MedicalResearch.com Interview with: Dr. Jeffery C. Huffman, M.D.
Harvard Medical School
Department of Psychiatry
Massachusetts General Hospital, Boston
MedicalResearch.com: What are the main findings of the study?Dr. Huffman: Depression and anxiety in cardiac patients are associated with adverse cardiac outcomes. We completed a very low-intensity care management intervention to identify depression and anxiety disorders during a cardiac admission and then to assist in the monitoring and management of the condition over the next 24 weeks. There have been other care management trials in cardiac patients, but ours was the first to co-manage depression and anxiety, the first to initiate treatment in the hospital, the first to take a broad population of cardiac patients rather than a single diagnosis, and the first to use such a low-resource strategy with only a single part-time social worker to coordinate care.
We found that the care management intervention was associated with significant improvements in mental health treatment, mental health related quality of life, depression, and function at 24 weeks compared to enhanced treatment as usual. We did not find differences in anxiety, adherence, or cardiac readmissions.
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MedicalResearch.com Interview with:Cara Tannenbaum, MD, MSc
The Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging,Professor of Medicine and Pharmacy
University of Montreal Centre de Recherche
Institut Universitaire de Gériatrie de Montréal
Montreal, QC
MedicalResearch.com: What are the main findings of the study?Dr. Tannenbaum: The EMPOWER study showed that providing older patients with information about the harms of sleeping pill use led to discontinuation or dose reduction in 1-in-every 4 patients with longstanding use of benzodiazepines. Receipt of evidence-based information about drug harms resulted in a 8-fold higher likelihood of benzodiazepine cessation. Many physicians think that patients become too dependent on sedative-hypnotics to successfully discontinue. Regardless of age, sex, and duration of use, 27% of patients aged 65-95 in this study successfully completed the recommended 20-week tapering protocol during a 6-month time period and another 11% were in the process of tapering. EMPOWERing patients with evidence-based information therefore results in appropriate risk reduction.
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MedicalResearch.com Interview with: Wei-ping Zhou, MD, PhD
Department of Hepatic Surgery
Eastern Hepatobiliary Surgery Hospital
Shanghai, China
MedicalResearch.com: What are the main findings of the study? Answer: The main finding is that Quantitative HBsAg can be used as a new prognostic factor of Hepatocellular Carcinoma recurrence after partial hepatectomy in patients with a low HBV-DNA level.
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MedicalResearch.com Interview with:Bradley S. Peterson, MD
Director of the Center for Developmental Neuropsychiatry
Director of the Center for Developmental Neuropsychiatry,
New York State Psychiatric Institute
Suzanne Crosby Murphy Professor in Pediatric Neuropsychiatry,
Columbia University, NY
MedicalResearch.com: What are the main findings of the study?Dr. Peterson: We detected the presence of lactate in the brains of 13% of 75 participants who had ASD (Autism Spectrum Disorder), compared with 1% of the brains of 96 typically developing control participants. The presence of lactate was especially more common in adults who have ASD. Lactate is a product of anaerobic metabolism, which generally should not occur in healthy, living brains under normal circumstances. The presence of lactate in the brains of persons with Autism Spectrum Disorder therefore suggests the presence of deficient production of energy stores by a component of brain cells called “mitochondria”. We detected lactate most commonly in the cingulate gyrus, a region that supports the higher-order control of thought, emotion, and behavior, and that has been implicated previously in Autism Spectrum Disorder.
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MedicalResearch.com Interview with: Dr. Marie Claude Ouimet, Ph.D.
Assistant Professor/ Professeure adjointe
University of Sherbrooke/ Université de Sherbrooke
Faculty of Medicine and Health Sciences/ Faculté de médecine et des sciences de la santé
Longueuil, QC, Canada, J4K 0A8
MedicalResearch.com: What are the main findings of the study?
