JAMA
17 Sep Resistant E. Coli Produces Slimy Coating To Prevent Removal By Immune System
MedicalResearch.com Interview with: [caption id="attachment_28049" align="alignleft" width="133"]
Dr. Daria Van Tyne[/caption]
Dr. Daria Van Tyne, PhD
The Gilmore Lab
Department of Ophthalmology
Harvard Medical School
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A specific clone of E. coli, type ST131, which produces an extended-spectrum beta-lactamase (ESBL – an enzyme that inactivates many penicillin-type antibiotics), has rapidly spread around the globe to become the leading cause of multidrug-resistant, non-intestinal E. coli infection. Despite this, E. coli is a rare cause of infection of the cornea. A patient was recently seen at the Massachusetts Eye and Ear Infirmary with a severe E. coli infection of the cornea, and the large number of antibiotic resistances of this strain tipped us off to the possibility that it might be the highly virulent ST131 ESBL type. By sequencing the DNA of its genome, we found that it was indeed ST131 ESBL E. coli. Moreover, we discovered a new mutation in this strain that allows it to produce a slimy outer coating on its surface. This slime layer, or capsule, makes the bacteria more resistant to removal by phagocytic cells of the immune system. The slime layer also makes these particular colonies appear different on a special type of agar that contains the dye Congo Red.
16 Sep Intensive Blood Pressure Management Found To Be Cost Effective
MedicalResearch.com Interview with: [caption id="attachment_27999" align="alignleft" width="146"]
Dr. Ilana B. Richman[/caption]
Ilana B. Richman, MD
Palo Alto VA Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research/Center for Health Policy
Department of Medicine
Stanford University School of Medicine
Stanford, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently.
Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value.
15 Sep Early Menopause Linked To Increased Risk of Heart Disease and Carotid Atherosclerosis
MedicalResearch.com Interview with: Taulant Muka, MD, MPH, PhD Postdoctoral Researcher Erasmus University, Rotterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Menopause marks a major life transition for women, resulting in the loss of ovarian follicle development. Although menopause is a universal phenomenon among women, the timing of the final menstrual period differ greatly between women, and is considered a marker of aging. By quantifying data of nearly 310,329 non-overlapping women, we found that women who experienced an early menopause (i.e. younger than 45 years) have an excess risk of CHD, CVD-mortality and all-cause mortality. Furthermore, being 45-49 years at menopause compared to ≥50 years was associated with increased risk of carotid atherosclerosis.15 Sep Risk of breast cancer associated with a diagnosis of atypical ductal hyperplasia may be lower than previously reported
MedicalResearch.com Interview with: Tehillah S. Menes, MD Department of Surgery Tel Aviv-Sourasky Medical Center Tel Aviv, Israel MedicalResearch.com: What is the background for this study? Response: Atypical ductal hyperplasia (ADH) is a known risk factor for breast cancer. The diagnosis is made by a biopsy showing a uniform proliferation of cells lining the ducts of the breast. These cells have monomorphic round nuclei and characteristically fill only part of the involved duct. Women diagnosed with ADH are recommended to undergo increased surveillance and offered chemoprevention (i.e. Tamoxifen) for risk reduction. Most studies reporting on the risk of subsequent breast cancer in women with ADH were done prior to the wide use of screening mammography and percutaneous needle biopsy. Our study examined 10-year risk of invasive breast cancer in women diagnosed with ADH (by needle biopsy or excisional biopsy), using data collected by the Breast Cancer Surveillance Consortium (BCSC).14 Sep JAMA Study Updates Goals of Cost-Effective Health Care
MedicalResearch.com Interview with: [caption id="attachment_27808" align="alignleft" width="149"]
Dr. Gillian D. Sanders-Schmidler[/caption]
Gillian D. Sanders-Schmidler Ph.D.
Professor of Medicine
Duke Evidence Synthesis Group, Director
Duke Evidence-based Practice Center, Director
Duke Clinical Research Institute
Duke University
MedicalResearch.com: What is the background for this study?
Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations.
This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.
