BMJ
16 Aug Oral Glucosamine Found No More Effective Than Placebo For Osteoarthritis Pain
MedicalResearch.com Interview with: [caption id="attachment_36483" align="alignleft" width="133"]
Dr. Runhaar[/caption]
Jos Runhaar, PhD
Erasmus MC
Department of General Practice
Rotterdam
The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages.
For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding.
The study did show, however, that glucosamine can be extremely beneficial for pets, and specifically dogs who have joint related issues. Knowing the most valuable sources of glucosamine for dogs is important, as it can be extracted and gained from multiple sources, and each have their own varied levels of quality and potency.
04 Aug More Babies Experiencing Neonatal Drug Withdrawal After Exposure To Opioids and Psychotropic Meds
MedicalResearch.com Interview with: [caption id="attachment_27170" align="alignleft" width="179"]
Dr. Krista Huybrechts[/caption]
Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood.
In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.
20 Jul Dieting and Physical Activity During Pregnancy Linked To Lower C-Section Rate
MedicalResearch.com Interview with: [caption id="attachment_35949" align="alignleft" width="150"]
Prof. Thangaratinam[/caption]
Shakila Thangaratinam
Professor of Maternal and Perinatal Health
Joint Director of BARC
(Barts Research Centre for Women's Health)
Women's Health Research Unit | Multidisciplinary Evidence Synthesis Hub (MESH)
Barts and the London School of Medicine and Dentistry
R & D Director for Women's Health
Queen Mary University of London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pregnant women who are overweight or obese, or who gain excess weight gain in pregnancy are at high risk of complications. We wanted to find
- If healthy diet and physical activity in pregnancy reduced weight gain, and improved outcomes for the mother and baby
- If the effects of the interventions differed according to the characteristics of the mother such as body mass index, parity, ethnicity, and underlying medical condition
09 Jul Proton Pump Inhibitors Linked To Increased Risk of Adverse Effects and and Death
MedicalResearch.com Interview with: [caption id="attachment_35797" align="alignleft" width="145"]
Dr. Ziyad Al-Aly[/caption]
Ziyad Al-Aly MD FASN
Assistant Professor of Medicine
Co-director for Clinical Epidemiology Center
Department of Medicine, Washington University School of Medicine
Saint Louis, Missouri
Associate Chief of Staff for Research and Education
Veterans Affairs Saint Louis Health Care System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Proton Pump Inhibitors (PPI) are commonly used, and they are associated with adverse events including kidney disease, dementia, fractures, cardiovascular disease, and pneumonia. We asked the question of whether this translates to increased risk of death.
We conducted this large cohort study to specifically examine the association between PPI use and risk of death. The results consistently showed an association between use of PPI and increased mortality risk. Moreover, there was a graded relationship between duration of PPI use and risk of death in that longer duration of use was associated with incrementally higher risk of death.
03 Jul When Interpreting Skin Biopsies, Pathologists Often Disagree
MedicalResearch.com Interview with: [caption id="attachment_35671" align="alignleft" width="142"]
Dr. Elmore[/caption]
Joann G. Elmore M.D., M.P.H.
Professor of Medicine,
Adjunct Professor of Epidemiology,
University of Washington School of Medicine
Harborview Medical Center
Seattle, WA 98104-2499
MedicalResearch.com: What is the background for this study?
JE: Previous studies on diagnostic accuracy in interpreting melanocytic lesions exist but have small sample size, inclusion of experts only, or small numbers of specimens. We sought to examine accuracy and reproducibility in melanocytic skin lesions by improving upon the methodological limitations of previous studies. Specifically, we recruited a large national sample of practicing community and academic pathologists with a wide range of experience, and we utilized a large sample of biopsy cases that were carefully selected. Given that diagnostic errors can lead to patient deaths and invasive melanoma kills more than 9,000 Americans each year, we wanted to study the issue of diagnostic accuracy in interpreting melanocytic skin lesions in a very robust fashion.
15 Jun Maternal Obesity Linked To Increased Risk of Congenital Malformations in Offspring
MedicalResearch.com Interview with: Dr. Martina Persson Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospita MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that obesity increases risks of several maternal, fetal and neonatal complications including congenital malformations. However, it has not been clear if risks...
14 Jun Patients With Paroxysmal Atrial Fibrillation Less Likely To Receive Anticoagulants
MedicalResearch.com Interview with: [caption id="attachment_35317" align="alignleft" width="200"]
Dr. Adderley[/caption]
Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD
Institute of Applied Health Research
Research Fellow
University of Birmingham
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major global public health problem. It is associated with a five-fold increase in risk of stroke.