Dr. Ouimet :The goal of our study was to examine if teenagers’ driving risk was associated with a neurobiological factor. Driving was continuously observed with cameras and sensors installed in the vehicles of teenagers during their first 18 months of licensure. Cortisol response was measured within the first weeks of licensing. Our study showed two main findings:
1) Higher cortisol response to a stressful event was associated with lower crash and near crash rates over the study period;
2) Higher cortisol response was also linked to a sharper decrease in crash and near crash rates over time.
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MedicalResearch.com Interview Sandra L. Decker, Ph.D.Distinguished Consultant
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, MD 20782
MedicalResearch.com: What are the main findings of the study?Dr. Decker: One of the main findings is that the percent of the low income population that is uninsured is higher in states not expanding Medicaid than those expanding. The low income uninsured in non-expansion states are more likely to report having or having had certain health conditions such as hypertension, cancer, stroke, emphysema, or a heart condition than those in expansion states. (more…)
MedicalResearch.com Interview with:
Dr. LydiaPace, MD, MPH
Division of Women’s Health, Brigham and Women’s Hospital
Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?Dr. Pace: We reviewed the existing literature about the benefits and harms of mammography, focusing on the reduction of breast cancer deaths associated with mammography, as well as the two most often-discussed harms: false positive results and overdiagnosis. We also reviewed the literature about interventions to help patients make informed decisions. We found that the literature suggests that routine screening mammography does reduce mortality associated with breast cancer, across all age groups. However, it is also associated with high rates of false positive results, and considerable rates of overdiagnosis. Overdiagnosis is the most concerning potential risk of mammography screening. Overdiagnosis is the detection of a tumor through screening that would never have caused problems for a patient. It occurs either because of a very slow-growing tumor, or because a woman has medical problems (or is old enough) such that she will likely die of another cause before the cancer became apparent. Overdiagnosis is concerning because we cannot know when a cancer is overdiagnosed, and thus a patient who is overdiagnosed will receive unnecessary treatment for cancer. The scientific literature on mammography is complex, and there are important limitations to the studies both of mammography’s benefits and harms. However, we feel that the best available data suggest that among 10,000 50 year old women undergoing annual mammography for 10 years, 5 deaths will be averted through screening mammography, while about 6130 women will experience at least one positive result. Furthermore, there is about a 19% chance that, if that woman is diagnosed with cancer detected by a mammogram, that cancer is one that would never have caused her problems. Lastly, our review showed that we need more studies to guide us in how an individual woman’s risk should dictate her mammography decisions, and how to support women in making those decisions. However, we know that most women with higher risk for breast cancer will experience higher benefit from mammography screening. (more…)
MedicalResearch.com Interview with: Daniel J. Elliott, M.D., MSCE, FACPAssociate Chair of Research
Department of Medicine and Research Scholar
Value Institute, Christiana Care Health System
MedicalResearch.com: What are the main findings of the study?Dr. Elliott:The optimal workload for hospitalists has been a question since the earliest days of hospital medicine. However there has been very little empirical evidence to understand the relationship between workload and outcomes.
The objective of our study was to determine the association of daily workload for hospitalists on the efficiency, quality, and cost of care. We analyzed data from a single private practice hospitalist group at a community-based health system between February 2008 and January 2011. Our research showed that both length of stay and cost increased for patients as hospitalist workload increased.
At the same time, our research showed that workload did not affect patient satisfaction as measured by HCAHPS scores or quality and safety outcomes including admissions, rapid response team activation and mortality.
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MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS
Research Associate Professor
Research Director, Patient Safety Enhancement Program
Department of Internal Medicine
University of Michigan Ann Arbor, MI 48109-2800
MedicalResearch.com: What are the main findings of the study?Dr. Rogers: The risk of serious infection is considerably elevated after receiving allogeneic (donor) red blood cell transfusions. For every 38 patients under consideration for transfusion, 1 patient could be spared an infection if more restrictive hemoglobin thresholds were used. When patients were given transfusions only after their hemoglobin fell below 7.0 g/dL, 1 patient avoided an infection of every 20 patients treated. The results were most consistent in elderly patients receiving hip and knee replacement surgeries. Their risk of infection decreased by 30% when lower hemoglobin thresholds were used.
