MedicalResearch.com Interview with:
Kenneth L. Kehl, MD
Division of Cancer Medicine, MD Anderson Cancer Center
Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions. We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication. We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication. This effect was independent of patients' stated preferences regarding involvement in decision-making.
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MedicalResearch.com Interview with:
Elizabeth Walker, PhD, MPH, MAT
FIRST Postdoctoral Fellow
Center for Behavioral Health Policy Studies
Rollins School of Public Health, Emory University
Medical Research: What is the background for this study?
Response: Mental disorders are a major cause of disability globally and are associated with premature mortality. Quantifying and understanding excess mortality among people with mental disorders can inform approaches for reducing this burden. The purpose of this study was to systematically review the literature in order to estimate individual- and population-level mortality rates associated with mental disorders. We conducted a comprehensive systematic review and meta-analysis, which included 203 studies from 29 countries.
Medical Research: What are the main findings?
Response: We estimated that 8 million deaths worldwide per year are attributable to mental disorders. People with mental disorders have over 2 times the risk of mortality compared to the general population or people without mental disorders. This translates to a median of 10 years of life lost. In total, 67.3% of people with mental disorders died from natural causes, 17.5% from unnatural causes, and the remainder from unknown causes.
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MedicalResearch.com Interview with:
Omar A. Ibrahimi, M.D., Ph.D
Connecticut Skin Institute
Founding Medical Director
Stamford, CT 06905
www.ctskindoc.comMedical Research: What is the background for this study? What are the main findings?
Dr. Ibrahimi: The delivery of healthcare in a efficient and cost effective fashion is one of the largest themes in medicine today. Malpractice lawsuits have steadily increased with the cost of healthcare delivery. Mohs surgery involves the surgical removal, the tissue analysis and the reconstruction of a skin cancer all in a single visit that bundles multiple procedures in a cost effective manner that is proposed to be the gold standard for treating certain skin cancers.
Information regarding malpractice involving Mohs surgery is lacking. The only previous study that has been done was a survey of Mohs surgeons looking at how many had been involved in lawsuits and the reasons for being involved. Our study examined a legal database to identify all the lawsuits involving Mohs surgery and skin cancer. We were surprised to find that the majority of lawsuits involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis, cosmetic outcome issues, lack of informed consent, and a delay of or failure in referral to a Mohs surgeon.(more…)
MedicalResearch.com Interview with:
Prof. Kazem Rahimi DM MSc FESC
Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom
Medical Research: What is the background for this study? What are the main findings?
Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease.
We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes.
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MedicalResearch.com Interview with:
Andres Moreno De Luca, MD
Investigator and Resident Physician
Autism & Developmental Medicine Institute
Department of Radiology Geisinger Health System
Danville, PA 17822
Medical Research: What is the background for this study? What are the main findings?Response: The main finding of our study is that family background contributes to the variability in cognitive, behavioral, and motor performance seen in children with 16p11.2 deletions, and perhaps other genetic syndromes, and this may be attributed in part to genetic background effects.
In the general population the best predictor of a child’s outcomes in traits such as cognitive ability, height, BMI, etc. is the biparental mean performance in such domains and this is due in part to genetic background. For example, if a child’s parents have IQ scores of 130 and 110, it is expected that the child will have an IQ within 2 standard deviations of 120 (bi-parental mean). However, when studying individuals with genetic conditions, most researchers tend to overlook the influence of familial/genetic background on the affected child’s outcomes and commonly attribute the manifestations (or lack thereof) to the genetic mutation alone.
This creates confusion when studying children with neurodevelopmental disorders, such as autism, which show significant clinical variability, as some children with a specific genetic mutation (e.g. deletion 16p11.2) may have intellectual disability without autism, while other children with the same mutation may have autism without intellectual disability. Based on these observations, some researchers have argued that deletion 16p11.2 is incompletely penetrant. However, our study showed that the 16p11.2 deletion has a detrimental effect on cognitive and behavioral performance for all children, but the clinical status (affected vs. unaffected) and ultimate performance level is influenced by the parental performance.
