Lancet

14 Feb

Posted at 14:07h in Accidents & Violence, Lancet, Sexual Health
MedicalResearch.com Interview with: Professor Naeemah Abrahams Senior Specialist Scientist:  Gender & Health Research Unit, South African Medical Research Council Extraordinary Professor:  Faculty of Community Health Sciences -School of Public Health: University of the Western Cape Associate Professor: Faculty of Health Sciences - School of Health and Rehabilitation Sciences: University of Cape Town MedicalResearch.com: What are the main findings of the study? Prof. Abrahams: We found a global estimate of non-partner sexual violence of 7.2%  for women 15 years and older - but this estimate varied across the globe. The regions with the highest prevalence was Sub Sahara Africa Central and Southern with a prevalence was 21% in the central region and  17.4 % in the Southern region. This is nearly 3 times the global estimate . The region with the lowest prevalence was  Asia South at 3.3%. The low level could be due to a number of reasons. Firstly data from this region was very limited – from 2 countries only  and we have found that if sexual violence questions are added to other larger studies the level of disclosure is not very high. It is also  more likely that people from Asia region do not disclose the violence in research studies because of stigma and shame.

12 Feb

Posted at 00:59h in Author Interviews, Diabetes, Lancet, Nutrition
MedicalResearch.com Interview with: Kirstie Bell Diabetes Dietitian, CDE & PhD Candidate Human Nutrition Unit The University of Sydney MedicalResearch.com: What are the main findings of the study? Answer: Overall, the evidence to support carbohydrate counting is limited, with current data showing a non-significant improvement in HbA1c.  Pooled results from 7 quality randomised control trials studies showed carbohydrate counting had no significant effect on glycemic control (-0.35%, p = 0.096).  There was a significant improvement in HbA1c of 0.64% points in studies in adults that were conducted in a parallel design. This is the first meta-analysis of carbohydrate counting in type 1 diabetes. Up until now, it has not been known what improvement in glycemic control can be expected. Current international guidelines for diabetes management have been based merely on gradings of the available evidence. However, assessing the overall effectiveness of carbohydrate counting is critical in clinical practice to guide medical and dietary management decisions.

10 Feb

Posted at 11:08h in Alcohol, Author Interviews, Lancet
Dr John Holmes PhD, MA, BA (Hons) (York) Section of Public Health, ScHARR, University of Sheffield, Sheffield S1 4DA, UKMedicalResearch.com with: Dr John Holmes PhD, MA, BA (Hons) (York) Section of Public Health, ScHARR, University of Sheffield, Sheffield S1 4DA, UK MedicalResearch.com: What are the main findings of the study? Dr. Holmes: The study aimed to examine which groups in society would be affected by a 45p minimum unit price for alcohol.  This was in response to concerns expressed by, among others, the UK Government that the policy may not tackle harmful drinking and may penalise responsible drinkers. We found no support for these concerns.  As the policy targets the cheap alcohol which is disproportionately purchased by those drinking at harmful levels, the effects are mainly felt by those at greatest risk of suffering harm from their drinking.  On the other hand, moderate drinkers, including those on low incomes, buy very little of this cheap alcohol so are relatively unaffected.

28 Jan

Posted at 03:14h in Author Interviews, Lancet, Weight Research
Professor Sally Wyke Deputy Director, Institute of Health and Wellbeing Professor (Institute of Health and Wellbeing Social Sciences) The University of GlasgowMedicalResearch.com Interview with: Professor Sally Wyke Deputy Director, Institute of Health and Wellbeing Professor (Institute of Health and Wellbeing Social Sciences) The University of Glasgow MedicalResearch.com: What are the main findings of the study? Prof. Wyke: The FFIT programme was very effective.  The men who did the programme lost nine times as much weight as the men who did not.  On average, they lost over 5.5kg  (11lbs)and kept it off for the full 12 months. In addition, we found highly significant differences in favour of the intervention objectively-measured waist, percentage body-fat, systolic and diastolic blood pressure, and self-reported physical activity, diet and indicators of well-being and physical aspects of quality of life.