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MedicalResearch.com Interview with:Dr. Thomas M. Pisansky MD
Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What are the main findings of the study?Dr. Pisansky:This patient-reported outcomes research did not identify a beneficial effect of once-daily tadalafil to prevent radiotherapy-related erectile dysfunction in men with prostate cancer.
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MedicalResearch.com Interview Invitation with: Timothy Hughes, PhD, MPH
Roena B. Kulynych Center for Memory & Cognition Research
Department of Internal Medicine
Division of Gerontology and Geriatric Medicine
Wake Forest School of Medicine
Medical Center Boulevard, Winston-Salem, NC 27157-1207
MedicalResearch.com: What are the main findings of the study?Dr. Hughes: This study is a follow-up to our recent paper that showed a novel relationship between arterial stiffness (commonly measured by pulse wave velocity) and the presence and extent of amyloid deposition in the brain, a hallmark of Alzheimer’s disease. For this study, we repeated brain amyloid imaging (using the Pittsburgh Compound B during PET imaging) in order to look for predictors of change in amyloid over two years in n=81 elderly adults aged 80+ and free from dementia. We observed that measures of systemic arterial stiffness (e.g. brachial ankle pulse wave velocity) was strongly associated with the extent of amyloid deposition in the brain at both baseline and follow-up. The change in brain amyloid accumulation over two years resulted in an increase in in the number of participants with Alzheimer’s-like (amyloid-positive) from 45% at baseline to a surprising 75% after just two years. This change in brain amyloid accumulation over two years was strongly related to having greater central stiffness (as measured by carotid femoral pulse wave velocity). These relationships between arterial stiffness and brain amyloid deposition were independent of the effects of age, gender, body mass index, antihypertensive medication use and even current blood pressure.
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MedicalResearch.com Interview with:M.S. Reimers, MD PhD Student
and
Dr. Jan Liefers MD
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
MedicalResearch.com: What are the main findings of the study?Answer: Aspirin use was associated with an improved survival, as we have published before when investigating this cohort (Bastiaannet et al, Brit J Cancer 2012/ Reimers et al. J Am Geriatr Soc. 2012. In this study we have focused on investigating which patients will benefit from aspirin treatment by investigating some tumor markers, such as PTGS2 expression, HLA class I expression and PIK3CA mutation status. Interestingly, only patients with HLA class I expression on their tumor membrane will benefit from aspirin treatment and have a better outcome. We raise the hypothesize that aspirin inhibits platelet aggregation to circulating tumors cells. By interfering with this process, the metastatic potential of these circulating tumour cells is inhibited, thereby preventing metastasis and colon cancer death.HLA class I expression might be needed for signalling between platelets and circulating tumor cells. If this hypothesis is confirmed by others or in vitro studies, than this might explain the finding that aspirin seems not only beneficial as an adjuvant therapy for colorectal cancer patients, but also for patients with other malignancies (oesophagus, breast, etc). Interestingly, preliminary findings from our team investigating aspirin use in oesophageal cancer also showed that aspirin use in these tumors was associated with an improved survival.
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MedicalResearch.com Interview with:Ann Marie Navar-Boggan, MD, PhD
Division of Cardiology,
Duke University Medical Center
Durham, North Carolina
MedicalResearch.com: What are the main findings of the study?Dr. Navar-Boggan: Two groups of adults are really affected by the updated guidelines. First, 13.5 million adults, including one in five adults over the age of 60, were previously considered to have uncontrolled blood pressure but now meet new guideline goals.
