Author Interviews, JAMA, Surgical Research, Weight Research / 09.02.2015

MedicalResearch.com Interview with: Torsten Olbers MD, PhD Assistant Professor of Surgery Sahlgrenska University Hospital Gothenburg, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th.
Aging, Author Interviews, Memory, Nature, Nutrition / 09.02.2015

Ashok K. Shetty, Ph.D. Professor and Director of Neurosciences Institute for Regenerative Medicine and Department of Molecular and Cellular Medicine
Texas A&M Health Science Center College of Medicine, Temple, TX
Research Career Scientist, Central Texas Veterans Health Care System (CTVHCS), Temple, TXMedicalResearch.com Interview with: Ashok K. Shetty, Ph.D. Professor and Director of Neurosciences Institute for Regenerative Medicine and Department of Molecular and Cellular Medicine
Texas A&M Health Science Center College of Medicine, Temple, TX
Research Career Scientist, Central Texas Veterans Health Care System (CTVHCS), Temple, TX Medical Research: What is the background for this study? Prof. Shetty: Hippocampus is a region in the brain important for maintaining functions such as learning, memory and mood. However, this region is highly vulnerable to aging and brain insults. Previous research has shown that diminished function in the dentate gyrus region of the hippocampus is one of the key reasons for memory impairments seen in old age. Dentate gyrus is also one of the few regions in the brain where neural stem cells generate new neurons on a daily basis, also referred to as "adult neurogenesis". Studies have suggested that a significant fraction of newly born neurons mature, get incorporated into the existing hippocampus circuitry and contribute to learning, formation of new memories, and normal mood. However, with aging, the dentate gyrus shows decreased function with some conspicuous structural changes, which include reduced production of new neurons, diminished microvasculature implying reduced blood flow, and occurrence of hypertrophy of astrocytes and activated microglia, signs of chronic low-level inflammation. Because alterations such as reduced neurogenesis, decreased blood flow and brain inflammation can contribute to memory and mood impairments, the idea that drugs that are efficacious for mitigating these changes may preserve memory and mood function in old age has emerged. Such drugs may be prescribed to the aging population if they are efficacious for maintaining normal cognitive and mood function in old age with no or minimal side effects. Medical Research: What is the rationale for choosing resveratrol for preventing age-related memory dysfunction in this study? Prof. Shetty:  Administration of resveratrol, a naturally occurring polyphenol found in the skin of red grapes, red wine, peanuts and some berries, appeared suitable for counteracting age-related detrimental changes in the hippocampus. This is because, previous studies have shown that resveratrol has ability to promote the formation of new capillaries (through pro-angiogenic effects) and to suppress oxidative stress and inflammation (via antioxidant and antiinflammatory effects) with no adverse side effects. Other studies have also reported that resveratrol can mediate extension of the life span and delayed onset of age related diseases. More importantly, a recent human study suggested that a reasonably lower dose of resveratrol intake for 26 weeks is good enough to improve memory performance as well as hippocampus functional connectivity in 23 healthy overweight older individuals (Witte et al., J. Neurosci., 34: 7862-7870, 2014).
AHA Journals, Author Interviews, Heart Disease, Lipids / 09.02.2015

Ann Marie Navar-Boggan, MD PhD Fellow, Cardiovascular Disease Duke University School of Medicine MedicalResearch.com Interview with: Ann Marie Navar-Boggan, MD PhD Fellow, Cardiovascular Disease Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Response: In this study of adults from the Framingham Offspring Study, we evaluated the impact of prolonged exposure to elevated cholesterol in early adulthood and future risk of coronary heart disease. In adults aged 55, the duration of time a person has been exposed to a non-HDL of >=160 mg/dL was associated with increased risk of coronary heart disease, and that risk was above and beyond the risk conferred by lipid levels at age 55. Every 10 years spent with a non-HDL of 160 or above was associated with a 39% increased future risk of coronary heart disease. We also looked at the association between prior average blood cholesterol between the age of 35 and 55, and found that every 10 mg/dL increase in prior average cholesterol above 125 mg/dL was associated with a 33% increased risk of coronary heart disease. These findings were particularly notable because the vast majority of adults with prolonged exposure to hyperlipidemia would not have been identified by the guidelines for statin therapy.​
Annals Internal Medicine, Author Interviews, End of Life Care / 07.02.2015