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MedicalResearch.com Interview with:
Torsten Olbers MD, PhD
Assistant Professor of Surgery
Sahlgrenska University Hospital
Gothenburg, Sweden
Medical Research: What is the background for this study? What are the main findings?
Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th.
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MedicalResearch.com Interview with:Dr. Eleanor B. Schwarz, M.D., M.S
University of California, Davis
Sacramento, CA
MedicalResearch.com:What is the background for this study? What are the main findings?Dr. Schwarz: The background for this study is that…
Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects.
Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others.
MedicalResearch.com:What should clinicians and patients take away from your report?Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard).
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MedicalResearch.com Interview with John Holcomb, M.D.
Principal investigator, Retired U.S. Army Surgeon
Director of the Division of Acute Care Surgery
The University of Texas Health Science Center at Houston
UTHealth Medical School
MedicalResearch: What is the background for this study?
Dr. Holcomb: This study is the result of two decades of work by literally hundreds of investigators. It started as an observation in 1993 in Somalia that whole blood was a superior resuscitation product in casualties that were bleeding to death. Unfortunately, whole blood is not widely available, and 1:1:1 is the closest we can get at this time. After many studies from the battlefield, and even more in the civilian area, we have now published a randomized study documenting that 1:1:1 is a superior transfusion strategy, safe and helps prevent patients from bleeding to death.
MedicalResearch: What are the main findings?Dr. Holcomb: The 1:1:1 resuscitation strategy significantly decreased the rate of bleeding to death, and there were no increased complications between groups.
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MedicalResearch.com Interview with:
Dr. Ryan Merkow, M.D. M.S.
American College of Surgeons
Chicago, Illinois
MedicalResearch.com:What is the background for this study? What are the main findings?Dr. Merkow: The measurement of hospital readmissions has become an important quality and cost-containment metric. Hospitals, policy makers, and individual practitioners are closely tracking readmissions. For the past decade the focus has been primarily on three medical conditions (pneumonia, heart failure and myocardial infarction) and although controversial, many thought leaders and policy makers believed that readmissions were preventable, and stemmed from poor transition of care, outpatient follow up or simply a failure of the medical system to appropriately care for these patients. Recently, the Center for Medicare and Medicaid Services has become increasingly interested in using readmissions as a quality measure and is now mandated by the Hospital Readmission Reduction Program to track hospital-wide readmissions (including all surgical patients), and for the first time, after individual surgical procedures (i.e., total hip and knee replacement). Future inclusion of additional surgical procedures is anticipated.
However, despite the growing focus on readmissions after surgery, there have been few studies comprehensively evaluating the underlying reasons and factors associated with readmissions after surgical hospitalizations. Furthermore, the relationship between readmissions and complications that occur during the initial hospitalization after surgery is not clearly established. Importantly, unlike medical conditions, surgical patients undergo a discrete invasive event with known risks of complications. By studying this topic, initiatives to decrease readmissions can be more precisely determined, and national policy decisions that are now targeting readmissions can be appropriately formulated.
The primary findings of our study identified surgical site infections as the most frequent reason that patients are readmitted after surgery, Importantly, in >95% of patients this complication was new, occurring after they left the hospital. The other common reason for readmission was obstruction or ileus, which was the second most frequent reason for readmission, particularly after abdominal surgery. Overall, the vast majority of readmissions were the result of new postdischarge, postoperative complications. With respect to factors associated with readmissions, most of the variation was due to differences in patient factors, such as ASA class, renal failure, ascites and/or steroid use.
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Nicholas Osborne, M.D., M.SVascular Surgery Fellow
University of Michigan, Ann Arbor
MedicalResearch.com: What is the background for this study?Dr. Osborne: The American College of Surgeons launched the National Surgical Quality Improvement Program (ACS-NSQIP) in the early 2000s. This program collects and reports surgical outcomes to participating hospitals. One retrospective study of participating hospitals in the ACS-NSQIP reported improvements in risk-adjusted outcomes with participation. This study, however, did not compare ACS-NSQIP hospitals to control hospitals. The purpose of our study was to compare ACS-NSQIP to similar non-participating hospitals over time and determine whether participation in the ACS-NSQIP was associated with improved outcomes.