Next, 14 million adults over the age of 60 (one in four adults in this age group) are currently on blood pressure lowering therapy and meeting the older, more stringent targets. The guidelines state that no changes are necessary in this group, but they may be eligible for reduced therapy, particularly if they have had side effects or difficulty with the therapies they are taking.
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MedicalResearch.com Interview with: Pamela Ling, MD MPH
Associate Professor, Department of Medicine
Director, Tobacco Control Policy Fellowship
Center for Tobacco Research and Education
University of California San Francisco
San Francisco, CA 94143-1390
MedicalResearch.com: What are the main findings of the study?Dr. Ling: We followed a sample of smokers from a nationally representative panel for one year. We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not. Put another way, smokers who had used e-cigarettes at the beginning of the study were equally likely to have quit smoking one year later as those who did not use e-cigarettes. There was no relationship between e-cigarette use and quitting even after taking into account measures of tobacco dependence (number of cigarettes smoked per day, how early in the day a smoker has his first cigarette) and intention to quit smoking.
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MedicalResearch.com Interview with:Craig A. Anderson, Distinguished Professor
Director, Center for the Study of Violence
Department of Psychology
Iowa State University
Ames, IA 50011-3180
MedicalResearch.com: What are the main findings of the study?Dr. Anderson: There are three main findings from this long-term study of violent video game effects.
1. Over time, repeated play and practice of violent video games led to an relative increase in aggressive thought patterns and in physical aggression.
2. As predicted by social-cognitive theoretical models, the violent video game effect on physical aggression was directly linked to the increase in aggressive thought patterns. That is, one key reason why repeated exposure to violent video games increases aggression is because such exposure changes the way children and adolescents think about people and events that occur in their lives. In a sense, their personality changes, so that they perceive more hostility around them and come to view physically aggressive behavior as a proper solution to even minor conflicts and provocations.
3. These effects of repeated exposure to violent video games were quite general across types of people. Boys and girls, younger children and older adolescents, high aggressive and low aggressive children, all showed pretty much the same effects. In other words, no subgroup was immune to the harmful effects of violent video games.
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MedicalResearch.com Interview with: Elizabeth C. Wick, MD
Assistant Professor,Department of Surgery
The Johns Hopkins Hospital, Baltimore, Maryland
MedicalResearch.com: What are the main findings of the study?Dr. Wick: The main finding is the high variability in physician practice for prescribing steroids and the lack of clear guidance as to best practice in the literature.
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MedicalResearch.com Interview with: Denise Bonds, MD, MPH
National Heart, Lung, and Blood Institute (NHLBI)MedicalResearch.com:What are the main findings of the study?Dr.Bonds: We found no cardiovascular benefit to supplementation of the diet with either omega-3 fatty acids or with the macular xanthophyll’s lutein and zeaxanthin.
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MedicalResearch.com Interview Invitation Dr. Christian Fynbo Christiansen
Clinical Associate Professor
Department of Clinical Epidemiology
Aarhus University Hospital
MedicalResearch.com: What are the main findings of the study?Dr. Christiansen: We included 24,179 critically ill nonsurgical patients receiving mechanical ventilation in intensive care units in Denmark, and matched comparison groups of hospitalized patients and the general population. We assessed psychiatric diagnoses and medication prescriptions before and after critical illness.
We found an increased prevalence of psychiatric diagnoses in the 5 year period before critical illness, compared to both other hospitalized patients and the general population.
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MedicalResearch.com Interview with:Shamez Ladhani, MRCPCH PhD
Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London
MedicalResearch.com: What are the main findings of the study?Dr. Ladhani: Pregnancy was associated with an increased of serious infection by a bacterium called Haemophilus influenzae which is usually associated with respiratory tract infections. Nearly all the H. influenzae were unencapsulated; that is, they did not have an outer sugar capsule which is often required to make the bacterium more virulent. The encapsulated H. influenzae type b (Hib), for example, was the most common cause of bacterial meningitis in your children prior to routine immunisation. We also found that infection with unencapsulated H. influenzae was associated with poor pregnancy outcomes, including miscarriages, stillbirth and premature birth.