There are three types of AF – paroxysmal, persistent or permanent. In paroxysmal AF, episodes come and go, and usually stop without any treatment. With persistent AF episodes can last for periods of more than seven days and are treated with medication or a medical procedure called cardioversion. In permanent AF, the irregular heartbeat is present all the time and cardioversion has failed to restore a normal heart rhythm.
All patients with AF, including paroxysmal AF, are at an increased risk of stroke. UK guidelines recommend anticoagulant treatment, such as the blood-thinning drug warfarin, for patients with all types of AF in order to reduce the risk of stroke.
Our study aimed to determine whether patients with paroxysmal AF are less likely to be treated with anticoagulants than patients with persistent or permanent AF and to investigate trends in treatment between 2000 and 2015.
12 Jun Regular Adolescent Cannabis Users More Likely To Have Later Problems with Drugs, Alcohol and Tobacco
MedicalResearch.com Interview with: Dr Michelle Taylor PhD Senior Research Associate in Epidemiology MRC Integrative Epidemiology Unit (IEU) School of Social and Community Medicine University of Bristol Bristol UK MedicalResearch.com: What is the background for this study? Response: Many previous studies have looked at adolescent cannabis use, however most of these look at use at a single time point, for example whether an individual has ever used cannabis at age 16 years, or how regularly a person uses cannabis at age 18. However, as young people do not initiate use at the same time or follow the same pattern of use, using measures at a single time point does not always tell the whole story. We used a form of statistical modelling using data taken over the course of adolescence to try and characterise underlying patterns of cannabis use across adolescence. We used data from the Avon Longitudinal Study of Parents and Children which had information on cannabis use at six time points between the ages of 13 and 18 years.23 May Pharmaceutical Grade Chondroitin Sulfate As First-Line Treatment of Osteoarthritis
MedicalResearch.com Interview with: [caption id="attachment_34794" align="alignleft" width="180"]
Dr. Reginster[/caption]
Jean-Yves Reginster M.D.,PH.D.
Professor of Epidemiology, Public Health and Health Economics
Head of the Bone and Cartilage Metabolism Unit
University of Liège
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA).
This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.
21 May Whose Patients Have Lower 30-Day Mortality? Younger or Older Doctors?
MedicalResearch.com Interview with: [caption id="attachment_34755" align="alignleft" width="180"]
Dr. Tsugawa[/caption]
Yusuke Tsugawa, MD, MPH, PhD
Harvard T. H. Chan School of Public Health
Department of Health Policy and Management
Cambridge, MA 02138
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although evidence has suggested that older physicians may experience a
decline in medical knowledge and are less likely to adhere to standard care, patients in general had a perception that older doctors are more
experienced and therefore provide superior care.
Using a nationally representative sample of Medicare beneficiaries who were hospitalized
for medical conditions in 2011-2014, we found that patients treated by
younger doctors have lower 30-day mortality compared to those cared
for by older doctors, after adjusting for patient, physician, and
hospital characteristics.