14 Sep Some Pediatric Acute Otitis Media Can Be Managed With Close Parental Supervision, Without Antibiotics
MedicalResearch.com Interview with: Johanna M. Uitti, MD Department of Paediatrics and Adolescent Medicine Turku University Hospital Turku, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: According to several national guidelines, close follow-up is required if initial observation without antimicrobial agents is chosen for the management of acute otitis media (AOM) in children. The aim of this study was to examine whether close follow-up with reexamination is needed for children with AOM initially managed without antimicrobial agents who have symptomatic improvement during the first week after diagnosis, as assessed by their parents. Of the 104 children with symptomatic improvement, 3 (2.9%) developed worse signs or perforation of the tympanic membrane as seen on otoscopy. In contrast, of the 54 children with symptomatic failure, 16 (29.6%) developed worse signs or perforation of the tympanic membrane as seen on otoscopy.12 Sep Key Risk Factors of Non-Healing Bone Fractures Identified
MedicalResearch.com Interview with: [caption id="attachment_27845" align="alignleft" width="200"]
Dr. R. Grant Steen[/caption]
R. Grant Steen, PhD
Medical Affairs,
Bioventus LLC
Durham, North Carolina
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: When we started this research, it was really only guesswork as to how big a problem fracture nonunion really is. What we've done is to work with an enormous database of patient health claims, with two goals.
First, we wanted to characterize how common fracture nonunion is among patients across a wide age range.
Second, we wanted to identify risk factors that make a patient more likely to have problems healing.
We've now succeeded in both aims. We know that roughly 5% of fracture patients will go to nonunion, and we know a whole host of risk factors that predispose them to do so.
Most of the risk factors that we've identified—with a few exceptions—would not be a surprise to physicians who treat fracture patients. However, what we've done is to put all of these risk factors in a broader context, so that we know which risk factors are most important and which are less so.
For example, it has been known for a long time that smoking is a risk factor for nonunion. What we've shown is that, in the scheme of things, it's not all that important. Let me be more precise here, because this is an important point. If all you know about a patient is that they smoke, we've shown that smoking is associated with a 62% increase in risk of nonunion. That's a lot. But, as you learn more about that patient and can factor that new knowledge into a risk prediction, it turns out that smoking, all by itself, increases the risk of nonunion by only about 20%. However, smoking is a surrogate marker for a range of other risk factors that also increase risk, including male gender, cardiovascular disease, obesity, vitamin D deficiency, alcoholism, and so on. Once you factor these separate risk factors into your new nonunion prediction, you have a much more nuanced—and probably much more accurate—prediction of nonunion risk.
12 Sep Low-Intensity Interventions Addressing Social Needs In Pediatric Settings Can Improve Child Health
MedicalResearch.com Interview with: Laura M. Gottlieb, MD, MPH Department of Family and Community Medicine, 2Center for Health and Community University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Numerous studies have demonstrated that childhood exposures to social adversities, like family financial insecurity, food insecurity, and housing instability, lead to poorer health outcomes across the life course. These social adversities disproportionately affect low-income and racial minority populations. In response to this evidence there have been calls to address social needs in pediatric clinical care settings. For example, recently the American Academy of Pediatrics’ Task Force on Childhood Poverty endorsed the promotion of evidenced-based strategies to reduce the negative health effects of poverty on low-income children, including by increasing the availability of clinic-based interventions addressing social risks. In response to these calls to action, a growing number of pediatric health care organizations are screening for and address families’ social needs. There is a critical need for more evidence on the effectiveness of these types of interventions. Many of the studies conducted so far have focused primarily on assessing program process outcomes or impacts on families’ social needs, but have not evaluated actual health outcomes resulting from program participation. To our knowledge, this study was the first randomized clinical trial evaluating the impacts of a pediatric social needs navigation program on child health. The reported number of social needs identified at baseline ranged from 0 to 11 out of 14 possible items, with a mean [SD] of 2.7[2.2] needs identified by participating families. Family participation in the navigation program intervention significantly decreased families’ reports of social needs by a mean (SE) of .39(0.13) vs. an increase of a mean (SE) of .22(0.13) in the active control arm. Participation in the navigation program also significantly improved parent-reported overall child health, with a mean (SE) change of -.036(0.05), compared to the active control arm with a mean (SE) change of -0.12(0.05). At 4 months post enrollment, the number of social needs reported by those that participated in the navigation program decreased by a mean (SE) of .39(0.13).09 Sep LEAN Methodologies Improved Wait Time In VA Medical Center
MedicalResearch.com Interview with: [caption id="attachment_27754" align="alignleft" width="146"]
Dr. Andrew Eppstein[/caption]
Andrew C. Eppstein, MD, FACS
Assistant Professor of Clinical Surgery
Indiana University School of Medicine
Department of Surgery, Division of General Surgery
Richard L. Roudebush VA Medical Center
Indianapolis, Indiana
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A few years ago we encountered long wait times for patients undergoing elective general surgery in our tertiary care VA medical center. Demand had grown and our existing systems were not able to accommodate surgical patients in a timely fashion. By fiscal year (FY) 2012, our wait times averaged 33 days, though patients with malignancies would be moved to the head of the line, pushing more elective cases further back.