Adam E. Singer, MPhil, Pardee RAND Graduate School, RAND Corporation Santa Monica, CAMedicalResearch.com Interview with: Adam E. Singer, MPhil Pardee RAND Graduate School, RAND Corporation Santa Monica, CA MedicalResearch: What is the background for this study? What are the main findings? Response: In 1997, the Institute of Medicine (IOM) released a seminal report on the state of end-of-life care in the US that called for major changes in the organization and delivery of end-of-life care. Many of the IOM’s indictments have ostensibly been addressed since that time through the expansion of palliative care and hospice, along with a greater focus on symptom management in both policy and practice. This study was designed to ask whether end-of-life symptoms have become less prevalent from 1998 to 2010 for the population as a whole and also for subgroups that died suddenly or had cancer, congestive heart failure (CHF), chronic lung disease, or frailty. The study found that many alarming symptoms were common in the last year of life and affected more people from 1998 to 2010. For example, in the whole population, pain affected 54% in 1998 and 61% in 2010 (a 12% increase). Depression affected 45% in 1998 and 57% in 2010 (a 27% increase). Periodic confusion affected 41% in 1998 and 54% in 2010 (a 31% increase). Depression and periodic confusion also became more prevalent in subgroups with CHF and/or chronic lung disease and frailty. In addition, nearly all other symptoms in the whole population and in each of the subgroups trended toward increases in prevalence from 1998 to 2010, although most of these trends did not reach statistical significance. The one exception is that there were no significant changes in the subgroup with cancer.
Author Interviews, Lancet, Lifestyle & Health / 07.02.2015

Dr Sandra L Jackson PhD Atlanta VA Medical Center, Decatur, GA, Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences Emory University, Atlanta, GA, USAMedicalResearch.com Interview with: Dr Sandra L Jackson PhD  Atlanta VA Medical Center, Decatur, GA, Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences Emory University, Atlanta, GA, USA Medical Research: What is the background for this study? What are the main findings? Dr. Jackson: Lifestyle change programs are aimed to improve health, yet little is known about their impact once translated into clinical settings. The Veterans Health Administration (VA) MOVE! program is the largest lifestyle change program in the U.S. Participation is a key challenge of the program, as only 13% of the eligible population participated. However, among patients who did not have diabetes at baseline, we found that MOVE! participation was associated with lower diabetes incidence.
Author Interviews, Brigham & Women's - Harvard, PNAS, Sleep Disorders / 06.02.2015

Christa Van Dort PhD Department of Anesthesia, Critical Care, and Pain Medicine, Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts General Hospital, Harvard Medical School Boston, MA, 02114MedicalResearch.com Interview with: Christa Van Dort PhD Department of Anesthesia, Critical Care, and Pain Medicine, Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts General Hospital, Harvard Medical School Boston, MA, 02114 Medical Research: What is the background for this study? What are the main findings? Dr. Van Dort:  Sleep is crucial for survival and maintenance of health.  Inadequate sleep and sleep disorders impair many brain and body functions such as executive function, the immune system and memory consolidation. The benefits of sleep are dependent on normal sleep physiology and patterns. Natural sleep is composed of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep alternating every 90 min in humans.  Each stage provides different benefits, for example deep NREM sleep is associated with feeling rested and REM sleep is important for learning. Current sleep aids do not effectively restore normal sleep physiology or timing and as a result do not fulfill the important functions of natural sleep.  To develop new strategies for reproducing natural sleep, we aimed to understand each component of sleep (NREM and REM sleep) individually and then in combination. Cholinergic neurons have been hypothesized to control REM sleep for many years but no one had been able to test this directly due to limited methodology. Optogenetics solved this problem by giving us the ability to activate selectively the cholinergic neurons in the pedunculopontine tegmentum (PPT) and laterodorsal tegmentum (LDT). The primary finding of this study was that cholinergic neurons in the PPT and LDT are sufficient to drive REM sleep from NREM sleep. These cholinergic neurons were important for initiation of REM sleep but not the duration of REM sleep. Understanding REM sleep control is an important first step in reproducing normal sleep patterns and by itself could enhance learning and memory.
BMJ, Heart Disease, Hospital Readmissions, Yale / 06.02.2015

MedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Section of Cardiovascular Medicine Yale University School of Medicine, New Haven, CT 06510 Medical Research: What is the background for this study? What are the main findings? Dr. Dharmarajan: We know that patients are at high risk for rehospitalization and death in the month after hospital discharge. Yet little is known about how these risks dynamically change over time for the full year after hospitalization. This information is needed for patients and hospitals to set realistic goals and plan for appropriate care. We found that the risk of rehospitalization and death decline slowly following hospitalization and remain elevated for many months. We also found that specific risk trajectories vary by discharge diagnosis and outcome. For example, risk remains elevated for a longer period of time following hospitalization for heart failure compared with hospitalization for acute myocardial infarction. For all 3 conditions we studied (heart failure, heart attacks, and pneumonia), risk of rehospitalization remained elevated for a longer period of time than the risk of death.
Author Interviews, Genetic Research, Nature, Rheumatology / 06.02.2015

psoriasis_kneesMedicalResearch.com Interview with: Professor Anne Barton FRCP PhD and Dr John Bowes PhD Centre for Musculoskeletal Research and Centre for Genetics and Genomics, The University of Manchester, Manchester UK Medical Research: What is the background for this study? Response: Psoriatic arthritis (PsA) is an inflammatory condition causing pain and stiffness in joints and tendons. Approximately one third of patients with psoriasis will go on to develop PsA resulting in a reduction in their quality of life caused by increasing disability and additional health complications. A key area of research within the Arthritis Research UK Centre for Genetics and Genomics in the Centre for Musculoskeletal Research is the identification of risk factors for the development of Psoriatic arthritis; this will allow us to understand the underlying cause of disease and ultimately help identify psoriasis patients at high risk of PsA, allowing early treatment to be introduced to reduce the impact of PsA. Our study focuses on the identification of genetic risk factors for Psoriatic arthritis; we compared the frequency of genetic variants, referred to as single nucleotide polymorphisms (SNPs), between large numbers of DNA samples from patients with PsA and healthy control samples. When the frequency of the SNP is significantly different between cases and controls, the SNP is said to be associated with risk of developing Psoriatic arthritis and this association is interpreted as being important in the disease process. Medical Research: What are the main findings? Response: When we analysed the data from the study we found a new association to SNPs on chromosome 5, and when we investigated these SNPs for association with skin-only psoriasis, we did not find any evidence for association. In addition, we also found SNPs that were specifically associated with Psoriatic arthritis at a gene on chromosome 1. This gene is known to be associated with psoriasis, but our results show that there are different SNPs associated with PsA and psoriasis at this gene. Hence, our results identify new SNPs that are specifically associated with PsA. In addition, identifying which cells are the key drivers of inflammation in Psoriatic arthritis will help us to focus on how the genetic changes act in those cells to cause disease. Our results show that many of the PsA associated SNPs occur in regions of the genome that are important in the function of CD8+ cells,  an important cell type in the immune system.
ADHD, Author Interviews, FASEB, Occupational Health, Toxin Research / 06.02.2015

MedicalResearch.com Interview with: Jason R. Richardson MS,PhD DABT Associate Professor Department of Environmental and Occupational Medicine Robert Wood Johnson Medical School and Resident Member Environmental and Occupational Health Sciences Institute Piscataway, NJ MedicalResearch: What is the background for this study? What are the main findings? Dr. Richardson:  Although ADHD is often though of as a genetic disorder, no single gene can explain more than a fraction of the cases. This suggests that environmental factors are likely to interact with genetic susceptibility to increase risk for ADHD. Our study reports that exposure of pregnant mice to relatively low levels of a commonly used pesticide reproduces the behavioral effects of ADHD in their offspring. Because the study was in animals, we wanted to see if there was any association in humans. Using data from the Centers for Disease Control and Prevention we found that children and adolescents with elevated levels of metabolites of these pesticides in their urine, which indicates exposure, were more than twice as likely to be diagnosed with ADHD.
Author Interviews, Gastrointestinal Disease, mBio, Weight Research / 06.02.2015

Senior Principal Investigator - Systems Biology Singapore Institute for Clinical Sciences Brenner Centre for Molecular Medicine SingaporeMedicalResearch.com Interview with: Joanna Holbrook PhD Senior Principal Investigator - Systems Biology Singapore Institute for Clinical Sciences Brenner Centre for Molecular Medicine Singapore Medical Research: What is the background for this study? Dr. Holbrook: Bacteria in the human gut may influence many aspects of our health; however, it is not fully known what determines the composition of the gut microbiota. Rapid bacterial colonisation of the infant gut could be influenced by the environment of the baby before birth, and microbiota content has been associated with the development of obesity and insulin resistance. Medical Research: What are the main findings? Dr. Holbrook: The rate of bacterial colonisation of the gut is influenced by external factors such as the method of delivery and duration of gestation. Also, infants with a mature gut bacteria profile at an early age gained normal levels of body fat, while infants with less mature gut bacteria profiles displayed a tendency to gain lower levels of body fat at the age of 18 months, indicating that gut bacteria could be related to normal development and healthy weight gain.
Author Interviews, Geriatrics, Hip Fractures, Lancet / 06.02.2015

