Author Interviews, JAMA, Mental Health Research / 13.08.2014

Dr Golam Khandaker Clinical Lecturer, Department of Psychiatry University of Cambridge MedicalResearch.com Interview with Dr Golam Khandaker Clinical Lecturer, Department of Psychiatry University of Cambridge Medical Research: What are the main findings of the study? Dr. Khandaker: The study shows low grade systemic inflammation may have a role in the pathogenesis of depression and psychotic disorders. Low grade systemic inflammation may also be a common cause for chronic physical and psychiatric illnesses. The study shows that higher serum levels of the circulating inflammatory marker, interleukin 6 (IL-6), in childhood is associated with nearly two-fold increased risk of developing depression and psychotic disorder in young adulthood. This association persisted after taking into account effects of age, sex, social class, ethnicity, body mass index, maternal depression, and past psychological and behavioural problem in the participant. We studied a sample of 4,500 individuals from the Avon Longitudinal Study of Parents and Children birth cohort, taking blood samples at age 9 and following up at age 18, to see if they had experienced episodes of depression or psychosis. We excluded children with an infection at the time of blood test at age 9 years. (more…)
Author Interviews, Heart Disease, JAMA / 13.08.2014

Dr. Juhani Airaksinen, MD, PhD Heart Center, Turku University Hospital Turku, FinlandMedicalResearch.com Interview with: Dr. Juhani Airaksinen, MD, PhD Heart Center, Turku University Hospital Turku, Finland Medical Research: What are the main findings of the study? Dr. Airaksinen:  The main result of our study is that the risk of thromboembolic complications in general was low (0.7%). However the risk rose to a 3.7-fold level when the delay to cardioversion exceeded 12 hours. The time-dependent increase in the risk of thromboembolic complications was more pronounced in female patients. In addition, as expected, old age, heart failure and diabetes were the other significant predictors of postcardioversion thromboembolic complications. (more…)
Author Interviews, JAMA, Surgical Research / 13.08.2014

Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, BaltimoreMedicalResearch.com Interview with: Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, Baltimore Medical Research: What are the main findings of this study? Dr. Scalea:  The main findings of the study was that putting this financial incentive program in place had immediate and dramatic effects on first cases starting on time and turnaround times decreasing in our operating room. (more…)
JAMA, Ophthalmology / 11.08.2014

Helen A. Mintz-Hittner, M.D., F.A.C.S. Alfred W. Lasher, III, Professor of Ophthalmology Department of Ophthalmology and Visual Science The University of Texas Health Science Center at Houston-Medical School Cizik Eye ClinicMedicalResearch.com Interview with: Helen A. Mintz-Hittner, M.D., F.A.C.S. Alfred W. Lasher, III, Professor of Ophthalmology Department of Ophthalmology and Visual Science The University of Texas Health Science Center at Houston-Medical School Cizik Eye Clinic Medical Research: What are the main findings of the study? Dr. Mintz-Hittner:
  • For retinopathy of prematurity (ROP), at age 2 ½ years, intravitreal bevacizumab (IVB) injections cause less myopia (nearsightedness) in diopters (D) compared to conventional laser therapy (CLT):f
  • or Zone I: -1.51 D versus -8.44 D (7 diopters difference: p = 0.001. for Posterior Zone II: -0.58 D versus -5.83 D (5 diopters difference: p = 0.001.
(more…)
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity / 10.08.2014