To address rising demand and worsening wait times, our Surgery Service convened an analysis of our processes using Lean methodology in collaboration with the Systems Redesign Service. Multidisciplinary meetings were held in 2013 to analyze inefficiencies in the current system and ways to address them to create a streamlined, ideal system. The collaborations included surgeons, nurses, ancillary staff, operating room and sterile processing staff, and hospital administration. Projects were rolled out stepwise in mid-2013 under General Surgery, the busiest surgical service at our institution.
We noted a sharp decline in patient wait times after initiation of reforms such as improved OR flexibility, scheduling process changes, standardization of work within the department, and improved communication practices. These wait times dropped to 26 days in FY 2013 and further to 12 days in FY 2014, while operating volume and overall outpatient evaluations increased, with decreased no-shows to clinic. Our decreased wait times were sustained through the remainder of the observed period.
08 Sep Breast Cancer: Long-term Prognostic Factors in the Boost vs No Boost Trial
MedicalResearch.com Interview with: [caption id="attachment_27762" align="alignleft" width="200"]
Dr. Conny Vrieling[/caption]
Conny Vrieling, M.D., Ph.D.
Radiation Oncologist
Clinique des Grangettes
Geneva
MedicalResearch.com: What is the background for this study?
Response: In the early ’90s, the EORTC (European Organisation for Research and Treatment of Cancer) ran the “boost no-boost” trial, randomizing 5569 early-stage breast cancer patients, treated with breast-conserving surgery and whole-breast irradiation, between no boost and a 16-Gy boost. A third of the patients were included in a central pathology review. The 10-year follow-up results of this subpopulation showed that young age and high-grade invasive carcinoma were the most important risk factors for ipsilateral breast tumor recurrence (IBTR).
In this study, we re-analyzed with long-term follow-up the pathological prognostic factors related to IBTR, with a special focus on the evolution of these effects over time.
08 Sep US Task Force Recommends TB Screening For Those Who Have Lived in High Risk Settings
MedicalResearch.com Interview with: [caption id="attachment_27742" align="alignleft" width="133"]
Dr. Francisco Garcia[/caption]
Dr. Francisco García M.D. M.P.H.
Task Force member and
Director and Chief medical officer at
Pima County Department of Health
Tucson, AZ
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Tuberculosis infection is one of the most common infectious diseases in the world.
Although less common in the United States, many people still become infected every year and are at risk of getting sick and spreading the infection to others. We know there are effective screening tests that can detect latent tuberculosis infection before people become sick with active tuberculosis disease. Additionally, there are effective treatments to prevent people from progressing from latent tuberculosis infection to active tuberculosis disease.
Thus, for people with increased risk of contracting tuberculosis, the Task Force recommends screening for latent tuberculosis infection.
People who are considered at increased risk include those who were born in or have lived in countries where tuberculosis is highly prevalent, or who have lived in congregate settings where exposure to tuberculosis is more likely, such as homeless shelters or correctional facilities.