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Medical Research.com Interview with:Marc Righini, MD
Division of Angiology and Hemostasis
Geneva University Hospital, Geneva, Switzerland
MedicalResearch.com: What are the main findings of this study?Dr. Righini: The study shows that when compared with a fixed D-Dimer cutoff of 500 ng/ml, the combination of pretest clinical probability assessment with age-adjusted D-dimer cut-off was associated with a larger number of patients in whom Pulmonary Embolism could be excluded, with a low likelihood of recurrent VTE. The benefit was the most important in patients 75 years or older, in whom using the age-adjusted cutoff instead of the 500 ng/ml cutoff increased five-fold the proportion of patients in whom PE could be excluded on the basis of D-dimer measurement.
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MedicalResearch.com Interview with: Michelle M. Mielke, Ph.D.
Associate Professor
Department of Health Sciences Research, Division of Epidemiology
Department of Neurology
Mayo Clinic Rochester, MN 55905
MedicalResearch.com: What are the main findings of the study?Dr. Mielke: Using a population-based sample of cognitively normal individuals, aged 70-89 at baseline, we found that a medical-record confirmed diagnosis of COPD was associated with an increased risk of mild cognitive impairment, specifically non-amnestic mild cognitive impairment. The risk of mild cognitive impairment increased with a longer duration of COPD such that individuals who had COPD for more than 5 years had a 2.5-fold increased risk of developing non-amnestic mild cognitive impairment.
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MedicalResearch.com Interview Invitation with:Dr. Brian C. Callaghan MD
Department of Neurology
University of Michigan Health System, Ann Arbor
MedicalResearch.com: What are the main findings of the study?Dr. Callaghan: The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time.
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MedicalResearch.com Interview with: Pashtun Shahim, MD
Clinical Neurochemistry Laboratory
Institute of Neuroscience and Physiology
Department of Neurochemistry
Sahlgrenska University Hospital, Mölndal
Sweden
MedicalResearch.com: What are the main findings of the study?Dr. Shahim: Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. Plasma total tau, which is a highly central nervous system-specific protein, is a promising biomarker to be used both in the diagnosis of concussion and in the decision-making when an athlete can be declared fit to return to play.
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MedicalResearch.com Interview with:Glenn Yiu, MD, PhD
Duke Ophthalmology
Duke University Medical Center
MedicalResearch.com: What are the main findings of the study?Dr. Yiu:This paper reported a child who suffered injury to both eyes from a powerful blue laser pointer purchased via the internet from overseas. Our report reviews the scientific basis for laser injuries in eyes and the factors that may affect outcomes, such as power, wavelength, duration, and distance of exposure. Newer green and blue lasers, especially high-powered ones, may be more prone to inducing eye injuries. We summarized the clinical features of ocular laser injuries, methods of prevention, and discussed how consumer availability of high powered lasers may require careful federal regulations.
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MedicalResearch.com Interview with:Matthias Briel, MD, MSc
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
MedicalResearch.com: What are the main findings of the study?Dr. Briel: Using a retrospective cohort of 1017 randomized controlled trials (RCTs) based on archived protocols approved by six research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003, we found that 25% of initiated RCTs were discontinued. While discontinuation was common with RCTs involving patients (28%), it was rare in RCTs with healthy volunteers (3%). The most commonly reported reason for RCT discontinuation was poor recruitment (10% of included RCTs). We found that trials with investigator sponsor (versus industry) and those with smaller planned sample sizes were at higher risk of discontinuation due to poor recruitment. Of discontinued RCTs, up to 60% remained unpublished. Trial investigators rarely informed research ethics committees about trial discontinuation and publication.