Ingvild Saltvedt PhD Department of Neuroscience, Norwegian University of Science and Technology, Medical Faculty Trondheim, Norway MedicalResearch.com Interview with: Ingvild Saltvedt PhD Department of Neuroscience, Norwegian University of Science and Technology, Medical Faculty Trondheim, Norway Medical Research: What is the background for this study? What are the main findings? Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society.  In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of  orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness.  Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered. The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group.
Author Interviews, BMJ, Nutrition, Pulmonary Disease / 05.02.2015

MedicalResearch.com Interview with: Raphaëlle Varraso INSERM U1168, VIMA (Aging and chronic diseases. Epidemiological and public health approaches), 16 avenue Paul Vaillant Couturier Villejuif, France MedicalResearch: What is the background for this study? What are the main findings? Response: Respiratory health and lung function, strongly predict general health status and all-cause mortality. Chronic obstructive pulmonary disease (COPD) is currently ranked the third leading cause of death worldwide. The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, suggesting that other factors are involved. Besides smoking, relatively little attention has been paid to other modifiable risk factors that might decrease risk of developing COPD, including diet. The Alternate Healthy Eating Index (AHEI)-2010, a new measure of diet quality based on current scientific knowledge, has been linked to risk of major chronic diseases, such as cardiovascular disease, diabetes and cancer. However, the role of dietary scores on risk of COPD is unknown. We examined this issue among >120,000 US female and male health professionals (Nurses’ Health Study and Health Professionals Follow-up Study), and we reported that a high AHEI-2010 dietary score score (reflecting high intakes of whole grains, vegetables, fruit, polyunsaturated fatty acids, nuts and legumes, and long-chain omega-3 fats, a moderate intake of alcohol, and low intakes of red/processed meats, trans fat, sodium and sugar-sweetened beverages) was associated with a lower risk of COPD in both women and men. This novel finding supports the importance of diet in COPD pathogenesis.
Author Interviews, Hospital Readmissions, Pediatrics, Pediatrics / 05.02.2015

Mark Brittan MD MPH Assistant Professor, Pediatric Hospital Medicine Children's Hospital Colorado University of Colorado School of MedicineMedicalResearch.com Interview with: Mark Brittan MD MPH Assistant Professor, Pediatric Hospital Medicine Children's Hospital Colorado University of Colorado School of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Brittan: As hospitals face reimbursement penalties for excess readmissions, clinicians are increasingly focused on improving care transitions in order to reduce readmissions. We are interested in learning about feasible ways to reduce pediatric readmissions so that we can improve the quality of care and experience of children and families who are being discharged from the hospital. The purpose of this study was to assess whether outpatient follow-up visits after hospital discharge can help to prevent readmissions. We chose to examine this question in a population of medically complex children enrolled in Medicaid. Children with medical complexity account for a growing proportion of pediatric hospitalizations and inpatient costs. These children are often dependent on technology (for example, ventilator machines, feeding tubes, and chronic indwelling catheters), and can have very complex care plans and medication regimens. Publically insured children are also vulnerable to increased hospital utilization and may not always have optimal or easy access to outpatient services. Showing a relationship between post-discharge outpatient visits and fewer readmissions would suggest that improvements in coordination of care or access to outpatient follow-up care may help to reduce readmissions in these children. To assess this relationship, we retrospectively analyzed 2006-2008 Colorado Medicaid claims data from which we were able to gather demographic, clinical, and visit information for all enrollees. In our study, we excluded children who were readmitted within 3 days of hospital discharge so that we could evaluate children who had a chance to follow-up. The study cohort included 2415 medically complex children aged 6 months to 18 years who were hospitalized at least once. Of these children, 6.3% were readmitted on days 4 – 30 after hospital discharge. Almost 22% of the children had an outpatient follow-up visit within 3 days of discharge, and 40% had a visit on days 4-29 after discharge. In the final analysis, we found expected associations between readmission and previously described risk factors, including number of patient comorbidities and longer initial hospital length of stay. Examining the relationship between outpatient follow-up and readmission, we found that children with later outpatient follow-up visits (days 4-29) were significantly less likely to be readmitted than those who did not have an outpatient visit on days 4-29 after discharge.
Author Interviews, Dermatology, JAMA, OBGYNE, UC Davis / 05.02.2015