08 Sep MRI Generally Safe For Fetus in First Trimester, But Gadolinium Should Be Avoided Unless Strongly Indicated
MedicalResearch.com Interview with: Dr. Joel G. Ray MD, MS, FRCPC Professor, Department of Medicine, University of Toronto Professor Department of Obstetrics and Gynecology St. Michael’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have little information about the fetal safety to of MRI in the first trimester of pregnancy, or that of MRI with gadolinium contrast performed at any point in pregnancy.08 Sep Clinical Trial of 3 Nasal Sprays For HHT Nosebleeds Showed None Better Than Placebo
MedicalResearch.com Interview with: [caption id="attachment_27630" align="alignleft" width="142"]
Dr. Kevin Whitehead[/caption]
Dr. Kevin J. Whitehead MD
Adjunct Associate Professor, Pediatrics
Associate Professor, Internal Medicine
University of Utah
MedicalResearch.com: What is the background for this study?
Response: Hereditary hemorrhagic telangiectasia (or Osler-Weber-Rendu Syndrome) is a genetic vascular malformation syndrome that results in arteriovenous malformations. This syndrome is found in 1:5000 individuals, and is inherited in autosomal dominant fashion. It is often under diagnosed by the medical community (some estimate that 90% of patients do not know that they are affected).
In the skin and mucous membranes small AVMs - termed telangiectasias - form, and they have the potential to rupture and bleed. This happens most commonly in the nose, and 95% of patients with HHT have recurrent nose bleeding (epistaxis). While other dangerous internal organ AVMs also form, epistaxis is the most important determinant of quality of life for these patients. This epistaxis can lead to anemia, heart failure and rarely death. Patients often seek therapy for epistaxis, but cautery or laser treatment of the telangiectasias tends to provide only temporary benefit. Definitive therapy to eliminate epistaxis requires surgical closure of the nasal passages, and is too drastic for most patients.
We sought to test medical therapy for HHT-related epistaxis with our best candidate drugs in nose spray form. The drugs with the most anecdotal support include bevacizumab (an anti-angiogenic drug), estriol (an estrogen), and tranexamic acid (an inhibitor of fibrinolysis). Our patients received a nose spray with one of these drugs or a saline placebo and used two sprays in each nostril daily for 12 weeks and recorded their nose bleed frequency and duration in a daily diary.
06 Sep More People Without Celiac Disease Eating Gluten Free Diet
MedicalResearch.com Interview with: [caption id="attachment_27623" align="alignleft" width="125"]
Dr. Brandon Hyunseok Kim[/caption]
Brandon Hyunseok Kim, M.D., MPH
Internal Medicine Resident
Rutgers New Jersey Medical School
MedicalResearch.com: What is the background for this study?
Response: The background of this study was to investigate the time trends in the prevalence of celiac disease and gluten-free diet in the United States using most recent 6-year National Health And Nutrition Examination Survey. Previous studies using narrow populations or old study period mainly before mid 2000s suggested increasing prevalence of celiac disease. At the same time, there is a current popular trend of people following gluten-free diets beyond what would be expected if it were solely due to the increasing prevalence of celiac disease.
02 Sep Most Gastric Bypass Patients Keep Weight Off After Surgery
MedicalResearch.com Interview with: [caption id="attachment_27481" align="alignleft" width="156"]
Dr. Matt Maciejewski[/caption]
Matthew Leonard Maciejewski, PhD
Professor in the Division of General Internal Medicine
Department of Medicine
Duke University School of Medicine
Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care
Durham VA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: No study based on a US cohort undergoing current procedures has examined weight change comparing surgical patients and nonsurgical patients for as long as we have. This is the first study to report 10-year outcomes on gastric bypass patients and compare them to matched patients who did not get surgery. At 1 year, gastric bypass patients lost 31% of their baseline weight compared controls who only lost 1.1% of their baseline weight. At 10 years, gastric bypass had lost 28% of their baseline weight.
We also compared weight loss at 4 years for Veterans who received the 3 most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric banding). At 4 years, patients undergoing gastric bypass lost more weight than patients undergoing sleeve gastrectomy or gastric banding. Given that few high quality studies have examined sleeve gastrectomy to 4 years, the 4-year sleeve outcomes contribute to filling this important evidence gap as the sleeve gastrectomy is now the most commonly performed bariatric procedure worldwide.