15 Jan

Posted at 20:21h in Allergies, Asthma, Author Interviews, Lancet
Mariona Pinart, PhD CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance Parc de Recerca Biomèdica de Barcelona Doctor Aiguader, 88 | 08003 BarcelonaMedicalResearch.com Interveiw with: Mariona Pinart, PhD CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance Doctor Aiguader, 88 | 08003 Barcelona MedicalResearch.com: What are the main findings of the study? Answer: The study examined 23.434 children at 4 and 8 years from 12 ongoing European population-based birth cohort studies that recorded information on current eczema, rhinitis, and asthma from questionnaires and serum-specific IgE to six allergens. We wanted to assess how often eczema, rhinitis and asthma coexist in the same children (comorbidity) and whether the occurrence of comorbidities was due to causality or casualty and finally we wanted to examine whether the occurrence of comorbidity was modified by IgE sensitization. We found that comorbidity affects about 4% of children aged 4–8 years and that about 50% of this comorbidity is due to causality, suggesting that these diseases share common pathophysiological mechanisms. In addition, we found that children comorbidity at age 4 are 30 to 60 times more likely to have comorbidity at age 8 years, suggesting that the presence of comorbidity at age 4 years is a strong determinant of comorbidity at age 8 years. Even children with one single disease are also at high risk of developing comorbidity by age 8 years. Interestingly, we found that not only comorbidity is present in children both sensitized and not sensitized to IgE but also that only 38% of incident comorbidity at age 8 years is explained by the presence of IgE sensitization at age 4 years.

14 Jan

Posted at 15:11h in Author Interviews, Cancer Research, Lancet
MedicalResearch.com Interview with: Dr Jonathan Banks Programme Manager: The Discovery Research Programme Centre for Academic Primary Care NIHR School for Primary Care Research School of Social and Community Medicine University of Bristol Bristol BS8 2PSDr Jonathan Banks Programme Manager: The Discovery Research Programme Centre for Academic Primary Care NIHR School for Primary Care Research School of Social and Community Medicine University of Bristol  Bristol BS8 2PS MedicalResearch.com: What are the main findings of the study? Dr. Banks: We asked members of the public attending their local general practice or primary care centre to consider a series of hypothetical scenarios or vignettes which depicted cancer symptoms, their risk of cancer and the investigative processes involved in testing for cancer. We wanted to measure the point at which the risk of cancer outweighed the burden and inconvenience of testing in relation to lung, colorectal and pancreas cancers. Most people, around 88%, opted for testing even at the lowest risk of cancer which in our vignettes was 1%. Further analyses showed variation between cancers with fewer people opting for testing for colorectal cancer at a low (1%) risk and more people choosing to be tested for all cancers in the 60-69 age group.

05 Jan

Posted at 01:02h in Author Interviews, Lancet, Pulmonary Disease
Prof Sirpa Jalkanen MD, PhD MediCity Research Laboratory and Department of Medical Microbiology University of Turku Turku, FinlandMedicalResearch.com Interview with: Prof Sirpa Jalkanen MD, PhD MediCity Research Laboratory and Department of Medical Microbiology University of Turku Turku, Finland MedicalResearch.com: What are the main findings of the study? Answer: Pulmonary vascular leakage occurs early in acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Mortality is high (35-45%), but no effective pharmacotherapy exists. Production of anti-inflammatory adenosine by ecto-5’-nucleotidase (CD73) maintains endothelial barrier function. Interferon-beta-1a (IFN-beta) increases CD73 synthesis and might thus reduce vascular leakage and mortality in ALI/ARDS. We tested this hypothesis and the findings were as follows: 1.IFN-beta increased the number of CD73-positive vessels in human lung culture (4- and 14.3-fold on days 1 and 4 respectively, p=0.04 and 0.004). 2. The optimal tolerated FP-1201 dose (a unique intravenous formulation of interferon-beta 10 μg /day for six days) caused a significant rise in serum MxA (a marker for interferon response) and CD73 levels and a fall in interleukin-6 (an inflammatory cytokine) concentration. 3. Most importantly, odds of 28-day mortality was 81% lower in the treated than untreated subjects (8% vs 32%, OR[95% CI]0.19[0.03 to 0.72], p=0.01).

