MedicalResearch.com Interview with:Susan Matulevicius, MD, MSCS
Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
MedicalResearch.com: What are the main findings of the study?Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care.
MedicalResearch.com Interview with:Aneel Bhangu, MBChB, MRCS and Douglas M. Bowley, FRCS
Royal Centre for Defense Medicine, Birmingham, England
MedicalResearch.com: What are the main findings of the study? Answer: Our study was a meta-analysis, which combined the findings from 8 randomized controlled trials that included a total of 623 patients. The key finding was that delayed primary skin closure (DPC) for contaminated and dirty abdominal incisions may reduce the rate of surgical site infection. However, due to high risk of bias from the included studies, including flaws in study design, definitive evidence is lacking.
We believe that this meta-analysis represents an exciting development in biomedical publishing; this was a true collaboration between US and UK military surgeons to examine an area of major concern and interest to surgeons everywhere. This work uses experience hard-won on the battlefields of Iraq and Afghanistan, combined with published surgical trials, to inform both future research activity as well as military and civilian surgical practice. This cross-fertilization of ideas is one positive consequence of all the sacrifice and suffering of recent conflicts.
MedicalResearch.com Interview with: Andreas Beyerlein, PhD
Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
MedicalResearch.com What are the main findings of the study?Dr. Beyerlein: We identified respiratory infections in early childhood, especially in the first year of life, as a risk factor for islet autoimmunity, which is known as a precursor of type 1 diabetes (T1D). We also found some evidence for short term effects of infectious events on development of autoimmunity.
MedicalResearch.com Interview with Jill M. Norris, MPH, PhDColorado School of Public Health, University of Colorado, Aurora
MedicalResearch.com: What were the most significant findings? How do they relate to what was already known about this subject?Dr. Norris: One of the most intriguing findings is that if mothers are still breast-feeding when they introduce gluten-containing foods to their baby, they may reduce the risk for T1D. This is similar to a finding from a Swedish study that found that breast-feeding while introducing gluten-containing foods may reduce the risk for celiac disease, an autoimmune condition that has several similarities with T1D.
In children at increased genetic risk for T1D, our data suggest that parents should wait to introduce any solid foods until after the 4 month birthday. And when the baby is ready, solid foods should be introduced by the 6 months birthday or soon thereafter, preferably while the mother is still breast-feeding the baby, which may reduce the risk of T1D.
MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S.
Division Head, Hospital Medicine
University of Wisconsin Department of Medicine
Ann M. Sheehy, M.D., M.S.
Division Head, Hospital Medicine
University of Wisconsin Department of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Sheehy: There were three main findings of our study.
First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined.
Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services.
Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin.
MedicalResearch.com Interview with:
Maarten C. Bosland, DVSc, PhD
Professor of Pathology
Department of Pathology
University of Illinois at Chicago
College of Medicine
Chicago, IL 60612
MedicalResearch.com: What are the main findings of the study?Dr. Bosland: Daily consumption of a supplement containing soy protein isolate for two years following radical prostatectomy did not reduce recurrence of prostate cancer in men at high risk for this (radical prostatectomy is surgical removal of the prostate to treat prostate cancer). The study showed that this soy supplementation was safe. It is not clear whether this result indicates that soy does not prevent the development of prostate cancer, but men that have the disease probably do not benefit from soy supplementation.
MedicalResearch.com Interview with: Jonas Eriksson, PhD-student
Clinical Epidemiology Unit
Karolinska Institutet, T2
171 76 STOCKHOLM
Biological vs Conventional Combination Treatment and Work Loss in Early Rheumatoid Arthritis A Randomized TrialMedicalResearch.com: What are the main findings of the study?
Answer: The main finding from this study is that in patients with early rheumatoid arthritis and with an insufficient response to methotrexate, addition of biologic (infliximab) or conventional combination therapy (sulfasalazine+hydroxychlorquine) resulted in significant improvements in work ability over 21 months. However, at 21 months, no significant difference could be detected in work ability change between patients randomized to addition of biologic or conventional therapy. When comparing the randomized early rheumatoid arthritis patients to matched general population comparators, the average number of days of work loss did not return to the level of the general population, underscoring the need for more effective treatment strategies and earlier diagnosis.