10 May All NSAIDS Raise Risk of Heart Attack, Even When Taken For Short Period of Time
MedicalResearch.com Interview with: Michèle Bally, BPharm, MSc, PhD Epidemiologist, Department of Pharmacy, CHUM Researcher, Health Innovation and Evaluation Hub, CRCHUM MedicalResearch.com: What is the background for this study? Response: The objective of this study was to better understand the risk of heart attack associated with using oral prescription non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, celecoxib, and naproxen) the way people usually do to treat pain and inflammation in real life circumstances. A lot of people take medication, but they do not understand that some can be more harmful than beneficial, especially with consistent use. Unfortunately, something like a heart attack can happen anywhere. You could be at work and show signs of an attack. If this does happen, hopefully you have someone who is first aid trained to at least help you deal with these symptoms, until you get to the hospital. This is why having someone who knows that they are doing is beneficial in any environment. If it wasn't for companies like Coast2Coast in Ottawa, the chances of someone who was suffering from a heart attack may not have made it to the hospital if it wasn't for the assistance of someone who was first aid trained. In clinical trials, NSAIDs were typically taken on a continuous basis in high standardized doses, as assigned by the trial protocol. However, the dosages and the treatment durations studied in trials may not represent the reality of many patients who use NSAIDs in low or varying doses, use these drugs on and off, or switch between NSAID medications. We were particularly interested in determining the onset of the risk, that is how soon does the risk of heart attack start increasing? Also, we wanted to investigate the effect of dose and duration of treatment. To do this, we studied the use of a low or high dose level of NSAIDs over certain set periods of time, including taking these medications only for 1 to 7 days.26 Apr Over 50? Exercise Linked To Improved Cognitive Function
MedicalResearch.com Interview with: Dr. Joseph Michael Northey UC Research Institute for Sport and Exercise (UCRISE), Discipline of Sport and Exercise Science, Faculty of Health University of Canberra, Canberra, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Physical exercise has an important role to play in maintaining cognitive function across the lifecycle. However, the benefits of implementing a physical exercise intervention were not clear. To address these issues which prevented evidence-based prescription of exercise for cognitive function, a systematic review of all the available literature up to November of 2016 in adults older than 50 was conducted.25 Apr Submission and Publication Bias Against Studies With Negative Results Declining
MedicalResearch.com Interview with: Gary Evoniuk, PhD Director of Publication Practices, Medical Communications Quality & Practices GlaxoSmithKline Research and Development, Research Triangle Park, NC 27709 MedicalResearch.com: What is the background for this study? Response: In recent years, industry, and to a lesser extent academia, have been criticised for failing to submit clinical trial data for publication, especially when the data are perceived to be “negative”, (i.e. unfavourable to the drug under study) leading to publication bias. We felt it was important to determine whether this criticism is based on perception or reality and so we conducted what is, to our knowledge the only study to systematically address the issue of submission and publication bias based on study outcome.22 Apr Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults
Posted at 15:21h
in Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Pediatrics
MedicalResearch.com Interview with:
Charlotte Björkenstam PhD
Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.
We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.
17 Apr Inhaling Poppers Associated With Visual Toxicity
MedicalResearch.com Interview with: Dr. Rebecca Rewbury Sussex Eye Hospital Brighton and Sussex University Hospitals Trust Brighton, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: ‘Poppers’ are recreational drugs which are illegal to sell for human ingestion, but are sold under the guise of household cleaning products. Inhalation leads to a brief sense of euphoria, enhanced sexual arousal and smooth muscle relaxation. The Psychoactive Substances Act 2016 was due to outlaw poppers, but they were excluded on the basis that they do not act directly on the central nervous system. The main constituent of poppers, isopropyl nitrite, replaced isobutyl nitrite when the latter was classified as a carcinogen in 2006. Since then, there have been several case reports of ‘poppers maculopathy.’ We noted an increase in patients presenting with central visual disturbances after using poppers and describe 12 such cases. They all demonstrated similar disruption of the photoreceptor layer on retinal imaging. Onset of symptoms was frequently linked to specific brands of poppers, with 3 people having used poppers for many years and only developing side effects on changing brand. Chemical analysis showed that these products contained isopropyl nitrite. One brand of poppers, used without side effects by one patient, contained amyl nitrite, 2-methyl butyl nitrite and isobutyl alcohol, but no isopropyl nitrite. The outcome of poppers maculopathy varied, but following abstention, visual disturbances and retinal damage tended to improve over months, if not fully resolve. Although in some cases, symptoms and/or imaging findings were prolonged. Ongoing use of implicated brands led to persistent, but not worsening maculopathy, whereas one patient that switched back to another brand showed full recovery.02 Apr Consequences of Interpersonal Violence Against Child Athletes Persist into Adulthood
Posted at 12:14h
in Abuse and Neglect, Author Interviews, BMJ, Exercise - Fitness, Mental Health Research
MedicalResearch.com Interview with:
[caption id="attachment_33615" align="alignleft" width="134"]
Tine Vertommen[/caption]
Tine Vertommen, Criminologist
Faculty of Medicine and Health Sciences
Universiteitsplein 1
Antwerp, Belgium
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A recent prevalence study into interpersonal violence against child athletes in the Netherlands and Belgium showed that 6% experienced severe sexual violence, 8% experienced severe physical violence, and 9% of respondents experienced severe psychological violence in sport (Vertommen et al., 2016). While general literature has repeatedly shown that exposure to interpersonal violence during childhood is associated with mental health problems in adulthood, this relationship has not yet been demonstrated in (former) athletes. Thus, the objective of the current study is to assess the long-term consequences of these experiences on adult mental health and quality of life.