23 Dec

Posted at 13:00h in Author Interviews, Diabetes, Education, Lancet, Nutrition
Prof. Raj S Bhopal Bruce and John Usher Professor of Public Health Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH89AGMedicalResearch.com Interview with: Prof. Raj S Bhopal Bruce and John Usher Professor of Public Health Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH89AG MedicalResearch.com: What are the main findings of the study? Prof. Bhopal: In a randomised controlled trial, a tailored, family orientated intervention whereby dietitians worked in the family home to provide diet and exercise advice in people at high risk of developing diabetes, had a modest but potentially important effect in reducing weight at the end of the three-year intervention, by 1.6 kg more than in the control group.

10 Dec

Posted at 12:39h in Author Interviews, Lancet, Psychological Science, Sexual Health
Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K.MedicalResearch.com Interview with: Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K. MedicalResearch.com: What are the main findings of the study? Dr. Mercer: Firstly, the National Surveys of Sexual Attitudes and Lifestyles, Britain’s nationally-representative surveys of sexual behaviour (or Natsal for short), have captured substantial changes in sexual attitudes and lifestyles over the past 60 years, having collected data from over 45,000 people born between the 1930s and the 1990s – a period spanning much of the 20th Century. Secondly, the recent changes in behaviour that we have observed - so over the past decade - have however been considerably more marked for women than men, with the gender gap in reported behaviour narrowing, and in some cases, disappearing altogether. Thirdly, we’ve seen a greater acceptance of more diverse sexual lifestyles, such as same-sex sexual partnerships, but greater intolerance of what many people might consider as ‘disrespectful’ sexual partnerships, including non-exclusivity in marriage.

06 Dec

Posted at 18:30h in Author Interviews, Lancet, Sexual Health
Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine 15-17 Tavistock Place London WC1H 9SHMedicalResearch.com Interview with: Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine MedicalResearch.com: What are the main findings of the study? Dr. Mitchell: We explored the distribution of sexual function in the British population using a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years. We measured sexual function using the Natsal-SF, a novel validated measure, which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life. Men and women in the oldest age groups surveyed (55 – 74) were more likely to have low overall sexual function than those in the youngest age group (16 – 24). After taking account of age differences, low sexual function was associated in both men and women with being unemployed, with current depression, and with poor general health. It was also associated with higher numbers of lifetime partners (women only), paying for sex (men only), and reporting same-sex partners, as well as with other aspects of sexual health, such as being diagnosed with an STI and experiencing sex against their will. Low sexual function was associated with relationship breakdown, and with people not being happy with their relationship. Within relationships, the most common problem was an imbalance in level of interest in sex between partners, which affected around a quarter of both men and women. Just under one in five men and women said their partner had experienced sexual difficulties in the last year, and this proportion increased with age, particularly among women. Lack of interest in sex was one of the most commonly reported problems for both men and women, affecting three in every twenty (15%) men, and with women twice as likely as men to say that this had been an issue in the last year. Difficulty reaching climax (16%) and vaginal dryness (13%) were among common problems for women; and reaching a climax more quickly than desired (15%), and difficulty getting or keeping an erection (13%) among men.

02 Dec

Posted at 12:24h in Author Interviews, Lancet, Sexual Health
MedicalResearch.com Interview with: Dr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UDr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UK MedicalResearch.com: What are the main findings of the study?
 Dr. Field: This study, published in The Lancet on Tuesday 26 November, reports data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal), interviewing over 15,000 participants aged 16-74 years, to systematically assess the association between people’s health and their sexual lifestyles in Britain. The key findings from the study are that close to one in six (17%) of men and women feel that their health had affected their sex life in the past year. This rises to three fifths (60%) among men and women who say that they are in bad health. However, only a quarter of men (24%) and under a fifth of women (18%) who say that ill-health affects their sex life had sought help from a health profession, usually a family doctor.

25 Nov

Posted at 01:07h in Author Interviews, Lancet, Pulmonary Disease
Professor Clive Page Director, Sackler institute of Pulmonary Pharmacology Joint Head, Institute of Pharmaceutical Science King's College London 150 Stamford Street Waterloo Campus London SE1 9NHMedicalResearch.com Interview with: Professor Clive Page Director, Sackler institute of Pulmonary Pharmacology Joint Head, Institute of Pharmaceutical Science King's College London 150 Stamford Street Waterloo Campus London SE1 9NH MedicalResearch.com: What are the main findings of the study? Prof. Page: RPL 554 was shown to cause bronchodilation and anti-inflammatory activity at the same dose. The drug showed benefit in both patients with COPD and asthma.