MedicalResearch.com Interview with: Dr. Eleanor B. Schwarz, M.D., M.S University of California, Davis Sacramento, CA MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Schwarz: The background for this study is that… Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects. Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard).
Author Interviews, Hepatitis - Liver Disease, HIV, Lancet / 05.02.2015

MedicalResearch.com Interview with: Prof Jean-Michel Molina Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris France MedicalResearch.com Interview with: Prof Jean-Michel Molina Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris France Medical Research: What is the background for this study? What are the main findings? Prof. Molina: Treatment of co-infected patients is complicated by drug drug interactions with HIV drugs, and the news DAAs are not very potent on HCV G2 and 3 infections.
AHA Journals, Author Interviews, Cleveland Clinic, Heart Disease, Kidney Disease / 05.02.2015

MedicalResearch.com Interview with: W. H .Wilson Tang, M.D., F.A.C.C., F.A.H.A. Professor in Medicine, Cleveland Clinic Lerner College of Medicine Cleveland Clinic, Cleveland, OH 44195MedicalResearch.com Interview with: W. H .Wilson Tang, M.D., F.A.C.C., F.A.H.A. Professor in Medicine, Cleveland Clinic Lerner College of Medicine Cleveland Clinic, Cleveland, OH 44195.   Medical Research: What is the background for this study? What are the main findings? Dr. Tang: Our group has previously demonstrated that TMAO is linked to future cardiac risks in both humans and in animal models.  We now show that long-term exposure to higher levels of TMAO promotes renal functional impairment and fibrosis in animal studies.  We also show that in humans, as the kidneys lose function, TMAO isn’t eliminated as easily, and their blood levels further rise, thereby increasing cardiovascular and kidney disease risks further.  This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and chronic kidney disease.
Author Interviews, Depression, Lancet, Multiple Sclerosis / 04.02.2015

Dr Stefan M Gold Institute of Neuroimmunology and Multiple Sclerosis (INIMS) Centre for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf Hamburg, GermanyMedicalResearch.com Interview with: Dr Stefan M Gold Institute of Neuroimmunology and Multiple Sclerosis (INIMS) Centre for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Gold: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (brain and the spinal cord). In addition to motor symptoms such as walking impairment, patients with Multiple sclerosis frequently suffer from psychological problems including difficulties with learning and memory as well as depressed mood. Depression is particularly common in this patient group with a 3-4 fold elevated risk for developing major depressive disorder compared to the general population. Depression in Multiple sclerosis is associated with decreased quality of life, absence from work, and numerous other psychosocial problems. Despite this major impact on patients’ lives, depression in Multiple sclerosis is often not adequately diagnosed and treated: Antidepressant medication in this patient group often has side effects and the neurological problems associated with MS such as difficulties with concentration and fatigue make it particularly difficult for MS patients to complete “classical” depression treatments such as psychotherapy. The goal of our study was to make psychological treatments available for the many patients with Multiple sclerosis suffering from depression, who often have difficulties to find adequate treatment. For this study, published in The Lancet Psychiatry, we conducted a randomized controlled trial of a fully-automated, computer-based program that can be accessed directly from patients’ homes over the internet. The program called “deprexis” was developed by the Hamburg-based company GAIA and uses methods of “cognitive behavioral therapy” or “CBT”. Ninety Multiple sclerosis patients were enrolled in the trial and randomly assigned to a 3 months therapy using the deprexis program or a waitlist control group. At the end of the intervention, depression had significantly decreased in the treatment group but remained unchanged in patients who did not have access to the program. In addition, patients using the computer program also reported reduced fatigue and improved quality of life.
Author Interviews, CDC, Infections, Lancet, Vaccine Studies / 04.02.2015