02 Sep Invasive Cardiac Therapies Linked To Better Survival Following Heart Attack
MedicalResearch.com Interview with: [caption id="attachment_27459" align="alignleft" width="163"]
Dr. Marlous Hall[/caption]
Dr Marlous Hall PhD
Senior Epidemiologist
Leeds Institute of Cardiovascular and Metabolic Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that death rates following heart attacks have fallen considerably over recent decades. Many studies have looked at the effect of medications and invasive strategies, and their association with better clinical outcomes is clear.
However, a big question remains: why have heart attack deaths fallen? Is it due to increased use of medications and treatment, is the risk of patients simply lower over time due to things like earlier diagnosis or are patients generally healthier with fewer comorbidities such as diabetes? Answering this is not straightforward - as gold standard studies like clinical trials on historic data cannot be done.
An alternative approach is to look for patterns in data observed from routine care to look at all these factors together. This study used a large and rich dataset covering heart attack care in the UK (Myocardial Ischaemia National Audit Project (MINAP)). This dataset was linked to outcome data from the Office for National Statistics to allow us to look at all the different factors that could influence the change in mortality over time.
31 Aug Advantaged Patients Receive More Low-Value Medical Services
MedicalResearch.com Interview with: Dr. Rachel O. Reid MD MS Associate Physician Policy Researcher RAND Corporation MedicalResearch.com: What is the background for this study? What are the main findings? Response: Waste in the US health care system is both common and expensive, estimated to be in the range of $750 billion annually. Contributing to this waste is over-treatment and use of low value services that offer little or no clinical benefit to patients. We studied 1.46 million adults from across the US with commercial insurance and found that spending on 28 low value services totaled $32.8 million in 2013, accounting for 0.5% of their medical spending or $22 per person annually. The most commonly received low-value services included hormone tests for thyroid problems, imaging for low-back pain and imaging for uncomplicated headache. The greatest proportion of spending was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million. Low-value spending was lower among patients who were older, male, black or Asian, lower-income or enrolled on consumer-directed health plans, which have high member cost-sharing.31 Aug Opportunities for Improvement in Pediatric Resuscitation Across US EDs
MedicalResearch.com Interview with: Marc Auerbach, MD, FAAP, MSc Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education) Director, Pediatric Simulation Yale Center for Medical Simulation; MedicalResearch.com: What is the background for this study? What are the main findings? Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores. The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation.30 Aug Most Physicians Overestimate Efficacy of Common Treatments
MedicalResearch.com Interview with: [caption id="attachment_27370" align="alignleft" width="159"]
Dr. Daniel Morgan[/caption]
Daniel J. Morgan M.D., M.S
Associate Professor
Epidemiology & Public Health
University of Maryland School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Physicians are generally taught if a treatment is indicated, not how well the treatment works. Although this has been part of evidence based medical training, doctors still perform poorly with ability to understand risk and how treatment limits risk (Bayesian reasoning). Many publications focus on relative risk reduction which inflates the perception of an effect over the more accurate absolute risk reduction.
26 Aug 70-Gene Signature Can Help Identify Early-Stage Breast Cancer Patients Who Do Not Need Chemotherapy
MedicalResearch.com Interview with: [caption id="attachment_27366" align="alignleft" width="150"]
Dr. Laura Van't Leer[/caption]
Prof. Laura van ’t Veer, PhD
Leader, Breast Oncology Program, and Director, Applied Genomics, UCSF Helen Diller Family Comprehensive Cancer Center
Angela and Shu Kai Chan Endowed Chair in Cancer Research
UCSF Helen Diller Family Comprehensive Cancer Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: MINDACT was designed to involve only patients with node negative and 1 to 3 positive lymph node breast cancer. Node negative breast cancer is a cancer that has not spread to the surrounding lymph nodes and therefore has a lower risk of recurrence. Scientists have also demonstrated that breast cancer which has spread to 1 to 3 lymph nodes may behave like node negative breast cancer. Patients with either node negative cancer or with a cancer that involves 1-3 lymph nodes are often prescribed chemotherapy, although physicians believe that approximately 15% of them do not require such treatment.