24 Nov

Posted at 23:52h in Author Interviews, Hepatitis - Liver Disease, Lancet
Prof Eric Lawitz MD Vice President of Scientific and Research Development at The Texas Liver Institute Clinical professor of Medicine San Antonio University of Texas Health Science Center.MedicalResearch.com Interview with: Prof Eric Lawitz MD Vice President of Scientific and Research Development at The Texas Liver Institute Clinical professor of Medicine San Antonio University of Texas Health Science Center. MedicalResearch.com: What are the main findings of the study? Dr. Lawitz: Currently available treatments for HCV involve weekly injections of pegylated interferon and daily doses of oral antivirals that must be taken for up to a year.  These regimens are not only burdensome for patients, but are not always effective and can cause serious and debilitating side effects, including anemia. So there is a significant need for new tablet-based treatment regimens for HCV that eliminate interferon and ribavirin, are more effective, better tolerated and easier for patients to take.

24 Nov

Posted at 22:25h in Author Interviews, Breast Cancer, Chemotherapy, Lancet, MD Anderson
Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TXMedicalResearch.com Interview with: Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TX MedicalResearch.com: What are the main findings of the study? Dr. Hunt: The primary endpoint of the Z1041 trial was the proportion of patients who had pathological complete response in the breast, defined as the percentage of women who started the neoadjuvant treatment with no histological evidence of disease in the breast at surgery.  We found that high pathologic response rates were observed in both treatment groups with similar cardiac safety profiles in both arms of the trial.  Specifically, 56.5% of patients in the sequential group (fluorouracil, epirubicin and cyclophosphamide on day one of a 21-day cycle for four cycles followed by paclitaxel plus trastuzumab weekly for 12 weeks) had a complete pathological response versus 54.2% of the patients who received the concurrent regimen (paclitaxel and trastuzumab weekly for 12 weeks followed by fluorouracil, epirubicin and cyclophosphamide on day one of a 21-day cycle with trastuzumab on days one, eight and 15 of the 21-day cycle for four cycles).  The difference in pathologic complete response rates between the treatment arms was not statistically significant.  Cardiac safety was a secondary endpoint of the trial and we found that both regimens had acceptable cardiac safety profiles.

12 Nov

Posted at 11:46h in Author Interviews, Brain Injury, Cognitive Issues, Lancet
prof_david_menonMedicalResearch.com Interview with: Prof David K Menon MD PhD FRCP FRCA FFICM FMedSci Head, Division of Anaesthesia, University of Cambridge 
Consultant, Neurosciences Critical Care Unit 
BOC Professor, Royal College of Anaesthetists Professorial Fellow, Queens' College, Cambridge Senior Investigator, National Institute for Health Research Box 93, Addenbrooke's Hospital, 
Cambridge CB2 2QQ, UK MedicalResearch.com: What is the background for your study? Dr. Menon: We have known for some time that a history of traumatic brain injury (TBI) results in a significant (between 2 and 10 fold) increase in the likelihood of getting dementia in later life.  On possible mechanistic explanation for this comes from the finding that about a third of individuals who died of TBI, regardless of age, are found at autopsy to have deposits of β-amyloid in the brain, often Aβ42, which is the same variant of amyloid seen in the brain of patients who have Alzheimer’s Disease. However, such detection after death has made it impossible to examine the linkage of such early amyloid deposition to late dementia.  More recently, imaging with positron emission tomography (PET) and Pittsburgh compound B (PIB) has been used to image amyloid deposits in Alzheimer’s  Disease.  However, the technique had not been validated in traumatic brain injury.

11 Nov

Posted at 23:13h in Author Interviews, Breast Cancer, Lancet, Radiation Therapy
Prof Jayant S Vaidya PhD Clinical Trials Group, Division of Surgery and Interventional Science University College London, London, UKMedicalResearch.com Interview with: Prof Jayant S Vaidya PhD Clinical Trials Group, Division of Surgery and Interventional Science University College London, London, UK MedicalResearch.com: What are the main findings of the study? Dr. Vaidya: The main findings are
  • a) these are longer term results that have confirmed our original publication in 201
  • (b) We found that when TARGIT intraoperative radiotherapy is given at the time of lumpectomy for breast cancer, the local control and survival from breast cancer is similar to several weeks of whole breast radiotherapy
  • c) we also found that with TARGIT there are significantly fewer deaths from other causes - i.e., fewer deaths from cardiovascular causes and other cancers