MedicalResearch.com: What are the main findings?Dr. Osborne: When comparing hospitals participating in a national quality reporting program (ACS-NSQIP) to similar hospitals, there is no appreciable improvement in outcomes (mortality, morbidity, readmissions or cost) outside of pre-existing trends across all hospitals. In other words, Hospitals nationwide were improving over this same time period and ACS-NSQIP hospitals did not improve above and beyond these existing trends.
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MedicalResearch.com Interview with:
Adeel A. Butt, MD, MS, FACP, FIDSA
Adjunct Associate Professor of Medicine and Clinical and Translational Science
University of Pittsburgh School of Medicine
MedicalResearch:What is the background for this study? What are the main findings?
Dr. Butt: Studying clinical consequences of hepatitis C virus (HCV) infection is often limited by the lack of knowledge of actual time of infection. We used the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES), a well-established national cohort of HCV infected veterans and corresponding HCV-uninfected controls, to identify patients with a known time frame for HCV infection. Our primary aim was to determine the rate of liver fibrosis progression among HCV-infected persons over time, with and to determine factors associated with development of cirrhosis and hepatic decompensation among these persons.
Among 1840 persons who were HCV+ and 1840 HCV− controls, we found that fibrosis progression started early after HCV infection tapered off after 5 years. After 10 years of follow-up, 18.4% of HCV+ and 6.1% of HCV- persons developed liver cirrhosis. Nine years after diagnosis of cirrhosis, only 1.8% of HCV+ and 0.3% of HCV- persons had developed hepatic decompensation.
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MedicalResearch.com Interview with:
Mohummad Minhaj Siddiqui, MD
Assistant Professor of Surgery - Urology
Director of Urologic Robotic Surgery
University of Maryland School of Medicine and
Peter A. Pinto, M.DHead, Prostate Cancer Section Director, Fellowship Program
Urologic Oncology Branch National Cancer Institute National Institutes of Health Bethesda, Maryland Medical Research: What is the background for this study? What are the main findings?
Response: For men suspected of having prostate cancer due to an elevated PSA or abnormal digital rectal exam, the next step in their diagnostic workup has traditionally been a standard 12-core biopsy to evenly sample the entire gland. Unlike most other cancers, prostate cancer is one of the few solid tumors left which is diagnosed by randomly sampling the gland with the hope of biopsying the tumor, if it is present. This paradigm has been largely due to the fact that imaging to date has been limited in its ability to identify prostate cancer. Recent advancements in multiparametric MRI of the prostate however has significantly improved clinician's ability to identify regions in the prostate suspicious for cancer. This has led to the emergence of MR/Ultrasound fusion technology which allows for targeted biopsy of the prostate into regions suspicious for cancer.
Although conceptually, it makes sense that a targeted biopsy has the potential to perform better than the standard random sampling of the prostate in the diagnosis of prostate cancer, studies were needed to understand if this is true, and if so, if the improvement was substantial enough to justify the extra expense and effort needed to obtain a MRI guided biopsy. This study performed at the National Cancer Institute's Clinical Center sought to address this clinical question of interest. From 2007-2014, a total of 1003 men suspected to have prostate cancer underwent an MRI of the prostate. If an area of suspicion was seen in the prostate, these men underwent both the targeted biopsy of the suspicious region in the prostate as well as the standard 12-core needle biopsy during the same session. The results from the targeted biopsy were compared to the results of the standard biopsy.