MedicalResearch.com Interview with Salim S. Virani, MD, PhD
Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine,
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
MedicalResearch.com: What are the main findings of the study?Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients. Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up.
Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing.
MedicalResearch.com Interview with: Susan Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Stanford University Medical Center & Cancer Institute
Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females
MedicalResearch.com: What are the main findings of the study?Dr. Swetter:Women diagnosed with melanoma tend to fare better than men in terms of improved survival, and this has mostly been attributed to better screening practices and behaviors in women that result in thinner, more curable tumors, and/or more frequent physician visits in older individuals that result in earlier detection. Our study focused on survival differences between young men and women (ages 15-39 years) diagnosed with cutaneous (skin) melanoma, who constitute a generally healthy population compared to the older adults that have usually been studied. We found that young men were 55% more likely to die of melanoma than age-matched women, despite adjustment for factors that may affect prognosis, such as tumor thickness, histology and location of the melanoma, as well as presence and extent of metastasis. Our results present further evidence that a biologic mechanism may contribute to the sex disparity in melanoma survival, since adolescent and young adults see physicians less frequently and are less likely to have sex-related behavior differences in skin cancer screening practices than older individuals.
MedicalResearch.com Interview with Genevieve Kenney Ph.D
Senior Fellow and Co-Director, Health Policy Center
The Urban Institute
2100 M Street NW Washington DC 20037
MedicalResearch.com: What are the main findings of the study?Dr. Kenney: Our study is the first published analysis that draws on physical examinations, laboratory tests, and patient reports to assess the health needs and health risks of uninsured adults who could be eligible for Medicaid coverage under the Affordable Care Act relative to the adults who are already enrolled in Medicaid.
Our main findings are that the uninsured adults who could enroll under the ACA are less likely than the adults with Medicaid coverage to be obese and to have functional limitations and chronic health problems, such as hypertension, hypercholesterolemia, or diabetes, but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. In comparison to the Medicaid population, the uninsured adults in our study were also less likely to have seen a health professional in the prior year and to have a routine place for care. The rates of undiagnosed and uncontrolled chronic health care problems found in our study indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues. These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the Affordable Care Act.
Research Associate, Dept Nutrition
655 Huntington Avenue Building 2, Room 351
Boston, Massachusetts 02115
Changes in Red Meat Consumption and Subsequent Risk of Type 2 Diabetes Mellitus: Three Cohorts of US Men and WomenMedicalResearch.com: What are the main findings of the study?Answer:
-- Compared with people who did not change their intake of red meat, those who increased it by as little as half a serving a day (about 1.5 ounces) over a four-year period had a 48% increased risk of developing type 2 diabetes in the subsequent 4 years.
-- People who decreased their intake by half a serving a day over four years did not have an acute reduced risk in the next four years compared to people who did not change their intake, but had a reduced risk of developing the disease by 14% in the entire follow-up period, suggesting a prolonged effect.
-- The findings included both processed meat such as lunch meat and hot dogs and unprocessed meats such as hamburger, steak and pork. And the association was generally stronger for processed red meat compared to unprocessed red meat.
-- Adjusting for weight modestly reduced the association between red meat consumption and diabetes suggesting that weight gain played a role in the development of the disease.
MedicalResearch.com Interview with
Dr. Karen E. Joynt, MD MPH
Brigham and Women's Hospital and VA Boston Healthcare System
Department of Health Policy and Management, Harvard School of Public Health
MedicalResearch.com: What are the main findings of the study?Dr. Joynt: The main findings of the study were two-fold.
First, high-cost patients in Medicare (the top decile of spenders) are responsible for about 80% of inpatient spending in the Medicare program, so understanding more about these patients' patterns of care is really important.
Second, we found that only about 10% of acute-care spending for these high-cost Medicare patients were for causes that we generally think of as preventable in the short term, like uncontrolled diabetes, COPD, or heart failure.
The rest of the spending was for acute conditions that we generally don't think of as preventable (at least in the short term), such as orthopedic procedures, sepsis, and cancer.
MedicalResearch.com Interview with Dr. Kumar Dharmarajan MD MBA
Yale School of Medicine
Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure
MedicalResearch.com: What are the main findings of the study?
We found that among a large contemporary cohort of heart failure hospitalizations, beta blockers are frequently started in patients with markers of clinical instability such as residence in an intensive care unit (ICU), volume overload requiring intravenous diuresis, and poor cardiac output requiring intravenous inotropes. Approximately 40% of patients in whom a beta blocker is started has at least one of these three potential contraindications to treatment.
This finding is concerning, as recent performance measures for heart failure recommend that a beta blocker be started during hospitalization for heart failure among patients with left ventricular systolic dysfunction. However, these performance measures also state that persons in whom a beta blocker is started "should not be hospitalized in an ICU, should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent."
Moving forward, we are concerned that the unselective application of the new performance measure may lead to the further use of beta blocker therapy in patients at higher risk for adverse consequences of therapy.
MedicalResearch.com Interview with Dr. H. Irene Hall, PhD
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
1600 Clifton Road, MS E-47, Atlanta, GA 30333
MedicalResearch.com: What are the main findings of the study?Dr. Hall: Our research finds that, across all populations, far too few Americans with HIV receive the care they need to stay healthy and reduce risk of transmission. According to our research, gaps in care are the largest among African Americans and young people. Moving forward, improving care for all HIV-infected people will be critical to achieving the goal of an AIDS-free generation in America.
More specifically, some of the key findings of the study include:
Overall, only a quarter of all Americans with HIV have a suppressed viral load – meaning the level of HIV in their bodies is low enough to stay healthy and dramatically reduce the chance of transmitting to others.
By race/ethnicity, African-Americans and Hispanics or Latinos are less likely to be aware of their infection compared to whites.
By age, younger Americans are less likely to be in ongoing care and have a suppressed viral load; HIV care and viral suppression generally improved with age. For example:
Fifteen percent of those aged 25-34 were virally suppressed, compared to 36 percent of those aged 55-64.
In terms of ongoing care, 28 percent of those 25-34 years old were retained in care, compared to 46 percent of those aged 55-64.
MedicalResearch.com Interview with: Dr. Ezio Bonifacio, Ph.D.
Professor, Preclinical Stem Cells/Diabetes
Center for Regenerative Therapies Dresden
Technische Universität Dresden
MedicalResearch.com: What are the main findings of the study?Dr. Bonifacio: Children who develop multiple islet autoantibodies are destined to develop diabetes. Only a minority will be diabetes-free 15 years after developing islet autoantibodies. This is regardless of whether they have a family history of type 1 diabetes. Progression to diabetes after seroconversion varied from weeks to decades, and 20% of children had diabetes within 2 years from seroconverting. Progression was fastest in children who developed their islet autoantibodies before age 3 years.
MedicalResearch.com: Were any of the findings unexpected?Dr. Bonifacio: Unexpected is probably not the right word. The Eisenbarth model of chronic disease proposes that diabetes will happen some time after autoimmunity and the findings show the reality of it. Perhaps the unexpected finding is that it is not always chronic and that for a number of children, intervention would need to be applied quickly.
MedicalResearch.com Interview with:
Marloes Heijstek MD
University Medical Center, Wilhelmina Children's Hospital
Department of Pediatric Immunology and Rheumatology
Room number KC 03.063.0
P.O. Box 85090 Lundlaan 6
3508 AB Utrecht
MedicalResearch.com: What are the main findings of the study?Dr. Heijstek: The main findings of our study are that MMR booster vaccination does not affect JIA disease, does not cause flares of arthritis and induces high rates of protective immunity.
MedicalResearch.com eInterview with: Michael J. Orlich, M.D.
Preventive Medicine Residency
Loma Linda University www.lluprevmedres.org
Research Fellow, Adventist Health Studies
www.adventisthealthstudy.orgMedicalResearch.com: What are the main findings of the study?Dr. Orlich: The main findings were these.
Vegetarians, as we defined them, had reduced risk of death during the study period compared to non-vegetarians.
This was true also for particular vegetarian diets including for vegans, lacto-ovo-vegetarians, and pesco-vegetarians. Reduced risk was seen in particular for deaths related to disease of the heart, kidneys, and diabetes.
Findings were stronger in men than women.
MedicalResearch.com eInterview with Kathryn L. Humphreys, M.A., Ed.M.
Clinical Psychology Doctoral Student
UCLA Department of Psychology
1285 Franz Hall, Box 951563
Los Angeles, CA 90095
MedicalResearch.com: What are the main findings of the study?Response: Our primary question was to answer whether the use of stimulant medication in the treatment of ADHD was associated with increased or decreased risk for a variety of substance use (ever tried) and substance use disorder (abuse or dependence) outcomes (alcohol, cocaine, marijuana, nicotine, and non-specific drug use).
Prior research from individual studies of children have provided mixed evidence (i.e., some found medication increased later risk, some found medication decreased risk, and still others found no difference in risk). We examined available longitudinal studies (i.e., medication treatment preceded measurement of substance outcome) together using meta-analysis, a technique that aggregates findings from a number of studies, in order to examine this question in a much larger sample of individuals.
Our main finding was that children with ADHD who received medication treatment did not differ in risk for lifetime substance use or abuse or dependence compared to those children with ADHD who did not receive medication treatment.
Dr. Rishi Gupta, MDAssociate Professor of Neurology, Neurosurgery and RadiologyEmory University School of Medicine
Director, Vascular Neurology Fellowship Program
Director, Multi-Hospital Acute Stroke Network
Marcus Stroke and Neuroscience Center
Grady Memorial Hospital
MedicalResearch.com: What are the main findings of the study?Dr. Gupta: The main findings of this study are that patients with more proximal cerebral arterial occlusion involving the middle cerebral artery and internal carotid artery appear to be the targets for endovascular reperfusion therapy trials. Moreover, previous clinical trials have used a NIHSS > 8 or > 10 threshold to include patients into randomzed trials comparing endovascular therapy versus IV tPA. The threshold may need to be higher and in our analysis we found that threshold to be 14 or greater.
MedicalResearch.com eInterview with:Mary Scourboutakos
PhD student at the University of Toronto
Mary R. L'Abbe, PhD
Earle W. McHenry Professor, and Chair, Department of Nutritional Sciences
Faculty of Medicine, University of Toronto
FitzGerald Building, 150 College Street, Rm 315
Toronto, ON, Canada M5S 3E2
MedicalResearch.com: What are the main findings of the study?Answer: We found that chain restaurant meals on average contained half a day's worth of calories, almost a full day's worth of fat and saturated fat, and more than a day's worth of sodium.
MedicalResearch.com eInterview with:Emily Y. Chew, MD
Division of Epidemiology and Clinical Applications
National Eye Institute (NEI)/National Institutes of Health (NIH),
MedicalResearch.com: What are the main findings of the study? Dr. Chew: For patients who have intermediate age-related macular degeneration (AMD) or those with advanced AMD in one eye, we have recommended a mixture of vitamins and minerals (vitamin C, E and beta-carotene, and zinc oxide and cupric oxide), known as Age-Related Eye Disease Study (AREDS) formulation. We tested the effects of adding carotenoids, lutein/zeaxanthin, or omega-3 fatty acids or both to the AREDS formulation. Omega-3 fatty acids did not have any effect on AMD. Addition of lutein/zeaxanthin provided an additional 10% increase in the reduction of progression to advanced AMD. In persons with the lowest dietary intake of lutein/zeaxanthin, supplementation with lutein/zeaxanthin provided 25% reduction in rates of developing advanced AMD When we tested lutein/zeaxanthin directly against beta-carotene, the risk of progressing to advanced AMD was reduced by 20%. Furthermore, beta-carotene was found to increase the risk of lung cancer. To improve the safety and efficacy of the AREDS formulation, we would suggest the elimination of beta-carotene and adding lutein/zeaxanthin. Omega-3 fatty acids added no further benefit.
Medical Research.com eInterview with: Prof. Jean Decety PhD
Irving B. Harris Professor of Psychology and Psychiatry
The University of Chicago
5848 S. University Ave.
Chicago, IL 60637 - USA
Faculty Web page: http://psychology.uchicago.edu/people/faculty/jdecety.shtml
SCNL Web page: www.scnl.org
Child NeuroSuite: www.childneurosuite.orgMedicalResearch.com: What are the main findings of the study?Dr. Decety: In our study, psychopaths exhibited significantly less activation in the ventromedial prefrontal cortex, lateral orbitofrontal cortex, and brainstem relative to controls, but surprisingly showed greater activation in the insula. The major difference in brain response between psychopaths compared to controls during the perception of others in pain was the lack of engagement of regions in the brainstem, orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC).
MedicalResearch.com eInterview with Dr. David Perry
UCSF School of Medicine
Clinical Fellow in Neurology
675 Nelson Rising Lane
San Francisco CA 94158
MedicalResearch.com: What are the main findings of the study?
Dr. Perry: We described two patients with clinical syndromes and brain imaging patterns that are consistent with Alzheimer’s disease. Both were found to have mutations in GRN, which are typically associated with inherited frontotemporal dementia. They both showed evidence of underlying Alzheimer’s pathology, in one case through autopsy confirmation (demonstrating Alzheimer’s disease in addition to TDP-43 pathology), and in the other case from a positive amyloid PET scan.
MedicalResearch.com Author Interview with Dr. Koon Teo, MB, PhD
Population Health Research Institute, Hamilton Health Sciences,
McMaster University, Hamilton, Ontario, Canada
MedicalResearch.com: What are the main findings of the study?Dr. Teo: In this study we examined the prevalence of smoking cessation or avoidance, eating a healthy diet and undertaking regular physical activities in nearly 8000 individuals who had previously experienced a coronary heart disease event or stroke, on average 5 years after their events. The individuals were recruited from over 600 communities in 17 countries with varying incomes and economic development. We found that although these healthy lifestyle activities could reduce the risk of further heart or stroke events, about one fifth of individuals continued to smoke, only one third undertook regular leisure or work related physical activities and about two fifths ate a healthy diet.
MedicalResearch.com eInterview with XinQi Dong, MD MPH
APSA Congressional Policy Fellow/Health and Aging Policy Fellow
Chair, IOM Global Violence Prevention Forum on Elder Abuse
Senior Policy and Research Advisor, Administration on Aging
Senior Policy Advisor (OCSQ), Center for Medicare and Medicaid Services
Director, Chinese Health, Aging and Policy Program
Associate Director, Rush Institute for Healthy Aging
Associate Professor of Medicine, Nursing and Behavioral Science
Rush University Medical Center
Chicago, IL 60612
MedicalResearch.com: What are the main findings of the study?Answer: Dong and Simon investigated the prospective association between elder abuse and rate of hospitalization in a Chicago community population. From the Chicago Health and Aging Project, the study surveyed 6,674 older adults. After consideration of potential confounding factors, elder abuse victims compared to those without elder abuse had 2.7 times more frequent rate of hospitalizations in this Medicare population. Older adults who suffered psychological abuse, financial exploitation and caregiver neglect also had more frequent rate of hospitalization. Health care professionals should consider screening for elder abuse in hospital settings. Future research is needed to quantify impact of elder abuse and broader health service utilization in community-dwelling older persons. Elder abuse and neglect is something hundreds of thousands of senior citizens suffer from. It is advised to act if you suspect elder abuse is occurring by contacting the police. People may also see it fit to enlist the services of an elder neglect attorney to fight for the rights of the elderly (siegel-law-elder-abuse-neglect-attorney).
MedicalResearch.com Interview with Dr. Ciaran McMullan MD
from Channing Division of Network Medicine in Boston, a research division within the Department of Medicine at Brigham and Women’s Hospital, Boston Mass
MedicalResearch.com: What are the main findings of the study?Dr. McMullan: In this observational study performed in non-diabetic women we found that lower nocturnal melatonin secretion predicted future risk of developing type 2 diabetes. When we categorized the individuals by category of nocturnal melatonin secretion we found that those in the lowest category had twice the risk as those in the highest category of nocturnal melatonin secretion. This association remained even after adjusting for other well established risk factors for development of diabetes including body mass index, physical activity, dietary factors, family history of diabetes, smoking and hypertension. This increased risk translates into the lower melatonin secretion group having an additional 5 cases of incident diabetes per 1000 person years than the high melatonin secretion group.
MedicalResearch.com Interview with Carron D. Gordon, PhD
Section of Physical Therapy, University of the West Indies,
Mona, Box 126, Kingston 7, Jamaica, West Indies
MedicalResearch.com: What are the main findings of the study?Dr. Gordon: The walking group showed a 17.6% improvement in distance walked in six minutes (measure of endurance) compared to 4% in the control group and 16.7% improvement in SF36-Physical Component (health-related quality of life) compared to 2.6% in the control group.
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