07 Nov

Posted at 03:38h in AHA Journals, Author Interviews, Lancet, Stroke
Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USAMedicalResearch.com Interview with: Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USA MedicalResearch.com: What are the main findings of the study?  Dr. Derdeyn: The primary results indicate that medical management, consisting of dual antiplatelets for 3 months after a transient ischemic attack (TIA) or stroke, and rapid, effective control of blood pressure (systolic BP less than 140 mm Hg and 130 mm Hg if diabetic) and LDL-cholesterol (less than 70 mg/dl), in addition to management of other risk factors, is superior to angioplasty and stenting in addition to the same medical regimen for reducing the risk of future stroke in patients with severe atherosclerotic stenosis (>70%) of a major intracranial artery.    In addition, while there were subgroups at higher risk for stroke on medical treatment (older age, female gender, prior stroke in the territory),  none of these subgroups appeared to have a benefit from stenting (i.e. stroke rates in the stenting groups in these subgroups was higher too).

01 Nov

Posted at 19:19h in Author Interviews, Lancet, Vaccine Studies
Dr Belén Pedrique Epidemiologist Drugs for Neglected Diseases initiative DNDi, 15 Chemin Louis Dunant 1202 Geneva, Switzerland MedicalResearch.com Interview with : Dr Belén Pedrique Epidemiologist Drugs for Neglected Diseases initiative DNDi, 15 Chemin Louis Dunant 1202 Geneva, Switzerland MedicalResearch.com : What are the main findings of the study? Dr. Pedrique: Of the 850 new drugs and vaccines approved for all diseases in 2000-2011, 4% (37) were for neglected diseases, defined broadly as those prevalent primarily in poor countries: malaria, tuberculosis, 17 neglected tropical diseases (NTDs) as defined by the World Health Organization (WHO), 11 diarrheal diseases, and 19 other diseases of poverty, excluding HIV/AIDS. Globally these neglected diseases represent an 11% health burden, based on a recent assessment of 2010 disability-adjusted life-years (DALYs). Most newly developed therapeutic products were repurposed versions of existing drugs. Of the 336 brand-new drugs (new chemical entities, or NCEs) approved for all diseases in 2000-2011, only four, or 1%, were for neglected diseases; three were for malaria, and one for diarrheal disease. None were for any of the 17 WHO-listed NTDs Of 148,445 phase I-III clinical trials registered as of Dec 31, 2011, only 1% (2,016) were for neglected diseases.

01 Oct

Posted at 01:59h in Author Interviews, Global Health, Infections, Lancet
Prof Didier Pittet, MD, MS Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, SwitzerlandMedicalResearch.com Interview with : Prof Didier Pittet, MD, MS Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland   MedicalResearch.com : What are the main findings of the study? Prof. Pittet: The main finding is that the WHO hand hygiene promotion strategy is feasible and sustainable across healthcare settings worldwide. For the first time, we have evidence of its feasibility and successful effects to improve hand hygiene in a variety of different geographical and income settings, with an even greater impact in low-/middle-income countries than in high-income countries.

26 Sep

Posted at 11:30h in Author Interviews, Cancer Research, Lancet, Prostate Cancer, Sloan Kettering
Dr. Ethan Basch MD Memorial Sloan-Kettering Cancer CenterMedicalResearch.com Interview with Dr. Ethan Basch MD Memorial Sloan-Kettering Cancer Center MedicalResearch.com: What are the main findings of the study? Dr. Basch: The primary clinical finding of this study is that treatment with abiraterone acetate delays the time until pain develops or worsens in men with advanced prostate cancer.  Furthermore, abiraterone delays the time until quality of life and functioning deteriorate, compared to placebo.  There is also a broader research finding of this study, which is that it is feasible to rigorously study the time until symptom progression in cancer clinical trials, which paves the way for future studies to use a similar approach.