MINDACT provides the highest level of evidence to show that using MammaPrint® can substantially reduce the use of chemotherapy in patients with node-negative and 1-to-3 node positive breast cancer – in other words, it can identify patients with these types of breast cancer who can safely be spared a treatment that may cause significant side effects, and will offer no to very little benefit.
25 Aug Capecitabine Cancer Treatment Can Result in Loss of Fingerprints
MedicalResearch.com Interview with: [caption id="attachment_27352" align="alignleft" width="96"]
Leni van Doorn[/caption]
Leni van Doorn, MSc
Department of Medical Oncology
Erasmus MC Cancer Institute
Rotterdam, the Netherlands
MedicalResearch.com: What is the background for this study?
Response: The common cancer treatment capecitabine, a regular treatment for patients mostly diagnosed with breast-, colon- or gastic cancer, induces hand foot syndrome (HFS). HFS is a cutaneous condition that may lead to red palms and blisters in approximately 50% to 60% of the patients and is believed to result in the loss of fingerprints. This fingerprint loss has been described sporadically in the literature.
The main aim of our prospective study was to have a closer look of the association between hand foot syndrome and the loss of fingerprints.
25 Aug Technetium Cardiac Imaging Predicts Prognosis of Cardiac Amyloidosis
MedicalResearch.com Interview with: [caption id="attachment_27269" align="alignleft" width="100"]
Dr. Adam Castano[/caption]
Adam Castano, M.D., M.S.
Division of Cardiology
Columbia University Medical Center
New York Presbyterian Hospital
MedicalResearch.com: What is the background for this study?
Response: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF). Traditionally, the gold standard for diagnosis has required an endomyocardial biopsy coupled with either immunohistochemistry or mass spectroscopy. These specialized tests are only performed at centers with experienced satff, do not yield prognostically useful information, may be inadvisable for frail older adults, and often present logistical challenges that lead to delayed care.
Fortunately, single center studies have demonstrated excellent diagnostic accuracy using technetium 99m pyrophosphate (Tc99mPYP) cardiac imaging for noninvasively detecting ATTR-CA and differentiating it from another major type of cardiac amyloidosis called light chain (AL). But the diagnostic accuracy of this technique in a multicenter study and the association of Tc99mPYP myocardial uptake with survival were not known prior to this study.
Therefore, we assessed in a multicenter study Tc99mPYP cardiac imaging as a diagnostic tool and its association with survival. We conducted a retrospective cohort study of 229 patients evaluated at 3 academic specialty centers for cardiac amyloidosis and also underwent Tc99mPYP cardiac imaging. We measured retention of Tc99mPYP in the heart using a semiquantitative visual score (range 0-3) and a more quantitative heart-to-contralateral (H/CL) ratio calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc99mPYP imaging.
25 Aug Many Leading Oncologists Have Pharmaceutical Ties
MedicalResearch.com Interview with: [caption id="attachment_27281" align="alignleft" width="160"]
Dr. Aaron Mitchell[/caption]
Dr. Aaron Mitchell MD
Hematology/Oncology Fellow
University North Carolina
MedicalResearch.com: What is the background for this study?
Response: It is well known that many physicians work with the pharmaceutical industry. In some cases, this can create conflicts of interest with physicians' other responsibilities. The Open Payments law, passed as part of the Affordable Care Act, recently made these relationships public, which now allows us to study them more systematically.
25 Aug Study Finds Hair Transplantation Improves Attractiveness in Men With Male Pattern Baldness
MedicalResearch.com Interview with: [caption id="attachment_27278" align="alignleft" width="80"]
Dr. Lisa Ishii[/caption]
Lisa Earnest Ishii, M.D.
Associate Professor, Department of Otolaryngology-Head and Neck Surgery
Division of Facial Plastic and Reconstructive SurgeryJohns Hopkins School of Medicine
Baltimore Maryland 21287
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hair transplantation for men suffering from male pattern hair loss is a common procedure to improve their appearance. However, to the best of our knowledge the impact of the procedure for men with hair loss had never been clearly demonstrated.