29 Mar Knee Replacement Would Be More Cost Effective If Limited To Those With Severe Symptoms
MedicalResearch.com Interview with: [caption id="attachment_33519" align="alignleft" width="130"]
Dr. Bart Ferket[/caption]
Bart S Ferket, MD, PhD
Assistant Professor, Population Health Science and Policy
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.
15 Mar Combination Opioids and Benzodiazepines Raises Risk of Overdose
MedicalResearch.com Interview with: [caption id="attachment_32934" align="alignleft" width="200"]
Dr. Eric Sun[/caption]
Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.
02 Mar Environmental Pyrethroids May Be Associated With Behavioral Problems in Children
Posted at 12:28h
in Author Interviews, BMJ, Environmental Risks, Mental Health Research, Pediatrics, Toxin Research
MedicalResearch.com Interview with:
Professor Jean-Francois Viel
Department of Epidemiology and Public Health
University Hospital
Rennes, France
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The use of pyrethroid insecticides has increased substantially throughout the world over the past several decades, replacing organophosphate and carbamate insecticides, because of their chemical potency against many pests, their relatively low mammalian toxicity and their favorable environmental profiles. However, despite the neurotoxicity of these insecticides at high doses, the potential impact of environmental exposure to pyrethroid insecticides on child neurodevelopment has only just started to receive attention.
Using a longitudinal design (PELAGIE mother-child cohort), we were able to assess pyrethroid exposure (trough urine concentrations) both prenatally and during childhood (at 6 years of age). We showed that increased prenatal concentrations of one pyrethroid metabolite (cis-DCCA, a metabolite of permethrin, cypermethrin and cyfluthrin) were associated with internalising difficulties (children showing behaviours that are inhibited and over-controlled).
Moreover, for childhood 3-PBA (a common metabolite of up to 20 synthetic pyrethroid insecticides) concentrations, a positive association was observed with externalising difficulties (children showing behaviours that are under-controlled and having generally a more challenging temperament).
01 Mar 11 Cancer Types Have Strong Connection to Obesity
Posted at 18:08h
in Author Interviews, BMJ, Cancer Research, Imperial College, Pediatrics, Weight Research
MedicalResearch.com Interview with:
[caption id="attachment_32473" align="alignleft" width="149"]
Dr. Kyrgiou[/caption]
Dr Maria Kyrgiou MSc, PhD, MRCOG
Clinical Senior Lecturer & Consultant in Gynaecologic Oncology
IRDB - Department of Surgery and Cancer, Imperial College London
West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity has become a major public health challenge and it's prevalence worldwide has more than doubled amongst women n the last four decades. Excess body weight has been associated with an increased risk of developing and dying from numerous cancers. Although the reported associations may be potentially causal, some of the associations may be flawed due to inherent study biases such as residual confounding and selective reporting of positive results.
We included 204 meta-analyses investigating associations between adiposity and the development or death from 36 primary cancers and their sub-types. Adiposity was associated with a higher risk of developing esophageal adenocarcinoma, gastric cardia, colon and rectal cancer in men, biliary tract system, pancreatic, postmenopausal breast among HRT non-users, endometrial, ovarian, and kidney cancer and multiple myeloma.
01 Mar Flu Treatment With Neuraminidase Inhibitors During Pregnancy Not Linked To Birth Defects
Posted at 18:00h
in Author Interviews, BMJ, Flu - Influenza, Karolinski Institute, OBGYNE, Pediatrics, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_32424" align="alignleft" width="146"]
Dr. Graner[/caption]
Dr. Sophie Graner
Department of Women's and Childrens Health
Karolinska Institute, Stockholm, Sweden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pregnant women are at increased risks of severe disease and death due to influensa infection, as well as hospitalization. Also influenza and fever increase the risk of adverse pregnancy outcomes for their infants such as intrauterine death and preterm birth. Due to this, the regulatory agencies in Europe and the US recommended post exposure prophylaxis and treatment for pregnant women with neuraminidase inhibitors during the last influenza pandemic 2009-10. Despite the recommendations, the knowledge on the effect of neuraminidase inhibitors on the infant has been limited. Previously published studies have not shown any increased risk, but they have had limited power to assess specific neonatal outcomes such as stillbirth, neonatal mortality, preterm birth, low Agar score, neonatal morbidity and congenital malformations.