20 Sep

Posted at 12:14h in Author Interviews, Lancet, Smoking

Dr. Chris Bullen MBChB MPH PhD FAFPM FNZCPHM Director School of Population Health, The University of Auckland Private Bag 92019 Auckland 1142, New Zealand Co-Director of the NZ Tobacco Control Research Turanga: A national programme of research to inform rapid smoking prevalence reduction.MedicalResearch.com Interview with:

Dr. Chris Bullen MBChB MPH PhD FAFPM FNZCPHM Director School of Population Health, The University of Auckland Private Bag 92019 Auckland 1142, New Zealand Co-Director of the NZ Tobacco Control Research Turanga: A national programme of research to inform rapid smoking prevalence reduction. Web: http://www.turanga.org.nz/ MedicalResearch.com: What are the main findings of the study? Dr. Bullen:
  • E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar levels of abstinence as with nicotine patches, and few adverse events.
  • ?At 6 months, verified abstinence was 7·3% with nicotine e-cigarettes, 5·8% with patches, and 4·1% with placebo e-cigarettes. However, there was insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes.
  • No significant differences in rates of adverse events occurrence were found between the groups.
  • E-cigarettes, like the vapes found at MagicVaporizers, were very popular throughout the trial, with almost 90% of users stating they would recommend them to a friend trying to quit smoking.

20 Sep

Posted at 11:53h in Author Interviews, Breast Cancer, Cancer Research, Lancet
Prof Aron Goldhirsch Department of Medicine European Institute of Oncology Via Ripamonti 435, 20141 Milan, ItalyMedicalResearch.com Interview with: Prof Aron Goldhirsch Department of Medicine European Institute of Oncology Via Ripamonti 435, 20141 Milan, Italy MedicalResearch.com: What are the main findings of the study? Prof. Goldhirsch:  Two years of adjuvant trastuzumab after standard chemotherapy is not more effective than is 1 year of treatment with the drug for patients with HER2-positive early breast cancer.

20 Sep

Posted at 11:38h in Author Interviews, Breast Cancer, Lancet
Prof John R Yarnold Division of Radiotherapy and Imaging The Royal Marsden NHS Foundation Trust Sutton, Surrey SM2 5PT, UKMedicalResearch.com Interview with: Prof John R Yarnold Division of Radiotherapy and Imaging The Royal Marsden NHS Foundation Trust Sutton, Surrey SM2 5PT, UK   MedicalResearch.com: What are the main findings of the study? Prof. Yarnold: A 3-week schedule of curative post-operative radiotherapy for women with breast cancer involving 15 treatments (fractions) delivered Monday to Friday each week, is at least as safe and effective as historical schedules given over 5 or 6 weeks. In fact the 3-week schedule is gentler on the healthy tissues than earlier standard regimens.

20 Sep

Posted at 11:21h in Author Interviews, Lancet, OBGYNE
Prof Sally K Tracy DMid Midwifery and Women's Health Research Unit University of Sydney, Royal Hospital for Women Randwick, NSW, AustraliaMedicalResearch.com Interview with: Prof Sally K Tracy DMid Midwifery and Women's Health Research Unit University of Sydney, Royal Hospital for Women Randwick, NSW, Australia MedicalResearch.com: What are the main findings of the study? Prof. Tracy: We recruited 1748 pregnant women, of all risk types, from two tertiary teaching hospitals in different states in Australia and allocated them to receive either caseload midwifery care (871) or standard maternity care (877). The study found more women in caseload midwifery experienced an unassisted vaginal birth without pharmacological analgesia, and fewer women experienced an elective caesarean. While the trial findings did not show a statistically significant difference in the rate of caesarean sections between either group, the overall rate fell by more than 20 percent from pre-trial levels. Newborn infants in both groups achieved similar physical assessment scores (Apgar scores). A slightly lower number of pre-term births and neonatal intensive care admissions among the midwifery caseload group was not statistically significant. Important secondary findings of the study include:
  • 30 percent more spontaneous onset of labour
  • less induction of labour
  • less severe blood loss, and
  • stronger likelihood of breastfeeding at discharge from hospital.
These small differences accounted for an overall difference of AU$566.74 less with caseload midwifery than with standard care. Caseload midwifery appeared to alter some of the pathways that recurrently contribute to increased obstetric intervention.  Having this level of continuity of care works on the assumption that women will labour more effectively, need to stay in hospital less time and feel a stronger sense of satisfaction and personal control if they have the opportunity to get to know their midwife at the beginning of pregnancy.

15 Aug

Posted at 19:37h in Author Interviews, Gastrointestinal Disease, Infections, Lancet, Probiotics
Prof. Steve Allen Professor of Paediatrics and International Health; RCPCH International Officer and David Baum Fellow Room 314, The College of Medicine, Swansea University, Swansea, SA2 8PP, UK.Prof. Steve Allen Professor of Paediatrics and International Health; RCPCH International Officer and David Baum Fellow Room 314, The College of Medicine, Swansea University, Swansea, SA2 8PP, UK. MedicalResearch.com: What are the main findings of the study? Answer: Overall, diarrhoea occurred in just over 10% participants and diarrhoea caused by C. difficile in about 1%. These outcomes were equally common in those taking the microbial preparation and those taking placebo. Other outcomes (e.g. common GI symptoms, length of hospital stay, quality of life) were also much the same in the two groups. So, there was no evidence that the microbial preparation had prevented diarrhoea or had led to any other health benefit. In agreement with previous research, serious adverse events were also similar in the two groups – so we found no evidence that the microbial preparation caused any harm.

07 Aug

Posted at 01:13h in Author Interviews, Disability Research, Lancet
MedicalResearch.com Interview with: Evelyn Wong MBBS (Hons) MPH PhD Candidate Baker IDI Heart and Diabetes Institute Level 4, 99  Commercial Rd, Melbourne. VIC 3004 MedicalResearch.com: What are the main findings of the study? Answer: Researchers at Baker IDI Heart and Diabetes Institute reviewed previously published literature on the association between diabetes and the risk of developing physical and functional disability. In this study, disability was defined by a person’s difficulty walking; carrying out daily activities such as using a telephone or transport, managing finances, shopping; or attending to basic self-care needs such as eating, dressing and bathing. Although there have been many previous studies on diabetes and disability, the findings have varied and to date, no one has pooled all studies together for a combined measure of risk. From 26 relevant studies, we measured the pooled effect of the association between diabetes and disability. We found that diabetes increased the risk of disability by 50-80% compared to those without diabetes and this result was consistent across all types of disability.

30 Jul

Posted at 13:31h in Author Interviews, Environmental Risks, Lancet, Lung Cancer
Ole Raaschou-Nielsen, MSc, PhD Head of Research Group for Work, Environment & Cancer Danish Cancer Society Research Center Strandboulevarden 49 2100 Copenhagen ØMedicalResearch.com Interview with: Ole Raaschou-Nielsen, MSc, PhD Head of Research Group for Work, Environment & Cancer Danish Cancer Society Research Center Strandboulevarden 49 2100 Copenhagen Ø MedicalResearch.com: What are the main findings of the study? Answer: The study shows that people who live at locations with higher levels of particles in the air are at higher risk for development of lung cancer. It seems that there is no threshold for air pollution with particles below which there is no risk; the results show that it is more like “the more air pollution the worse and the less pollution the better”. The strongest association was seen for adenocarcinoma of the lung.

24 Jul

Posted at 12:58h in Author Interviews, Cannabis, Lancet, Multiple Sclerosis, Neurological Disorders
Professor John Zajicek Professor of Clinical Neuroscience, Centre for Clinical Trials & Health Research - Translational & Stratified Medicine (Peninsula Schools of Medicine and DentistrMedicalResearch.com Interview with: Professor John Zajicek Professor of Clinical Neuroscience, Centre for Clinical Trials & Health Research - Translational & Stratified Medicine (Peninsula Schools of Medicine and Dentistry) MedicalResearch.com: What are the main findings of the study? Prof. Zajicek: Our study investigated whether dronabinol (one of the major active ingredients of cannabis) may slow the progression of multiple sclerosis. We currently have no treatments that are effective in modifying the disease course in people with either primary or secondary MS. We did a clinical trial across the UK involving nearly 500 patients, who were randomly allocated to dronabinol or placebo, and followed them up for three years to look at progression on rates. Overall we failed to find an effect of dronabinol on disease progression,  either clinically (using a variety of clinical measures) or using magnetic resonance imaging (MRI). There was a suggestion of an effect in people with the least disability (who didn't need a stick to help them walk), and there were no major problems with serious side effects.  However, over all the population that took part in the study also progressed less than we expected, which reduced our chances of finding an effect of treatment. The  study was not designed to investigate an effect on MS-related symptoms (such as pain and muscle stiffness), which have been investigated before.