MedicalResearch.com Interview with: Sahil Khera, MD and Dhaval Kolte, MD, PhD Department of Medicine, Division of Cardiology New York Medical College, NY Medical Research: What are the main findings of the study? Answer: We used the publicly available Nationwide Inpatient Sample (NIS) databases for our study. We analyzed data on 6.5 million patients with heart attack (all types) from 2002 to 2011 in United States. Out of these 3.98 million were admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Our objective was to describe how the care for patients with NSTEMI has changed over the past 10 years and whether this has resulted in better patient outcomes. We looked at the proportion of patients with NSTEMI who underwent cardiac catheterization each year. We also studied how many patients died in the hospital, how long was the hospital stay, and what was the total cost of hospitalization for this condition. Lastly, we determined if the changes in treatment and outcomes over the years were similar for different age- groups, men and women, and for different racial/ethnic groups. In this analysis, we looked at cardiac catheterization trends after NSTEMI for both within 24 hours and within 48 hours. This is the first study of its kind to analyze two different time frames of early catheterization simultaneously. Although there was an increase in the proportion of patients with NSTEMI with increase in utilization of early cardiac catheterization and decrease in in-hospital death and length of stay, age-, sex-, and race/ethnicity-specific differences in the management and outcomes of NSTEMI were observed, and further studies are needed to develop strategies to ensure more equitable care for patients with this type of heart attack. (more…)
Author Interviews, JAMA, Surgical Research / 06.08.2014

MedicalResearch.com Interview Cristina B. Geltzeiler, MD Knight Cancer Institute Oregon Health & Science University Portland, OR 97239-3098 Medical Research: What are the main findings of the study? Dr. Geltzeiler: The main findings of the study are that implementing an Enhanced Recovery After Surgery (ERAS) program at a community hospital can be successfully implemented and can allow patients to recover quicker from their surgery with ongoing safety. (more…)
Addiction, Author Interviews, JAMA / 06.08.2014

Dr. Richard Saitz MD MPH Department of Community Health Sciences Boston University School of Public Health Boston, Massachusetts MedicalResearch.com Interview with: Dr. Richard Saitz MD MPH Department of Community Health Sciences Boston University School of Public Health Boston, Massachusetts Medical Research: What are the main findings of the study? Dr. Saitz: We found that brief counseling interventions had no efficacy for reducing the frequency of illicit drug use or drug use consequences among primary care patients identified by screening as using drugs. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA / 06.08.2014

Maurizio Gasparini, MDMedicalResearch Interview with: Maurizio Gasparini MD Humanitas Research Hospital Rozzano, Italy Medical Research: What are the main findings of the study? Dr. Gasparini: We found that a strategic programming of implantable cardioverter defibrillators which allows the non-sustained arrhythmias to self-terminate is associated with reductions in hospitalizations, length of hospital stay and cost per patient-year and an increase in the time to first hospitalization. These results were mainly driven by reduction in cardiovascular-related events. (more…)
Allergies, Author Interviews, Dermatology, JAMA / 06.08.2014

upcoming JAMA publication: Shuen-Iu Hung, PhD, for the Taiwan SCAR consortium Associate Professor, Department of Pharmacology, National Yang-Ming University, Taipei, 112 TaiwanMedicalResearch.com Interview with: Shuen-Iu Hung, PhD, for the Taiwan SCAR consortium Associate Professor, Department of Pharmacology, National Yang-Ming University, Taipei, 112 Taiwan   Medical Research: What are the main findings of the study? Reply: Phenytoin, a widely prescribed antiepileptic drug, can cause severe cutaneous adverse reactions (SCAR) (e.g., Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) ), which carry high mortality and morbidity. The genomic basis of phenytoin-induced SCAR has not been known. This study identifies CYP2C variants, including CYP2C9*3 known to reduce drug clearance, as the key genetic factors associated with phenytoin-related severe cutaneous adverse reactions. These findings have potential to improve the safety profile of phenytoin in clinical practice and offer the possibility of prospective testing for preventing phenytoin-related SCAR. (more…)
Blood Pressure - Hypertension, JACC, JAMA, Kidney Disease / 05.08.2014

Dr. John J. Sim Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center, Los Angeles,MedicalResearch.com Interview with: Dr. John J. Sim Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center, Los Angeles, Medical Research: What are the main findings of the study? Dr. Sim: Among a large diverse population of treated hypertensive people, those who achieved systolic blood pressures (SBP) in the ranges of 130-139mm Hg had the lowest risk for death and end stage renal disease (kidney failure).  Not surprisingly, those with SBP above 139 had incrementally greater risk, but somewhat surprising was that those with SBP under 130 also had a greater risk for death and kidney failure. (more…)
Author Interviews, Genetic Research, JAMA, Schizophrenia / 31.07.2014

Dr Angelica Ronald Genes Environment Lifespan (GEL) laboratory Centre for Brain and Cognitive Development Department of Psychological Sciences Birkbeck, University of London London WC1E 7HXMedicalResearch.com Interview with: Dr Angelica Ronald Genes Environment Lifespan (GEL) laboratory Centre for Brain and Cognitive Development Department of Psychological Sciences Birkbeck, University of London London WC1E 7HX Medical Research: What are the main findings of the study? Dr. Ronald: Psychotic experiences, such as paranoia, hallucinations and disorganised thinking, are commonly reported by adolescents. Until now it has not been understood whether mild variations in psychotic experiences in the community are part of the same construct as more severe psychotic experiences in adolescence. Our findings suggest that they are. In our study, over 10,000 16-year-old adolescents in England and Wales were assessed on measures of psychotic experiences. The study identified a close link between normal, less frequent psychotic experiences and more severe and frequent experiences in the general population. A classic twin design was employed, which enabled us to conduct analyses investigating the role of genetic and environmental influences on psychotic experiences. The same genetic influences appeared to play a role across the spectrum of severity of psychotic experiences. The study found that psychotic experiences are moderately heritable in adolescence in the general population. This suggests it would be worth directing molecular genetic endeavours towards this area, which has so far received very little attention in terms of causal explanations. We also show that psychotic experiences have considerable environmental influence; in fact, environmental influence appears to play a larger role in causing psychotic experiences in adolescence than for diagnosed psychotic disorders in adults, such as schizophrenia. This result suggests a fruitful avenue will be to tackle what environmental risk factors influence adolescents to have psychotic experiences. (more…)
Addiction, Author Interviews, JAMA, Pediatrics / 29.07.2014

Sharon Levy, M.D., M.P.H. Director, Adolescent Substance Abuse Program Assistant Professor in Pediatrics Boston Children’s HospitaMedicalResearch.com Interview with: Sharon Levy, M.D., M.P.H. Director, Adolescent Substance Abuse Program Assistant Professor in Pediatrics Boston Children’s Hospital   Medical Research: What are the main findings of the study? Dr. Levy: We found that questions that asked about the frequency of alcohol, tobacco and drug use accurately triaged adolescents into "risk categories".  In other words, kids who reported using alcohol or marijuana "once or twice" last year were unlikely to have a substance use disorder, those who reported "monthly" use were very likely to meet diagnostic criteria for a "mild" or "moderate" substance use disorder while those who reported use weekly or more were very likely to meet diagnostic criteria for a "severe" substance use disorder. (more…)
Author Interviews, Heart Disease, JAMA / 27.07.2014

Dr. Danny Dvir MD St Paul’s Hospital, Vancouver British Columbia, CanadaMedicalResearch.com Interview with: Dr. Danny Dvir MD St Paul’s Hospital, Vancouver British Columbia, Canada Medical Research: Who were the patients studied? Dr. Dvir: The VIVID registry included high-risk patients with failed aortic bioprostheses treated with valve-in-valve. These patients had many comorbidities and high risk scores for early mortality with conventional redo surgery. Medical Research: What are the treatment options for these patients? Dr. Dvir: Patients with failed bioprosthetic valves are conventionally treated with redo surgery. Transcatheter valve-in-valve is a less-invasive approach. (more…)
Author Interviews, JAMA, Psychological Science, University of Pittsburgh / 25.07.2014

John Blosnich, Ph.D., M.P.H., Post-doctoral fellow at the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System. MedicalResearch.com Interview with: John Blosnich, Ph.D., M.P.H., Post-doctoral fellow at the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System. Medical Research: What are the main findings of the study? Dr. Blosnich: I think there are two main findings from our study: First, since the beginning of the All-Volunteer U.S. military in 1973, there has been a shift in childhood experiences among men who have served in the military. Second, the childhood experiences of women who have served in the military have been largely similar across the Draft and All-Volunteer Eras. (more…)
Author Interviews, Cancer Research, JAMA, OBGYNE / 24.07.2014

Jason D. Wright, M.D. Levine Family Assistant Professor of Women's Health Florence Irving Assistant Professor of Obstetrics and Gynecology Division of Gynecologic Oncology Columbia University College of Physicians and Surgeons 161 Fort Washington Ave, 8th Floor New York, New York 10032MedicalResearch.com Interview with: Jason D. Wright, M.D. Levine Family Assistant Professor of Women's Health Florence Irving Assistant Professor of Obstetrics and Gynecology Division of Gynecologic Oncology Columbia University College of Physicians and Surgeons 161 Fort Washington Ave, New York, New York 10032 Medical Research: What are the main findings of the study? Dr. Wright: This study is one of the first large scale studies to examine the risk of cancer specifically in women who underwent hysterectomy with electric power morcellation. Among 32,000 women treated at over 500 hospitals across the US we noted cancer in 27 per 10,000 women. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Neurological Disorders, Stroke / 23.07.2014

MedicalResearch.com Interview with: Agustin Ibanez, PhD Laboratory of Experimental Psychology and Neuroscience Institute of Cognitive Neurology and the National Scientific and Technical Research Council and Sandra Baez, MS; Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina Medical Research: What are the main findings of the study? Answer: Both patients with the behavioral variant of frontotemporal dementia (bvFTD) and patients with frontal strokes presented moral judgment abnormalities. Their deficits were related to impairments in the integration of intentions and outcomes. Specifically, both patient groups judged moral scenarios by focusing on the actions' outcomes instead of the protagonists' intentions. (more…)
Author Interviews, Education, JAMA, Surgical Research, UC Davis / 23.07.2014

  Erin Brown, MD General Surgery PGY6 UC Davis Medical CenterMedicalResearch.com Interview with: Erin Brown, MD General Surgery PGY6 UC Davis Medical Center Medical Research: What are the main findings of the study? Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting.  We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children.  We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores.  Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting. (more…)
Author Interviews, Education, JAMA / 22.07.2014

MedicalResearch.com Interview with: Brian M. Wong, MD, FRCPC Staff Physician, Division of General Internal Medicine Assistant Professor, Department of Medicine Director, Continuing Education & Quality Improvement Associate Director, Centre for Quality Improvement & Patient Safety (C-QuIPS) Sunnybrook Health Sciences Centre Lisa Richardson, MD., MA, FRCPC Department of Medicine, University of Toronto, Division of General Internal Medicine, University Health Network, HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada Medical Research: What are the main findings of the study? Answer: Our study sought to characterize how many clinically important issues that occur during the overnight on-call period were handed over and discussed by the on-call resident with the daytime medical team. For example, if a patient developed chest pain in the middle of the night and the on-call resident evaluated the patient, did the resident then 'handover' this issue to the team the next morning so that they could follow up and make sure that the patient receives timely care? In our study, we found that approximately 40% of these issues did not get handed over. This finding was consistent across 2 major Canadian academic teaching hospitals. (more…)
Author Interviews, Clots - Coagulation, JAMA / 21.07.2014

Riyaz Bashir MD, FACC, RVT Associate Professor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140MedicalResearch.com Interview with Riyaz Bashir MD, FACC, RVT Associate Professor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine, Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140 Medical Research: What is the background for this study? Dr. Bashir : Blood clots of legs called deep vein thrombosis (DVT) is a very common disease that occurs in about 1.0 person per 1000 population per year. This condition is responsible for more than 600,000 hospitalizations each year in the United States and approximately 6% of these patients will die within 1 month of the diagnosis. Amongst these patients 20% - to 50% will go on to develop chronic leg pains, swelling, heaviness, skin discoloration, and ulcers, in spite of conventional treatment with Blood thinning medications (anticoagulation) and compression stockings.This condition, which is called Post-thrombotic syndrome PTS markedly impairs the quality of life of these patients and is a significant economic burden (2.4 billion dollars and 200 million work days lost annually in US) on the society.In fact, many of these people lose their jobs because of the disability it causes. Several small studies have shown that early clot removal by minimally invasive catheter-based clot busting procedure called Catheter-directed thrombolysis (CDT) leads to a significant reduction in Post-thrombotic syndrome along with improvements in quality of life. Unfortunately, due to the small number of patients in these studies, we did not have any data about the safety of this treatment option. This has led to conflicting recommendations by various medical societies like the American College of Chest Physicians recommending against its use while the American Heart Association recommends Catheter-directed thrombolysis as first-line treatment for these patients. In light of these conflicting directives, we reviewed the frequency and safety of CDT versus conventional treatment in these patients with blood clots above the knees in the United States using Nationwide Inpatient Sample database from 2005 to 2010. (more…)
Author Interviews, Brigham & Women's - Harvard, HIV, JAMA, Weight Research / 21.07.2014

Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114MedicalResearch.com Interview with Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114 Medical Research: What are the main findings of the study? Dr. Grinspoon: The primary finding is that tesamorelin, a hypothalamic peptide that increases the endogenous pulsatile secretion of growth hormone, reduced liver fat in HIV-infected patients with increased visceral (abdominal) fat.  Increased visceral fat is very closely linked with increased liver fat in HIV patients, but the effects on liver fat were not known.  Our data show that tesamorelin reduces liver fat in conjunction with decreasing visceral fat, which may be clinically important for patients with HIV-infection who have both increased abdominal fat and fatty liver disease. In addition the study demonstrated that this treatment strategy was neutral to glucose by the end of the 6 month study. (more…)
Author Interviews, HIV, JAMA / 20.07.2014

Dr Peter MacPherson MBChB PhD Wellcome Trust Clinical Research Fellow Liverpool School of Tropical Medicine Department of Clinical Sciences Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QAMedicalResearch.com Interview with: Dr Peter MacPherson MBChB PhD Wellcome Trust Clinical Research Fellow Liverpool School of Tropical Medicine Department of Clinical Sciences Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QA Medical Research: What are the main findings of the study? Dr. MacPherson: In 2012, an estimated 35 million individuals were infected with the human immunodeficiency virus (HIV) worldwide. Antiretroviral therapy (ART) substantially reduces the risk of HIV transmission as well as greatly reducing illness and death, raising hopes that high uptake of annual HIV testing and early initiation of ART could improve HIV prevention as well as care. Achieving high coverage of HIV testing and treatment is a major challenge however, with low rates of HIV testing and poor linkage into HIV care. Self-testing for HIV infection (defined as individuals performing and interpreting their HIV test in private) is a novel approach that has seen high acceptance in Malawi and the United States, and is a process that could overcome barriers to conventional facility-based and community-based HIV testing, which lack privacy and convenience. However, no studies in high HIV prevalence settings have investigated linkage into HIV care after HIV self-testing. Among 16,6660 adults in Blantyre, Malawi offered HIV self-testing, optional home initiation of HIV care (including two-weeks of ART for those eligible) compared with standard HIV care resulted in a substantial and significant increase in the proportion of adults initiating antiretroviral therapy. HIV self-testing was also extremely popular, with 58% of the adult population self-testing with just 6-months. To our knowledge, this is the first study to investigate a comprehensive home-based HIV testing, eligibility assessment and treatment initiation strategy. (more…)
Author Interviews, HIV, JAMA, OBGYNE / 19.07.2014