MedicalResearch.com Interview with: Dr Matthew R Moore, MD National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USADr Matthew R Moore, MD National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA MedicalResearch: What is the background for this study? Dr. Moore: Since introduction, pneumococcal conjugate vaccines have resulted in dramatic decreases in the number of cases of invasive pneumococcal disease in both children and adults.  The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine infant immunization program in the United States in 2000. It was recommended for infants using a 4-dose schedule: 2, 4, 6, and 12 through 15 months of age. Studies showed that PCV7 was highly effective in preventing invasive pneumococcal disease. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 using the same 4-dose schedule. PCV13 is similar to PCV7, but includes protection against six additional serotypes of Streptococcus pneumoniae. There are more than 90 serotypes of pneumococcal bacteria. Streptococcus pneumoniae, or pneumococcus, is a major cause of illness and death globally. Pneumococcus can cause many types of illness that ranging from mild to life-threatening, including pneumonia, ear and sinus infections, meningitis, and bacteremia. Some of these infections are considered invasive because they invade parts of the body that are normally free from bacteria. Invasive pneumococcal disease, including meningitis and bacteremia, is often severe and can be deadly. MedicalResearch: What are the main findings? Dr. Moore: Invasive pneumococcal disease decreased substantially in the first 3 years after PCV13 was introduced into the U.S. infant immunization schedule. By June 2013, more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths are estimated to have been prevented in the United States due to PCV13. Children under the age of five, which is the age group that actually received the vaccine, experienced the greatest and quickest benefit from PCV13.  For example, the overall number of cases of invasive pneumococcal disease decreased by 64% in this age group between 2010 and 2013. Significant decreases were seen as early as six months after the immunization recommendation was made. Adults, who were not targeted for vaccination, also experienced health benefits from PCV13 introduction. For example, the overall number of cases of invasive pneumococcal disease decreased by 32% for adults aged 18 to 49 years, while adults 65 and older experienced a more modest 12% decrease.  These reductions are further evidence that both PCV7 and PCV13 reduce the spread of pneumococcus, which is why vaccinating children leads to disease reductions in adults. For both children and adults, the greatest reductions were seen in the number of cases of invasive pneumococcal disease that were caused by serotypes that are covered by PCV13 but not PCV7 (serotypes 19A and 7F specifically).
Author Interviews, JAMA / 04.02.2015

John Holcomb, M.D. Principal investigator, Retired U.S. Army Surgeon Director of the Division of Acute Care Surgery The University of Texas Health Science Center at Houston UTHealth Medical SchoolMedicalResearch.com Interview with John Holcomb, M.D. Principal investigator, Retired U.S. Army Surgeon Director of the Division of Acute Care Surgery The University of Texas Health Science Center at Houston UTHealth Medical School MedicalResearch: What is the background for this study? Dr. Holcomb: This study is the result of two decades of work by literally hundreds of investigators. It started as an observation in 1993 in Somalia that whole blood was a superior resuscitation product in casualties that were bleeding to death. Unfortunately, whole blood is not widely available, and 1:1:1 is the closest we can get at this time. After many studies from the battlefield, and even more in the civilian area, we have now published a randomized study documenting that 1:1:1 is a superior transfusion strategy, safe and helps prevent patients from bleeding to death. MedicalResearch: What are the main findings? Dr. Holcomb: The 1:1:1 resuscitation strategy significantly decreased the rate of bleeding to death, and there were no increased complications between groups.
AHA Journals, Author Interviews, Compliance, Heart Disease / 04.02.2015

Robert Hutchins, M.D., M.P.H. Department of Medicine, Division of General Internal Medicine UCSFMedicalResearch.com Interview with: Robert Hutchins, M.D., M.P.H. Department of Medicine, Division of General Internal Medicine UCSF Medical Research: What is the background for this study? What are the main findings? Dr. Hutchins: "Utility" refers to the effect on quality of life that a certain intervention carries and a utility value generally varies from 0-1.0.  The more negative the effect is, the lower the utility value (closer to 0), and the less it affects quality of life, the closer to 1.0 it is.  On a theoretical scale, "perfect health" is 1.0 and death is 0.  There are a number of studies that -- USE a utility value for taking pills, generally between 0.95 and 1.0.  However, many cost-effectiveness analyses ignore the utility value altogether, or arbitrarily choose 1.0 as the utility.  We found that a small change in the utility value can have a very large effect on the overall cost-effectiveness of an intervention.  We found that the utility value of taking pills, assessed by three different commonly used methods, to be 0.990-0.994, depending on the method.
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 03.02.2015

Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, IllinoisMedicalResearch.com Interview with: Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, Illinois     MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Merkow: The measurement of hospital readmissions has become an important quality and cost-containment metric. Hospitals, policy makers, and individual practitioners are closely tracking readmissions. For the past decade the focus has been primarily on three medical conditions (pneumonia, heart failure and myocardial infarction) and although controversial, many thought leaders and policy makers believed that readmissions were preventable, and stemmed from poor transition of care, outpatient follow up or simply a failure of the medical system to appropriately care for these patients. Recently, the Center for Medicare and Medicaid Services has become increasingly interested in using readmissions as a quality measure and is now mandated by the Hospital Readmission Reduction Program to track hospital-wide readmissions (including all surgical patients), and for the first time, after individual surgical procedures (i.e., total hip and knee replacement). Future inclusion of additional surgical procedures is anticipated. However, despite the growing focus on readmissions after surgery, there have been few studies comprehensively evaluating the underlying reasons and factors associated with readmissions after surgical hospitalizations. Furthermore, the relationship between readmissions and complications that occur during the initial hospitalization after surgery is not clearly established. Importantly, unlike medical conditions, surgical patients undergo a discrete invasive event with known risks of complications. By studying this topic, initiatives to decrease readmissions can be more precisely determined, and national policy decisions that are now targeting readmissions can be appropriately formulated. The primary findings of our study identified surgical site infections as the most frequent reason that patients are readmitted after surgery, Importantly, in >95% of patients this complication was new, occurring after they left the hospital. The other common reason for readmission was obstruction or ileus, which was the second most frequent reason for readmission, particularly after abdominal surgery. Overall, the vast majority of readmissions were the result of new postdischarge, postoperative complications. With respect to factors associated with readmissions, most of the variation was due to differences in patient factors, such as ASA class, renal failure, ascites and/or steroid use.
Aging, Author Interviews, Bone Density, FASEB / 03.02.2015

Dr. Jean-Pol Frippiat Stress, Immunity and Pathogens Laboratory at Lorraine University Vandoeuvre-lès-Nancy, FranceMedicalResearch.com Interview with: Dr. Jean-Pol Frippiat Stress, Immunity and Pathogens Laboratory Lorraine University Vandoeuvre-lès-Nancy, France  What is the background for this study? What are the main findings? Dr. Frippiat: Osteoporosis is associated to spaceflight. Consequently, we wondered whether changes in bone micro-structure induced by a ground-based model of spaceflight, hindlimb unloading (HU) that simulates some of the effects of spaceflight on mice, induces changes in B lymphocyte production in the bone marrow. To this end, we analyzed both bone parameters and the frequency of cells of the B lineage in the bone marrow of young, old and HU mice. We found that HU leads to a decrease in both bone micro-structure and the frequency of B cell progenitors in the bone marrow. A major block at the pro-B to pre-B cell transition was observed indicating a decrease in the formation of B cells in the bone marrow. Interestingly, the modifications in B cell production were similar to those observed in aged mice. These findings demonstrate that mechanical unloading, to which astronauts are subjected during spaceflight, results in a decrease in B cell differentiation that resemble age-related modifications in B lymphopoiesis.
Author Interviews, JAMA, Outcomes & Safety, University of Michigan / 03.02.2015

Nicholas Osborne, M.D., M.S Vascular Surgery Fellow University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Dr. Osborne: The American College of Surgeons launched the National Surgical Quality Improvement Program (ACS-NSQIP) in the early 2000s. This program collects and reports surgical outcomes to participating hospitals. One retrospective study of participating hospitals in the ACS-NSQIP reported improvements in risk-adjusted outcomes with participation. This study, however, did not compare ACS-NSQIP hospitals to control hospitals. The purpose of our study was to compare ACS-NSQIP to similar non-participating hospitals over time and determine whether participation in the ACS-NSQIP was associated with improved outcomes. MedicalResearch.com: What are the main findings? Dr. Osborne: When comparing hospitals participating in a national quality reporting program (ACS-NSQIP) to similar hospitals, there is no appreciable improvement in outcomes (mortality, morbidity, readmissions or cost)  outside of pre-existing trends across all hospitals. In other words, Hospitals nationwide were improving over this same time period and ACS-NSQIP hospitals did not improve above and beyond these existing trends.
Author Interviews, Hepatitis - Liver Disease, JAMA, University of Pittsburgh / 03.02.2015

Adeel A. Butt, MD, MS, FACP, FIDSA Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of MedicineMedicalResearch.com Interview with: Adeel A. Butt, MD, MS, FACP, FIDSA Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of Medicine   MedicalResearch: What is the background for this study? What are the main findings? Dr. Butt: Studying clinical consequences of hepatitis C virus (HCV) infection is often limited by the lack of knowledge of actual time of infection. We used the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES), a well-established national cohort of HCV infected veterans and corresponding HCV-uninfected controls, to identify patients with a known time frame for HCV infection. Our primary aim was to determine the rate of liver fibrosis progression among HCV-infected persons over time, with and to determine factors associated with development of cirrhosis and hepatic decompensation among these persons. Among 1840 persons who were HCV+ and 1840 HCV− controls, we found that fibrosis progression started early after HCV infection tapered off after 5 years. After 10 years of follow-up, 18.4% of HCV+ and 6.1% of HCV- persons developed liver cirrhosis. Nine years after diagnosis of cirrhosis, only 1.8% of HCV+ and 0.3% of HCV- persons had developed hepatic decompensation.
Annals Internal Medicine, Author Interviews, Supplements / 02.02.2015