10 Jul

Posted at 01:10h in Asthma, Author Interviews, Duke, Genetic Research, Lancet, NEJM
Daniel Belsky, PhD NIA Postdoctoral Fellow Center for the Study of Aging and Human Development Duke UniversityMedicalResearch.com Interview with: Daniel Belsky, PhD NIA Postdoctoral Fellow Center for the Study of Aging and Human Development Duke University Polygenic risk and the development and course of asthma: an analysis of data from a four-decade longitudinal study MedicalResearch.com: What are the main findings of the study? Dr. Belsky : We looked to the largest-ever genome-wide association study of asthma (that study by the GABRIEL Consortium included more than 26,000 individuals) to identify genetic variants that could be used to construct a genetic profile of asthma risk. We then turned to The Dunedin Multidisciplinary Health and Development Study, a unique cohort of 1,000 individuals who have been followed from birth through their fourth decade of life with extensive measurements of asthma and related traits. We computed a “genetic risk score” for each person based on the variants identified in GWAS.  Then, we looked at who developed asthma, when they developed asthma, and what that asthma looked like in terms of allergic response and impaired lung function. What we found: (1) People with higher genetic risk scores were more likely to develop asthma and they developed asthma earlier in life. (2) Among children who developed asthma, the ones at higher genetic risk were more likely to have persistent asthma through midlife. (3) Genetic risk was specifically associated with allergic asthma that resulted in chronic symptoms of impaired lung function. (4) People with higher genetic risk score developed more severe cases of asthma. As compared to people with a lower genetic risk, they were more often absent from school and work because of asthma and they were more likely to be hospitalized for asthma. (5) The genetic risk score provided new information about asthma risk that could not be obtained from a family history.

09 Jul

Posted at 15:35h in Author Interviews, Diabetes, Frailty, Lancet
MedicalResearch.com Interview with: Dr David Strain, MRCP MD Clinical senior lecturer and honorary consultant University of Exeter Medical School Institute of Biomedical and Clinical Science Department of Diabetes and Vascular Research Royal Devon & Exeter Hospital Exeter EX2 5AX MedicalResearch.com: What is the Background of the study? In early 2010 recent diabetes outcome trials such as ACCORD and ADVANCE had put into question the benefit of aggressive HbA1c reduction for all patients particularly in elderly population. After that there were several guidelines that suggested individualizing treatment targets for elderly patients according to their age, co-morbidities, frailty and baseline HbA1c. This featured in the Finnish guidelines and the European Working Party for the management of Diabetes in the Older Person. However this was also completely without any evidence base. I worked with Paivi Paldanius (the final author of the paper and a medical advisor for Novartis) to establish a pragmatic study. We both acknowledged the importance of having a patient-centric, pragmatic and 'real-life' approach and as there was already evidence that DPP-4 inhibitors, in this case vildagliptin (due to Päivi's affiliation), had demonstrated it's efficacious and had no tolerability issues in the elderly population we decided to go ahead with the study. It was obvious that we needed to implement a holistic approach and take into account as many clinically relevant parameters as possible, such as age, baseline HbA1c, duration of the disease, co-morbidities and frailty, for implementation of the individualized care. Our primary goal was to request that the physicians acting as investigators would still apply their clinical judgment based on these clinical features of each individual patient but also, follow their local guidelines as in their daily clinical practice. This would later provide us with invaluable information and perspective when interpreting the data and recommending implementation of the results.  For assessment of frailty we screened for many different methodologies but Prof Timo Strandberg (known expert of the field and mentioned in the acknowledgements section of our paper) suggested to apply modified Linda Fried's method for assessment of phenotype of frailty as this method is validated, very pragmatic, reproducible and also feasible to be used for the first time also by a non-geriatric investigator. All investigators were trained to follow these parameters by the protocol. We also wished to evaluate in parallel the conventional HbA1c drop assessment in order to be able to put the potential success of our new endpoint, meeting the individualized target, into perspective and for comparison against other standard data from other studies with DPP-4 inhibitors with elderly. We also wished to simulate a clinical, real-world setting as much as possible and included patients who would seem representative of most elderly T2DM patients.