The key findings in this study was that targeted biopsy improved the rate at which high-risk clinically significant cancer was diagnosed by 30%. Of interest, the study also found that low-risk, clinically insignificant disease (the type of prostate cancer that is unlikely to cause any harm to the patient over the course of his natural life) was decreased in diagnosis by 17%. Decrease of diagnosis of such disease has the potential benefit that it could lead to less over-treatment of cancer that never needed to be treated. In a subset of 170 men that ultimately underwent surgery to remove the prostate to treat their cancer, we were further able to examine how well the prostate biopsy reflected the actual cancer burden in the whole gland. It is well known that standard biopsy can actually underestimate the total cancer grade in the whole prostate in upwards of 30-40% of cases. We found that the targeted biopsy was significantly better at predicting whether the patient had intermediate to high-risk cancer compared to standard biopsy. Through further analysis using a statistical method called decision curve analysis, we further found that for men who wish to undergo surgery for intermediate to high-risk cancer, but wish to go on active surveillance for low-risk cancer, targeted biopsy led to better decision making compared to standard biopsy, or even the two techniques combined.
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MedicalResearch.com Interview with:
Margaret T. Dillon, AuD
University of North Carolina School of MedicineMedical Research: What is the background for this study? What are the main findings?Dr. Dillon: The goal of this study was to evaluate whether age at revision cochlear implantation influences post-revision speech perception performance. A cochlear implant is an implantable auditory prosthesis that aims to provide sound to patients with certain degrees of hearing loss, by converting and transmitting the acoustic sound into electric stimulation. Research has shown cochlear implant recipients experience improved speech perception in quiet and noise as compared to preoperative performance with conventional amplification (ie, hearing aids). There is variability in postoperative performance. Understanding the cause or causes of this variability is the primary goal of a number of research studies. One suspected indicator for this variability is advanced age at the time of surgery.
Though the incidence of revision cochlear implantation is low, it may be warranted when the internal device is no longer functional or not functioning optimally. We reviewed the pre-revision and post-revision speech perception performance of younger (< 65 years of age) and older (> 65 years of age) adult cochlear implant recipients. There was no difference between the post-revision speech perception performance between the two groups.
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MedicalResearch.com Interview with:Shelly L. Gray, PharmD, MS
Professor of Pharmacy
School of Pharmacy, University of Washington, Seattle
Medical Research: What is the background for this study? What are the main findings?Dr. Gray: Many medications have anticholinergic effects such as those used to treat overactive bladder, seasonal allergies, and depression. The general view is that anticholinergic-induced cognitive impairment is reversible, however, emerging evidence suggests that these medications may be associated with increased dementia risk. We conducted a prospective population-based cohort study in 3434 older adults to examine whether cumulative anticholinergic medication use is associated with increased risk of incident dementia. Using automated pharmacy data, we found that higher 10-year cumulative dose was associated with increased risk for dementia and Alzheimer disease over an average of 7.3 years of follow-up. In particular, people with the highest use (e.g. taking the equivalent of oxybutynin 5 mg/day or chlorpheniramine 4 mg/day for longer than 3 years) were at greatest risk.(more…)
MedicalResearch.com Interview with:
Simone L. Li, PhD
Retina Foundation of the Southwest
Dallas, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Li: In a previous study, we found that binocular iPad game play significantly improved visual acuity in the amblyopic eye. The purpose of the current study was to determine the longevity of these effects and we found that the visual acuity improvements obtained with binocular iPad game play had been retained for at least 12 months after the treatment ended.
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MedicalResearch.com Interview with:
David P.G. van den Berg PhD student
Clinical Psychologist Cognitive behavioural therapist
Parnassia Psychiatric Institute
Early Detection and Intervention Team (EDIT)
Zoutkeetsingel, The Netherlands
Medical Research: What is the background for this study? What are the main findings?Response: The last decade it has become clear that many people with psychotic disorders suffered severe childhood trauma. These experiences enhance chances of developing psychosis, but also result in comorbid posttraumatic stress disorder (PTSD). PTSD is highly prevalent in patients with psychotic disorders and negatively influences prognosis and wellbeing. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective treatments and recommended as first choice treatments in PTSD guidelines worldwide. Although there is no evidence to support this, patients with psychosis are excluded from PTSD treatment due to fear of destabilization or psychotic decompensation. Moreover, psychosis is the most used exclusion criterion in PTSD trials. This is the first randomized clinical trial (RCT) of the efficacy of PTSD treatment in psychosis.
In this RCT 155 patients with a psychotic disorder and comorbid PTSD were randomly assigned to PE, EMDR or Waiting List (WL). In the treatment conditions participants received 8 sessions of 90-minutes therapy. Standard protocols were used. Treatment was not preceded by stabilizing psychotherapeutic interventions or skills training. The first session comprised psycho-education about PTSD and target selection. In sessions 2 to 8 traumas were treated, starting with the most distressing experience. Baseline, post-treatment and 6-month follow-up assessments were made. Participants in both PE and EMDR showed greater reduction of PTSD symptoms than those in WL. Between group effect sizes were large. About sixty percent of the participants in the treatment groups achieved loss of diagnosis. Treatment effects were maintained at six-month follow-up for both PE and EMDR. Treatments did not result in serious adversities.
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MedicalResearch.com Interview with:
Prof. David Mackey
Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth
Managing Director/Chair of University of Western Australia,
Perth, Australia
Centre for Eye Research Australia, Melbourne University
MedicalResearch: What is the background for this study? What are the main findings?Prof. Mackey: Too much or too little sun? Excessive sun exposure is associated with the eye disease pterygium, while lack of outdoor activity in childhood increases the risk of myopia (short sightedness).
Measuring the amount of early sun damage to a person’s eyes would be of great use to researchers and potential use in clinical practice.
Over the last few years we have developed a biomarker for sun exposure to the eye by photographing Conjunctival UV Auto-Fluorescence (CUVAF).
The study published in JAMA Ophthalmology looked at the genetic and environmental factors that contribute to CUVAF levels in three Australian studies from Tasmania, Perth and Brisbane.
People who live in sunnier environments closer to the equator have more evidence of sun damage using CUVAF. However, genetic factors also play a role.
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MedicalResearch.com Interview with:
Thomas C. Tsai, MD, MPH
Departments of Surgery and Health Policy and Management
Harvard School of Public Health, Boston, MassachusettsMedical Research: What is the background for this study? What are the main findings?
Dr. Tsai: Emerging evidence is suggesting that fragmented care is associated with higher costs and lower quality. For elderly patients undergoing major surgical procedures, fragmentation of care in the post-discharge period may be especially problematic. We therefore hypothesized that elderly patients receiving fragmented post-discharge care would have worse outcomes. We found that among Medicare patients who are readmitted after a major surgical operation, one in four are readmitted to a different hospital than the one where the original operation was performed. Even taking distance traveled into account, we find that this type of postsurgical care fragmentation is associated with a substantially higher risk of death.
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MedicalResearch.com Interview with:M. Justin Coffey MD
Associate Professor
Menninger Department of Psychiatry & Behavioral Sciences
Baylor College of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Coffey: Although both the US Surgeon General and the Institute of Medicine have called on health care systems to reduce suicide, the few assessments of suicide in such systems have examined only specific patient groups and not the entire population of health plan members. Our study reports the first information on suicide for the entire membership of a large health maintenance organization (HMO). The findings provide a previously unavailable baseline data for health care systems who are engaged in important efforts to measure and prevent suicide.
We identified all suicides among the entire membership of our HMO network between 1999 and 2010, determining the date and cause of death using official state mortality records. In our sample, the annual suicide rate among all HMO members (including non-patient members) did not change over time, whereas the annual suicide rate in the general population of the state of Michigan increased significantly. Importantly, suicides actually decreased among HMO members who received specialty mental health services, whereas suicides increased among HMO members who accessed general medical services but not specialty mental health services. (more…)
MedicalResearch.com Interview with:Dr. Juliane Kämmer Postdoctoral Researcheron behalf of the authors
Max Planck Institute for Human Development
Center for Adaptive Rationality Berlin Germany
Medical Research: What is the background for this study? What are the main findings?Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy).
In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error.
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MedicalResearch.com Interview with:
Sheree L. Boulet, DrPH, MPH
Division of Reproductive Health
Centers for Disease Control and Prevention, Atlanta, GeorgiaMedical Research: What is the background for this study? What are the main findings?Dr. Boulet: Intracytoplasmic Sperm Injection is generally considered a safe and effective treatment for male factor infertility; however, some studies have shown that ICSI is increasingly used in patients without male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). In addition to increasing the cost of an IVF cycle, use of Intracytoplasmic Sperm Injection has been found to increase the risk for adverse infant outcomes such as birth defects, chromosomal abnormalities and autism. Using data from CDC’s National Assisted Reproductive Technology Surveillance System, we found that use of ICSI increased by fourfold from 1996 through 2012 (from 15.4% to 66.9%). Furthermore, we found that use of Intracytoplasmic Sperm Injection did not improve reproductive outcomes such as rates of pregnancy, miscarriage and live birth, when compared with conventional IVF, regardless of whether male factor infertility was present.
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MedicalResearch.com Interview with:
Andreas Kalogeropoulos, MD MPH PhD
Assistant Professor of Medicine (Cardiology)
Emory University School of Medicine Emory Clinical Cardiovascular Research Institute
Atlanta GA 30322
Medical Research: What is the background for this study? What are the main findings?Dr. Kalogeropoulos: There is ongoing debate on how low should we go when it comes to dietary sodium (salt) restriction recommendations. In this study, we examined the association between self-reported dietary sodium intake and 10-year risk for death, cardiovascular disease, and heart failure in approximately 2,600 adults 71-80 years old. The subjects (women: 51.2%; white: 61.7%; black: 38.3%) were participants of the community-based Health, Aging, and Body Composition Study, which is sponsored by NIH and focuses on aging processes, i.e. was not specifically designed to address the issue of dietary salt intake. Also, it is important to note that salt intake was self-reported (not objectively measured) using a food frequency questionnaire, which underestimates salt intake. Keeping these limitations in mind, we did not observe a significant association between self-reported sodium intake and 10-year mortality, cardiovascular disease, and heart failure. Ten-year mortality was lower in the group reporting 1500–2300 mg daily sodium intake (30.7%) compared to those reporting daily intake less than 1500 mg (33.8%) or over 2300 mg (35.2%); however, this difference was not statistically significant. The 10-year event rates for cardiovascular disease (28.5%, 28.2%, and 29.7%) and heart failure (15.7%, 14.3%, and 15.5%) were also comparable across the <1500-mg, 1500-2300-mg, and >2300-mg dietary sodium intake groups.
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MedicalResearch.com Interview with:
Jose Gutierrez MD, MPH
Assistant Professor of Neurology
Division of Stroke and Cerebrovascular Disease
Columbia University Medical Center NY, NYMedical Research: What is the background for this study? What are the main findings?
Dr. Gutierrez: There is growing interest in the effects of vascular health in cognition. The prevailing thought is that vascular disease leads to worse cognition due to direct structural damage of the brain, as in the case of brain infarcts, microhemorrhages or white matter hyperintensities, which are themselves associated with traditional cardiovascular risk factors such as hypertension, diabetes, smoking etc. Arterial stiffness, particularly of the aorta, has gained interest among researchers as predictors of vascular disease and worse cognition, but it is not clear whether arterial stiffness in the absence of traditional definition of vascular disease may be associated with worse cognition.
We investigated in a representative sample of the US among adults 60 years or older who underwent cognitive testing with the Digit Symbol Subtraction test and who also had other measures of vascular disease, including blood workup, blood pressure measurement and Pulse pressure. We hypothesized that indirect measures of arterial stiffness such as ABI > 1.3 or pulse pressure would be associated with worse cognition, even among those without any clinical vascular disease or traditional vascular risk factors. We Included 2573 US adults in the sample, segregated those with any self-reported vascular disease or vascular risk factors and we found that among those without vascular disease or risk factors, an ABI > 1.3 and increased intra-visit blood pressure variability were predictors of worse cognitive performance compared with those without these indicators. Among participants with both indirect markers of arterial stiffness, their cognitive performance was worse that having only one of them suggesting additive effects of these two variables.
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MedicalResearch.com Interview with:
Jane Wardle
University College LondonMedical Research: What is the background for this study? What are the main findings?
Dr. Wardle: Previous studies have shown that couples tend to have similar health behaviours to one another, but no studies had compared having a partner who takes up a healthy behaviour (e.g. quits smoking) with having one whose behaviour is consistently healthy (e.g. never smoked). Nor have there been other studies in the older age group – our participants were over 60 on average. We used data from 3722 couples participating in the English Longitudinal Study of Ageing (ELSA) to explore this issue for three behaviours: smoking, physical activity, and weight loss. For each behaviour, we found that when one partner changed their behaviour, the other partner was more likely to make a positive change, and the effect was stronger than having a partner whose behaviour was consistently healthy (i.e. never smoked/always exercised).
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MedicalResearch.com Interview with:
Soko Setoguchi, MD DrPH
Assistant Professor of Medicine
Harvard Medical School and Harvard School of Public Health
Director of Safety and Outcome Research in Cardiology
Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Setoguchi: Medicare made a decision to cover Carotid Artery Stenting (CAS) in 2005 after publication of SAPPHIRE, which demonstrated the efficacy of Carotid Artery Stenting (CAS) vs Carotid endarterectomy (CEA) in high risk patients for CEA. Despite the data showing increased carotid artery stenting dissemination following the 2005 National Coverage Determination, peri-procedural and long-term outcomes have not been described among Medicare beneficiaries, who are quite different from trial patients, older and with more comorbidities in general population.
Understanding the outcomes in these population is particularly important in the light of more recent study, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which established CAS as a safe and efficacious alternative to CEA among non-high-surgical risk patients that also expanded the clinical indication of carotid artery stenting.
Another motivation to study ‘real world outcomes in the general population is expected differences in the proficiency of physicians peforming stenting in trial setting vs. real world practice setting. SAPPHIRE and CREST physicians were enrolled only after having demonstrated CAS proficiency with low complication rates whereas hands-on experience and patient outcomes among real-world physicians and hospitals is likely to be more diverse.
We found that unadjusted mortality risks over study period of 5 years with a mean of 2 years of follow-up in our population was 32%. Much higher mortality risks observed among certain subgroups with older age, symptomatic patients and non-elective hospitalizations.
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MedicalResearch.com Interview with:
Dr. Jeanne Madden PhDInstructor, Department of Population Medicine
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Madden: When Medicare Prescription Drug Coverage started in 2006, many experts voiced concerns about disabled patients with serious mental illness making the transition from state Medicaid coverage to Medicare. Our study is one of the first to examine the impact of the transition in mentally ill populations. People living with schizophrenia and bipolar disorder are at high risk of relapse and hospitalization and are especially vulnerable to disruptions in access to their treatments.
We found that the effects of transitioning from Medicaid to Medicare Part D depended on where patients lived. Transition to Part D in states that put limits on Medicaid drug coverage resulted in fewer patients going without treatment.
By contrast, in states with more generous drug coverage, we saw reductions in use, of antipsychotics in particular, after patients shifted to Medicare Part D. This may have been due to new cost controls used within many private Medicare drug plans. Given that most states in the US are in this latter category, with the relatively generous Medicaid drug coverage, we also found reductions in antipsychotic use nation-wide.
Although a very large group of people made that transition from Medicaid to Medicare in 2006, thousands more still transition every year because when disabled people qualify for Medicare, they must wait 2 years for their benefits kick in. Also, many other disabled patients are on Medicaid only and don’t qualify for Medicare. They are of course affected by restrictions on Medicaid coverage, which vary from state to state.
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MedicalResearch.com Interview with:
Dr. Stefan Goldberg MD
Medical Officer in CDC’s Division of Tuberculosis Elimination
Clinical Research Branch
Medical Research: What is the background for this study? What are the main findings?
Dr. Goldberg: A shorter, simpler treatment regimen for children with latent TB infection can help prevent TB disease and reduce future transmission. The results from our study, a multinational, clinical trial, found that a once-weekly regimen of the anti-TB drugs rifapentine and isoniazid taken as directly observed therapy over a period of three months was safe and as effective for children (age 2-17) in preventing TB disease as the standard self-administered nine-month daily regimen of isoniazid alone. The study also showed that children are more likely to complete the shorter course of treatment, which is important given that treatment completion can be difficult. Specifically, we found that 88 percent of the trial participants on the combination regimen completed therapy while 81 percent completed the standard regimen.