08 Feb Is the Benefit of Arthroscopic Meniscus Surgery a Placebo Effect?
MedicalResearch.com Interview with: [caption id="attachment_31841" align="alignleft" width="109"]
Dr. Jonas Thorlund[/caption]
Jonas Bloch Thorlund
Associate Professor (MSc, PhD)
Department of Sports Science and Clinical Biomechanics
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.
07 Feb NSAIDS Have Minimal Effect On Back Pain and Risk GI Side Effects
MedicalResearch.com Interview with: [caption id="attachment_31800" align="alignleft" width="180"]
Dr. Gustavo Machado[/caption]
Dr. Gustavo Machado BPhty (Hons) Cert.MDT
The George Institute for Global Health
Sydney Medical School, University of Sydney
Sydney, New South Wales, Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: People with back pain are usually told by their health care practitioners to take analgesic medications to relieve their pain. But our previous research published in the BMJ showed that paracetamol does not have a measurable impact on patient’s symptoms. This resulted in recent changes in guidelines' recommendations. The 2017 National Institute for Health and Care Excellence (NICE) guidelines/UK no longer recommend paracetamol as a stand-alone intervention for back pain.
So now non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as the analgesic of first choice. However, our results show that compared to placebo, commonly used NSAIDs, such as Ibuprofen (e.g. Nurofen) and Diclofenac (e.g. Voltaren), provide only small benefits for people with back pain while increasing the risk of gastrointestinal adverse effects by 2.5 times.
06 Feb Study Validates Good Quality Care Provided By Foreign-Trained Doctors
Posted at 16:10h
in Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Outcomes & Safety
MedicalResearch.com Interview with:
[caption id="attachment_31685" align="alignleft" width="180"]
Dr. Yusuke Tsugawa[/caption]
Yusuke Tsugawa, MD, MPH, PhD
Research Associate at Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prior evidence has been mixed as to whether or not patient outcomes
differ between U.S. and foreign medical graduates.
However, previous studies used small sample sizes or data from a small number of states.
Therefore, it was largely unknown how international medical graduates
perform compared with US medical graduates.
To answer this question, we analyzed a nationally representative
sample of Medicare beneficiaries admitted to hospitals with a medical
condition in 2011-2014. Our sample included approximately 1.2 million
hospitalizations treated by 40,000 physicians. After adjusting for
severity of illness of patients and hospitals (we compared physicians
within the same hospital), we found that patient treated by
international medical graduates had lower mortality than patients
cared for by US medical graduates (adjusted 30-day mortality rate
11.2% vs 11.6%, p<0.001). We observed no difference in readmissions,
whereas costs of care was slightly higher for international medical
graduates.
27 Jan Approval of Medical Disability Claims Vary By the Examiner
MedicalResearch.com Interview with: [caption id="attachment_31578" align="alignleft" width="100"]
Prof. Regina Kunz[/caption]
Prof. Dr. Regina Kunz
Professorin für Versicherungsmedizin
Evidence-based Insurance Medicine I Departement Klinische Forschung
Universitätsspital Basel
Basel Switzerland
MedicalResearch.com: What is the background for this study?
Response: Many workers seek wage replacement benefits due to a disabling illness or injury. Public and private insurance systems provide wage replacement benefits for such employees, as long as eligibility criteria are met. Insurers often arrange for evaluation of eligibility by medical professionals, but there are concerns regarding low quality evaluations and poor reliability between medical experts assessing the same claimant. In order to better understand this situation, we performed a systematic review of reproducibility studies on the inter-rater agreement in evaluation of disability.
We carried out a systematic review of 23 studies, conducted between 1992-2016, from 12 countries in Europe, North America, Australia, the Middle East, and Northeast Asia. The studies include those carried out in an insurance setting, with medical experts assessing claimants for work disability benefits, and in a research setting, where evaluation of patients took place outside of actual assessments, for example, for rehabilitation.
27 Jan Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism
MedicalResearch.com Interview with: [caption id="attachment_31551" align="alignleft" width="200"]
Dr. Spyridoula Maraka[/caption]
Dr. Spyridoula Maraka
Assistant professor of medicine
Division of Endocrinology and Metabolism
Center for Osteoporosis and Metabolic Bone Diseases
University of Arkansas for Medical Sciences and
Central Arkansas Veterans Health Care System
Little Rock Arkansas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.
Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.
Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women.
23 Jan Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke
MedicalResearch.com Interview with: [caption id="attachment_31437" align="alignleft" width="134"]
Dr. Talar Markossian[/caption]
Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.
We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke.