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…)
Author Interviews, Clots - Coagulation, JAMA, Vaccine Studies / 09.07.2014

MedicalResearch.com Interview with: Nikolai Madrid Scheller Department of Epidemiology Research Statens Serum Institut, Copenhagen Medical Research: What are the main findings of the study? Answer: In a large and comprehensive study of more than 1.5 million women including more than 500,000 HPV vaccinated there was no association between HPV vaccination and blood clots. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 08.07.2014

MedicalResearch.com Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado   80045MedicalResearch.com Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado   80045 Medical Research: What are the main findings of the study? Dr. Olds: We’ve conducted a randomized controlled trial of a program of nurse home visiting for low-income women with no previous live firths during pregnancy and the first two years of the child’s life, with randomization of participants beginning in 1990. In our most recent follow-up of mothers and children in Memphis, those who received nurse-visitation were less likely to have died over a 2-decade period following the child’s birth than those in the control group.  Death among mothers and children in these age ranges in the US is rare and extraordinarily important for what it tells us about the health of the population studied in this trial. For children, the reduction in death was present for preventable causes, that is, sudden infant death syndrome, injuries, and homicide.  All of the child deaths for preventable causes were in the control group, for whom the rate was 1.6%.  None of the nurse-visited children died of preventable causes. The reductions in maternal mortality were found for two nurse-visited groups combined for this report: one received prenatal and newborn visitation and a second received visitation during pregnancy and through child age two.  Overall, mothers assigned to the control group were nearly 3 times more likely to die than those assigned to the two nurse-visited conditions.  The relative reduction in maternal mortality was particularly pronounced for deaths linked to maternal behaviors -- suicide, drug overdose, injuries, and homicide; for these external causes of death, 1.7% of the mothers in the control group had died, compared to 0.2% of those visited by nurses. (more…)
Author Interviews, JAMA, Psychological Science / 07.07.2014

W Curt LaFrance Jr MD, MPH Assistant Professor of Psychiatry and Neurology, Alpert Medical School, Brown University Director of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital Providence RI 02903-4923MedicalResearch.com Interview with: W Curt LaFrance Jr MD, MPH Assistant Professor of Psychiatry and Neurology, Alpert Medical School, Brown University Director of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital Providence RI 02903-4923 MedicalResearch: What are the main findings of the study? Dr. LaFrance: Patients treated with the 12 session, 1 hour, individual psychotherapy seizure treatment workbook had significant reductions in their seizures and improvement in their comorbid symptoms, quality of life and functioning. In contrast, treatment as usual /standard medical care (TAU/SMC) showed no improvement in seizures, comorbid symptoms or other outcomes. (more…)
Author Interviews, Hematology, JAMA, Stem Cells, Transplantation / 03.07.2014

John F. Tisdale, MDMedicalResearch.com Interview with: Dr. John Tisdale MD Molecular and Clinical Hematology Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland MedicalResearch: What are the main findings of the study? Dr. Tisdale: Using a nonmyeloablative allogeneic HLA-match peripheral blood stem cell transplantation strategy aimed at tolerance induction, we were able to revert the phenotype in 26 of 30 adult patients with severe sickle cell disease ranging in age from 16 to 65 years. In contrast to standard transplantation strategies which rely on high doses of chemo and/or radiotherapy after which the entire bone marrow and blood system is replaced by that of the donor, our patients had a mixture of their own and that of their donor. This procedure was well tolerated, with no non-relapse mortality, and led to complete replacement of red blood cells by that of the donor in successfully engrafted patients. This replacement resulted in decreases in pain, pain medication usage, hospitalizations, and improvements in organ function. (more…)
Author Interviews, Diabetes, JAMA / 01.07.2014

MedicalResearch.com Interview with:Sandeep Vijan, MD, MS Center for Clinical Management Research Ann Arbor Veterans Affairs Hospital, Department of Internal Medicine, University of Michigan, Ann Arbor Michigan Sandeep Vijan, MD, MS Center for Clinical Management Research Ann Arbor Veterans Affairs Hospital, Department of Internal Medicine, University of Michigan, Ann Arbor Michigan MedicalResearch: What are the main findings of the study? Dr. Vijan: The main finding was that the burdens and side effects of intensive glycemic treatment significantly detract from the overall benefit of lower risks of diabetes complications, often to the point where the treatments cause more loss than gain in quality of life. It takes many (often 15-20) years to gain benefit from treatment, but the burdens begin right away and continue throughout treatment. By the time you might experience treatment benefit in terms of reduced complication risk, you've had a lot of years to have the downsides of treatment - which commonly include significant weight gain, low blood sugars, gastrointestinal symptoms, not to mention having to take multiple pills or injections on a daily basis. (more…)
Author Interviews, JAMA, Pediatrics, Surgical Research / 26.06.2014

Frank H. Morriss, Jr., MD, MPH Professor of Pediatrics  - Neonatology University of Iowa Carver College of MedicineMedicalResearch.com Interview with: Frank H. Morriss, Jr., MD, MPH Professor of Pediatrics  - Neonatology University of Iowa Carver College of Medicine   MedicalResearch: What are the main findings of the study? Dr. Morriss: Our aim was to assess the association between surgery performed during the initial hospitalization of very low- birth-weight infants and subsequent death or neurodevelopmental impairment at 18-22 months’ corrected age. We conducted a retrospective cohort analysis of patients who were prospectively enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 to 2009. Surgery was classified by the expected anesthesia type as either major surgery that likely would have been performed under general anesthesia; or minor surgery, that is, procedures that could have been performed under non-general anesthesia and in general were shorter in duration. There were 2,186 major surgery patients and 784 minor surgery patients and more than 9,000 patients who did not undergo surgery. We found that any surgical procedure  increased the adjusted risk of death or neurodevelopmental impairment in low birth weight infants by about 30%. Not all surgical procedures were associated with increased risk, however. Compared with those who did not undergo surgery, patients  who were classified as having major surgery had a risk-adjusted odds ratio of death or neurodevelopmental impairment of 1.52 (95% confidence interval 1.24-1.87). However, those who were classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who did not undergo surgery the risk-adjusted odds ratio for neurodevelopmental impairment was 1.56 (95% confidence interval 1.26-1.93), and the risk-adjusted mean Bayley II Mental Developmental Index and mean Psychomotor Developmental Index values were significantly lower. (more…)
Author Interviews, Gender Differences, Heart Disease, JAMA / 25.06.2014

MedicalResearch.com Interview with: David Strauss, M.D., Ph.D., Senior Author Medical Officer Center for Devices and Radiological Health U.S. Food and Drug Administration, Silver Spring, Md MedicalResearch: What are the main findings of the study? Dr. Strauss: The underrepresentation of women in clinical trials for cardiac resynchronization therapy (CRT) devices, as with other devices, has made it difficult to assess differences in the safety and effectiveness of these devices for women vs. men. The FDA is exploring the potential of pooling and analyzing data from multiple trials to bridge the knowledge gap for certain subpopulations (such as women) often underrepresented in medical device clinical trials. By conducting one such meta-analysis, the FDA found that women benefit from cardiac resynchronization therapy (CRT) significantly more than men do. (more…)
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 24.06.2014

Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of MedicineMedicalResearch.com Interview with: Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of Medicine MedicalResearch: What are the main findings of the study? Dr. Brooke: This study was designed to evaluate whether high-risk surgical patients who visit a primary care provider (PCP) during the early period following hospital discharge are less likely to be readmitted within 30-days.  We examined this question by performing a retrospective cohort analysis of Medicare beneficiaries (2003-2010) who underwent a high risk surgery (open thoracic aortic aneurysm repair) as well as a control group of patients who underwent a lower risk surgical procedure (open ventral hernia repair), and then determining whether there was evidence of early PCP follow-up. In risk-adjusted analyses, we found that early primary care provider-follow-up was associated with a significant lower likelihood of 30-day readmission for high-risk patients undergoing open thoracic aortic aneurysm repair, particularly if a post-operative complication had occurred.  In comparison, early primary care provider follow-up did not have a significant effect on lowering readmissions in uncomplicated patients and those undergoing lower-risk operations such as ventral hernia repair. (more…)
Author Interviews, Cognitive Issues, JAMA, Mayo Clinic / 24.06.2014

Prashanthi Vemur, Ph.D. Mayo Clinic Rochester, MinnesotaMedicalResearch.com Interview with: Prashanthi Vemur, Ph.D. Mayo Clinic Rochester, Minnesota   MedicalResearch: What are the main findings of the study? Dr. Vemuri: Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic. We studied two non-overlapping components of lifetime intellectual enrichment: education/occupation-score and mid/late-life cognitive activity measure based on self-report questionnaires. Both were helpful in delaying the onset of cognitive impairment but the contribution of higher education/occupation was larger. (more…)
Author Interviews, JAMA, Pediatrics, Stanford, Surgical Research / 24.06.2014

Kay W. Chang, MD Associate Professor of Otolaryngology and Pediatrics Stanford University Department of Otolaryngology Lucile Packard Children's Hospital at Stanford Division of Pediatric OtolaryngologyMedicalResearch.com Interview with: Kay W. Chang, MD Associate Professor of Otolaryngology and Pediatrics Stanford University Department of Otolaryngology Lucile Packard Children's Hospital at Stanford Division of Pediatric Otolaryngology MedicalResearch: What are the main findings of the study? Dr. Chang: At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight. (more…)
Author Interviews, Breast Cancer, JAMA, MD Anderson, Race/Ethnic Diversity / 20.06.2014

Dalliah Black, MD F.A.C.S. Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, HoustonMedicalResearch.com Interview with: Dalliah Black, MD F.A.C.S. Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston   MedicalResearch: What are the main findings of the study? Dr. Black: This is a retrospective study from 2002 - 2007 using the SEER/Medicare database of over 31,000 women with node negative breast cancer evaluating the utilization of sentinel node biopsy (SNB) as it transitioned from an optional method for axillary staging to the standard of care instead of complete axillary lymph node dissection (ALND).  We found that SNB use increased each year in both white and black breast cancer patients throughout the study period.  However, SNB was less often performed in black patients (62.4%)compared to white patients (73.7%) and this disparity persisted through 2007 with a 12% difference.  Appropriate black patients more often had an ALND instead of the minimally invasive sentinel node biopsy which resulted in worse patient outcomes with higher lymphedema rates in black patients.  However, when black patients received the minimally invasive SNB, their rates of lymphedema were low and comparable to white patients who received SNB. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA / 19.06.2014

Carlos J. Rodriguez, MD, MPH Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaMedicalResearch.com Interview with Carlos J. Rodriguez, MD, MPH Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina MedicalResearch: What are the main findings of the study? Dr. Rodriguez: As a clinician there is a notion suggesting that lower blood pressure is better but our current research to date is controversial and not conclusive. We wanted to study a large group of people with hypertension and see whether over 20 years of follow up, if a lower systolic blood pressure would be associated with lower cardiovascular events (heart attack, stroke, heart failure, angina). We hypothesized that there would be a linear association between blood pressure and events, that lower blood pressure would be associated with lower events and that as the blood pressure went up there would be more events. We found this was not the case but that hypertensives with a blood pressure between 120-138mmhg have the greatest benefit and those with a blood pressure less than 120mmhg did not have additional benefit. (more…)