis. The main findings were: (i) Patients seeing clinical nurse specialists for their rheumatoid arthritis follow-up care do not get an inferior treatment. (ii) Nurse-led care is safe and in some aspects presents added value to patients (iii) Nurse-led care represents good value for money in terms of disease management for people with RA.30 Aug Type 2 Diabetes: Fruit and Fruit Juice Consumption
MEDICALRESEARCH.COM: INTERVIEW WITH:
Qi Sun, MD ScD
Assistant Professor of Medicine
Channing Division of Network Medicine
Brigham and Women's Hospital and Harvard Medical School, Assistant Professor
Department of Nutrition, Harvard School of Public Health
665 Huntington Avenue, Boston, MA 02115
MEDICALRESEARCH.COM: What are the main findings of the study?
Response: We have three major findings.
- First, we found that total fruit consumption was consistently associated with lower risk of developing type 2 diabetes in these large scale studies among U.S. men and women.
- Second, we found that different individual fruits were differentially associated with diabetes risk. For example, higher intakes of blueberries, grapes or raisins, apples or pears are particularly associated with a lower diabetes risk.
- Last, we found that fruit juice was associated with a higher diabetes risk, and replacing fruit juices with whole fruits will likely lead to reduced diabetes risk.
29 Aug Rheumatoid Arthritis: Are Two Drugs Better than One?
MedicalResearch.com Interview with:
Dr. Janet E Pope
Division of Rheumatology, Department of Medicine
The University of Western Ontario, St Joseph's Health Centre
268 Grosvenor Street, London, ON, Canada N6A 4V2
MedicalResearch.com: What are the main findings of the study?
Dr. Pope: We performed a RCT of patients who were stable for 6 months of etanercept added to methotrexate (inadequate responders to Mtx) who were randomized to stopping Mtx or continuing Mtx to determine if in the next 6 months (and later as the trial continues) the response rate would be the same if Mtx was discontinued. Overall, Mtx + etanercept was not statistically equivalent to etanercept alone (ie non-inferiority did not occur); implying 6 months after stopping Mtx, the etanercept patients on monotherapy performed slightly less well than those on combination therapy.