Jared Baeten, MD PhD Professor, Departments of Global Health and Medicine Adjunct Professor, Department of Epidemiology University of Washington Seattle, WA 98104MedicalResearch.com Interview with: Jared Baeten, MD PhD Professor, Departments of Global Health and Medicine Adjunct Professor, Department of Epidemiology University of Washington Seattle, WA 98104 Medical Research: What are the main findings of the study? Dr. Baeten: Among heterosexual African couples in which the male was HIV positive and the female was not, receipt of antiretroviral pre-exposure preventive (PrEP) therapy did not result in significant differences in pregnancy incidence, birth outcomes, and infant growth compared to females who received placebo. (more…)
Author Interviews, Brain Injury, JAMA / 17.07.2014

MedicalResearch.com Interview with: Emmanuel Lagarde Director of Research at INSERM, France  Medical Research: What are the main findings of the study?  Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.    Medical Research: Were any of the findings unexpected?  Dr. Lagarde: Yes, as we were expecting to observe long term (3-month) symptoms following brain injury, but few were found to be specific : most of them were as frequent among patients with other injuries.  Medical Research: What should clinicians and patients take away from your report?  Dr. Lagarde: It seems as if there is little evidence of the existence of a specific syndrome following mild traumatic brain injury. However, patients who experienced a concussion are at risk of  another well-known syndrome called Posttraumatic Stress Disorder, which is associated with the distressing event that led to the injury.  Medical Research: What recommendations do you have for future research as a result of this study?  Dr. Lagarde: The classification system of symptoms following mild brain injury should be revisited as our results are challenging the very relevance of the DSM-V post concussion syndrome.  Citation: Association of Symptoms Following Mild Traumatic Brain Injury With Posttraumatic Stress Disorder vs Postconcussion SyndromeMedicalResearch.com Interview with: Emmanuel Lagarde Director of Research at INSERM, France Medical Research: What are the main findings of the study? Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder. (more…)
Author Interviews, JAMA, Stroke, Surgical Research / 17.07.2014

Mads E. Jørgensen, M.B. University of Copenhagen, DenmarkMedicalResearch.com Interview with: Mads E. Jørgensen, M.B. University of Copenhagen, Denmark Medical Research: What are the main findings of the study? Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke. An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE. When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke. We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery. (more…)
Author Interviews, JAMA, Prostate Cancer, Testosterone / 16.07.2014

Grace Lu-Yao PhD, MPH Professor of Medicine Robert Wood Johnson Medical School Rutgers, The State University of New Jersey Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903-2681MedicalResearch.com Interview with: Grace Lu-Yao PhD, MPH Professor of Medicine Robert Wood Johnson Medical School Rutgers, The State University of New Jersey Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903-2681 Medical Research: What are the main findings of the study? Dr. Lu-Yao: Primary ADT (ie., use of androgen deprivation as an alternative to surgery, radiation or conservative management for the initial management of prostate cancer) is not associated with improved overall or disease specific survival. (more…)
Author Interviews, JAMA, Pain Research / 15.07.2014

Kurt Kroenke, M.D. Professor of Medicine, Indiana University School of Medicine Research Scientist, Indiana University Center for Health Services and Outcomes Research Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc. Director of Education and Training Programs, Regenstrief Institute, Inc. Core Investigator, VA HSR&D Center for Health Information and CommunicationMedicalResearch.com Interview with: Kurt Kroenke, M.D. Professor of Medicine, Indiana University School of Medicine Research Scientist, Indiana University Center for Health Services and Outcomes Research Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc. Director of Education and Training Programs, Regenstrief Institute, Inc. Core Investigator, VA HSR&D Center for Health Information and Communication
Medical Research: What are the main findings of the study? Dr. Kroenke: The telecare intervention including monitoring of pain using automated phone calls or the Internet with contacts by a nurse care manager who met weekly with a physician pain specialist to discuss treatment of new patients or patients already being followed who were not improving.
  • Almost twice as many patients in the telecare group had improvement in their pain compared to the usual care control group (52% vs. 27%).
  • Moreover, nearly twice as many patients in the usual care group got worse over 12 months (36% vs. 19%).  Thus, patients with chronic pain may not only fail to improve with current treatment, they in fact can get worse over time.
  • Although one-third of these chronic pain patients were on opioids at start of study, there were very few patients in which opioids needed to be started or dose increased.
  • The intervention group was about equally divided between those who chose to do automated symptom monitoring (ASM) by IVR (51%) or internet (49%).  The majority of patients rated the monitoring as easy to do, and the telecare intervention helpful.
(more…)
Author Interviews, JAMA, Mental Health Research / 12.07.2014