The CDC’s Tuberculosis Trials Consortium (TBTC), which conducted this study, works to include children in research when their inclusion is scientifically supportable and when children also might benefit from important new tools, such as alternative treatment regimens. This study is an extension of a large, international trial among persons age 12 and older, published by TBTC in 2011, which showed the shorter, simpler regimen to be as safe and effective as standard treatment. (more…)
MedicalResearch.com Interview with:
Javaid Iqbal, MD, MSC (Candidate)
Institute of Medical Sciences, and
Women’s College Research Institute/Women’s College Hospital
University of Toronto, Toronto Canada
What is the background for this study? What are the main findings?Dr. Iqbal: A woman’s racial/ethnic background predicts her participation in breast cancer control program (i.e., awareness and screening). The ultimate objective of breast cancer control program is to detect cancer at an optimal stage, which is stage I, because women with stage I breast cancer survive longer. Given the racial/ethnic diversity of North America, this poses questions such as “what predicts stage I breast cancer in the multiethnic North American population?”, “what predicts its survival?”, and “does a woman’s ethnic background plays a role in predicting an early stage, and survival?”
We studied 373,563 women diagnosed with invasive breast cancer in the United States between 2004 and 2011. We followed these women for 7 years and recorded whether or not they died of breast cancer, or whether they are still alive. We then divided all women into different ethnic groups, in particular white, black, Chinese, Japanese, and Indian/Pakistani (South Asian). For each racial/ethnic group, we estimated proportions of women who were diagnosed with stage I breast cancer, and risk of death at 7 years. Our aim was to determine if the racial/ethnic differences in early stage breast cancer, and its survival were better explained by intrinsic biological differences in tumor characteristics, or by differences in early-detection of breast cancer.
We found that a woman’s racial/ethnic background predicted the diagnosis of stage I breast cancer, as well as her risk of dying at 7 years after breast cancer. A black woman was less likely than a white woman to be diagnosed with stage I breast cancer. A black woman was also more likely than a white woman to die of stage I breast cancer 7 years after her diagnosis. The Japanese and Chinese women were more likely than white women to be diagnosed with stage I breast cancer. The risk of death at 7 years was lowest for Indian or Pakistani (South Asian) women. Furthermore, even for small sized (2.0) breast cancers the risk of death at 7 years was higher for black women (9%), compared to white women (5%). Compared to white women, small sized breast cancers in black women were more aggressive at diagnosis, and had spread to lymph nodes and other organs.
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MedicalResearch.com Interview with:
Teresa Waters PhD
Professor and Chair, Preventive Medicine
University of Tennessee Health Science Center
Memphis TN
Medical Research: What is the background for this study? What are the main findings?
Dr. Waters: On October 1, 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy penalizing hospitals for eight complications of hospital care, also known as never events. Under the HACs Initiative, hospitals could no longer justify a higher level Medicare MS-DRG when caring for a patient who developed 1 of the 8 never events. This Initiative was one in a series of CMS payment reforms intended to increase emphasis on value-based purchasing.
We found that Medicare's nonpayment policy was associated with significant improvements in the time trends for central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections(CAUTIs). For these outcomes, our data from the National Database of Nursing Quality Indicators showed that introduction of the Medicare policy was associated with an 11% reduction in the rate of change in central line associated blood stream infections and a 10% reduction in the rate of change in CAUTIs. We did not find any relationship between introduction of the policy and significant changes in injurious falls or hospital acquired pressure ulcers (two other important never events covered by the policy). We hypothesized that the Hospital-Acquired Conditions Initiative may have a great effect for conditions where there is strong evidence that better hospital processes yield better outcomes or where processes are more conducive to standardization.
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MedicalResearch.com Interview with:
Kenneth L. Kehl, MD
Division of Cancer Medicine, MD Anderson Cancer Center
Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions. We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication. We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication. This effect was independent of patients' stated preferences regarding involvement in decision-making.
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