We showed, for the first time, that men who undergo the procedure can have real improvements in attractiveness, age, and the appearance of successfulness as perceived by the casual observer in society.
24 Aug Patients With Psoriasis Have Coronary Calcium Scores Comparable to Diabetes
Posted at 21:00h
in Author Interviews, Dermatology, Diabetes, Heart Disease, JAMA, Medical Imaging, NIH
MedicalResearch.com Interview with:
Nehal N. Mehta, .MD., M.S.C.E. F.A.H.A.
Lasker Clinical Research Scholar
Section of Inflammation and Cardiometabolic Diseases
NIH
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Psoriasis is associated with accelerated cardiovascular (CV) disease; however, screening for CV risk factors in psoriasis remains low. Coronary artery calcium (CAC) score estimates the total burden of atherosclerosis. Psoriasis has been associated with increase CAC score, but how this compares to patients with diabetes, who are aggressively screened for CV risk factors, is unknown.
23 Aug Folic Acid May Reduce Progression of Chronic Kidney Disease
MedicalResearch.com Interview with:
Fan Fan Hou MD
Chief, Division of Nephrology, Nanfang Hospital
Professor of Medicine, Southern Medical University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous trials (HOST and DIVINe) of folic acid therapy in CKD patients were conducted in patients with advanced CKD and treated with super-high dose of vitamin B or with cyanocobalamin that has been shown to be renal toxic. The current study sought to evaluated the efficacy of folic acid therapy without cyanocobalamin on renal outcomes in patients without folic acid fortification and across a spectrum of renal function at baseline from normal to moderate CKD.
We found that treatment with enalapril-folic acid, as compared with enalapril alone, reduced the risk of progression of CKD by 21% and the rate of eGFR decline by 10% in hypertensive patients. More importantly, the presence of CKD at baseline was a significant modifier of the treatment effect (p for interaction = 0.01). Patients with CKD benefited most from the folic acid therapy, with a 56% and 44% reduction in the risk for progression of CKD and the rate of eGFR decline, respectively. In contrast, the renal protective effect in those without CKD was nominal.
22 Aug Patients Remain On High Risk Drugs Even After A Fragility Fracture
MedicalResearch.com Interview with: [caption id="attachment_27214" align="alignleft" width="160"]
Dr. Jeffrey Munson[/caption]
Jeffrey Munson, MD, MSCE
Assistant Professor
The Dartmouth Institute for Health Policy & Clinical Practice
Assistant Professor, Department of Medicine
Geisel School of Medicine at Dartmouth
MedicalResearch.com: What is the background for this study?
Response: Fragility fractures due to osteoporosis are a common and costly event among older Americans. Patients who experience one fragility fracture are at increased risk to have a second fracture. Our group is interested in exploring ways in which the risk of a second fracture could be reduced.
In this paper, we studied prescription drug use both before and after fracture. We know many prescription drugs have been shown to increase the risk of fracture, but we don’t know whether doctors try to reduce the use of these drugs after a fracture has occurred. Our study was designed to answer this question.
22 Aug Dialysis Patients Use Emergency Rooms At Six Times Rate of General Population
MedicalResearch.com Interview with: [caption id="attachment_27209" align="alignleft" width="122"]
Dr. Rachel Patzer[/caption]
Rachel Patzer, PhD, MPH
Director of Health Services Research,
Emory Transplant Center
Assistant Professor
Emory University School of Medicine
Department of Surgery
Division of Transplantation
MedicalResearch.com: What is the background for this study?
Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization.
22 Aug Incidence of Pneumonitis from PD-1 Blockers Across Cancers Identified
MedicalResearch.com Interview with: Mizuki Nishino, MD MPH Department of Radiology Brigham and Women’s Hospital and Dana-Farber Cancer Institute Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: Immune-checkpoint inhibitors including PD-1 and PD-L1 inhibitors have brought remarkable advances in treatment of cancer patients. Immune-checkpoint inhibitors are associated with a unique set of adverse events,...