MedicalResearch.com interview with: Lee M. Hampton, MD, MSc: Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta, Georgia Medical Research: What are the main findings of the study? Dr. Hampton: The study, which used CDC's national outpatient adverse drug event surveillance system (NEISS-CADES), found that there are almost 90,000 estimated annual emergency department visits by adults for adverse drug events from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants between 2009 and 2011. Almost one in five of those emergency department visits (19.3%) resulted in hospitalization. Sedatives and anxiolytics, antidepressants, and antipsychotics each caused 20,000 to 30,000 emergency department visits annually. However, relative to how often each of these types of medications was prescribed at outpatient visits, antipsychotics and lithium salts were more likely to cause emergency department visits for adverse drug events than were sedatives, stimulants, and antidepressants. Antipsychotics caused 3.3 times more emergency department visits for adverse drug events than sedatives, 4.0 times more emergency department visits than stimulants, and 4.9 times more emergency department visits than antidepressants relative to their outpatient use. Out of the 83 specific drugs the study looked at, ten drugs were implicated in nearly 60% of the emergency department visits for ADEs from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants. Zolpidem was implicated in nearly 12% of all such emergency department visits and 21% of such emergency department visits involving adults aged 65 years or older, more than any other antipsychotic, antidepressant, sedative or anxiolytic, lithium salt or stimulant. (more…)
Antibiotic Resistance, Author Interviews, JAMA, Surgical Research / 09.07.2014

Jean Marc Regimbeau MedicalResearch.com Interview with : Pr. Jean-Marc Regimbeau Service de Chirurgie Digestive Oncologique et Métabolique, CHU d’Amiens   Medical Research : What are the main findings of the study? Answer: In our study we found that the absence of postoperative administration of amoxicillin plus clavulanic acid did not improve the occurrence of postoperative infections in patients with mild or moderate acute calculous cholecystitis. The bile cultures were pathogen free in 60.9% of case. Moreover we show that less than 2 percent of the overall population presented a major complication defined according to the Clavien Dindo Classification (Clavien score ≥3a). After cholecystectomy the readmission rate was 6%. (more…)
Author Interviews, JAMA, Smoking / 09.07.2014

MedicalResearch.com Interview with: Coenie Koegelenberg, MBChB, MMed (Int), FCP (SA), MRCP (UK), Cert Pulm (SA), PhD Associate Professor: Pulmonology Stellenbosch University & Tygerberg Academic Hospital MedicalResearch.com Interview with: Coenie Koegelenberg, MBChB, MMed (Int), FCP (SA), MRCP (UK), Cert Pulm (SA), PhD Associate Professor: Pulmonology Stellenbosch University & Tygerberg Academic Hospital Medical Research: What are the main findings of the study? Dr. Koegelenberg: The aim of this study was to evaluate the efficacy of combining varenicline and a nicotine patch versus varenicline alone as an aid to smoking cessation in a double-blind study design in a larger group and with a longer assessment period than has been studied to date. It was found that the combination treatment was associated with a statistically significant and clinically important higher continuous abstinence rate at 12 weeks (55.4% vs. 40.9%; P=.007) and 24 weeks (49.0% vs. 32.6%; P=.004), and point prevalence abstinence rate at 6 months (65.1% vs. 46.7%; P=.002). The present study was not adequately powered to fully assess safety and tolerability endpoints, but the results suggest that adverse events were balanced across treatment arms, except for mild skin reactions that were more frequently observed in the nicotine patch group (14.4% vs. 7.8%, P=.03). (more…)