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MedicalResearch.com Interview with:Lauren Dutra, ScD
Postdoctoral Scholar, UCSF School of Medicine
Cardiovascular Research Institute
San Francisco, CA 94143
MedicalResearch.com: What are the main findings of the study?Answer:Middle and high school students who used e-cigarettes were more likely to smoke tobacco cigarettes. They were also more likely to progress from experimenting with tobacco cigarettes to becoming regular smokers.
Teen smokers who used e-cigarettes were more likely to be planning to quit in the next year and less likely to have abstained from smoking recently, compared to smokers who had never used e-cigarettes. They were also more likely to be heavier smokers (smoke more cigarettes per day) than those who had never tried e-cigarettes, that being said there are eliquids available that have no nicotine content whatsoever and these are therefore a much healthier option, you can see a wide variety of these at Gourmet E-Liquid.
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MedicalResearch.com Interview with:Dr. Dewleen Baker MD
Veterans Affairs (VA) San Diego Healthcare System, San Diego, California
MedicalResearch.com: What are the main findings of the study?Dr. Baker:The main finding of this study is that a marker of peripheral inflammation, plasma CRP may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD.
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MedicalResearch.com Interview with:Dr. Chuan-Ming Li MD, PhD
Statistician (Health/Medicine)
Division of Scientific Programs
The National Institute on Deafness and Other Communication Disorders
MedicalResearch.com: What are the main findings of the study?Dr. Chuan-Ming Li: We used data on adults 18 years or older from the National Health and Nutrition Examination Survey for the study and found that prevalence of moderate to severe depression was 4.9 percent for individuals who reported excellent hearing, 7.1 percent for those with good hearing and 11.4 percent for participants who reported having a little hearing trouble or greater hearing impairment (HI). Depression rates were higher in women than in men. The prevalence of depression increased as hearing impairment became worse, except among participants who were deaf. There was no association between self-reported HI and depression among people ages 70 years and older; however, an association between moderate HI measured by pure-tone threshold hearing exams and depression was found in women aged 70 years and older but not in men.
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MedicalResearch.com Interview with:Prof. Dr. Philip Van Damme, MD, PhD
Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven
Vesalius Research Center, VIB, Leuven
Leuven Institute of Neurodegenerative Disorders (LIND)
KU Leuven, Belgium
MedicalResearch.com: What are the main findings of the study?Prof: Van Damme: Earlier FDG-PET studies carried out in the 80’ties already pointed out that patients with ALS had decrease glucose uptake in the brain that is more extended than the motor cortex, at least at the group level. Of course, this imaging technique has been improved since then.
We prospectively assessed the diagnostic and prognostic value of FDG-PET in patients that were referred to us because a diagnosis of ALS was suspected.
The most important finding of our study probably is that FDG-PET shows perirolandic and variable frontotemporal hypometabolism in most patients with ALS at the first presentation in our clinic. It suggests that FDG-PET is a very sensitive marker of cerebral involvement in ALS, which has a high sensitivity at the single patient level.
In addition our study revealed that the co-occurrence of extensive prefrontal or anterior temporal hypometabolism was present in about 10% of patients and had a negative effect on survival after disease onset.
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MedicalResearch.com Interview with:
Andrew I. Geller, MD
Medical Officer in the Division of Healthcare Quality Promotion at CDC.
MedicalResearch.com: What are the main findings of the study?Dr. Geller: Using CDC’s national medication safety monitoring system, we estimated that, each year, there were about 100,000 visits made to U.S. emergency departments (EDs) for insulin-related hypoglycemia and errors during 2007-2011, or about half a million ED visits over the 5-year study period. This is important because many of these ED visits for insulin-related hypoglycemia may be preventable.
We also found these ED visits were more common with increasing age: every year, 1 in 49 insulin-treated seniors (aged 65 years or older) visited the ED because of hypoglycemia while on insulin or because of a medication error related to insulin. Among the very elderly (aged 80 years or older), this number was 1 in 8 annually.
(more…)
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