MedicalResearch.com Interview with: Emanuele Cereda, MD, PhD Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Federico D’Andrea MD SCDO Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy MedicalResearch: What is the background for this study? What are the main findings? Response: Pressure ulcers (PUs) represent an important indicator of patient safety and quality of care. They negatively affect patient quality of life and increase healthcare costs. PUs are closely linked to malnutrition as it contributes not only to their development but also to impaired healing. It's also a sign of neglect if the patient is in a nursing home so you may want to contact someone like this nursing home neglect lawyer if you are worried that your loved one is being mistreated. Pressure ulcers patients are frequently unable to meet energy requirements through spontaneous feeding and nutritional support becomes essential. International guidelines currently recommend nutritional assessment and nutritional support as most Pressure ulcers patients can take advantage from adequate supply of proteins and calories. Beside, recent studies have suggested that additional provision of larger amount of some nutrients putatively involved in wound healing - arginine, zinc and antioxidants - may be of additional benefit. The OEST study has specifically investigated the role of these nutrients and has demonstrated that supplementation of malnourished Pressure ulcers patients with an oral nutritional formula enriched with arginine, zinc and antioxidants improves Pressure ulcers healing, independently of the adequate supply of proteins and calories.
Author Interviews, Heart Disease, JACC, Obstructive Sleep Apnea, Stroke / 01.02.2015

Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health NetworkMedicalResearch.com Interview with: Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health Network Medical Research: What is the background for this study? What are the main findings? Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification.
Author Interviews, Lancet, Neurological Disorders, Pediatrics, Respiratory / 31.01.2015

Samuel Dominguez MD Departments of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, COMedicalResearch.com Interview with: Samuel Dominguez MD Departments of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, CO Medical Research: What is the background for this study? What are the main findings? Dr. Dominguez: Due to global poliovirus eradication efforts, clusters of acute flaccid paralysis (AFP) and/or cranial nerve dysfunction in children are rare and associated with few pathogens, primarily enteroviruses and flaviviruses.  Our study reports the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of EV-D68 respiratory illness, strengthening the potential link between EV-D68 and neurologic disease in children.
Author Interviews, Colon Cancer, Journal Clinical Oncology, Race/Ethnic Diversity, Stanford, Surgical Research / 30.01.2015

Kim F. Rhoads, MD, MS, MPH, FACS Assistant Professor of Surgery Director, Community Partnership Program Stanford Cancer Institute Unit Based Medical Director, E3 Surgery and Surgical Subspecialties Stanford University Stanford, Ca 94305MedicalResearch.com Interview with: Kim F. Rhoads, MD, MS, MPH, FACS Assistant Professor of Surgery Director, Community Partnership Program Stanford Cancer Institute Unit Based Medical Director, E3 Surgery and Surgical Subspecialties Stanford University Stanford, Ca 94305 Medical Research: What is the background for this study? What are the main findings? Dr. Rhoads: Colon cancer is the 3rd most common cancer in US men and women and is the 2nd most common cause of cancer death. For at least 2 decades, minorities with colon cancer have suffered a 15-20% additional risk of death when compared with non-minority patients. Our study set out to understand the influence of the location where treatment was delivered and the quality of care received, on overall survival and racial disparities. We examined more than 30,000 patients who were diagnosed and treated for colon cancer in California from 2001 through 2006.  Using cancer registry data linked to state level inpatient data and hospital information, we compared the rates of National Comprehensive Cancer Network (NCCN) guideline adherence and mortality by location of care and by race. We found that patients treated within an integrated health system (IHS) received NCCN guideline based care at higher rates than those treated outside the system—about 3% higher rates of surgery; and more than 20% higher rates of stage appropriate chemotherapy. The rates of guideline based care were nearly equal between the racial groups treated inside the IHS.  Propensity score matched comparisons revealed a lower risk of death for all patients and no racial disparities associated with treatment within the Integrated system.  For patients treated outside IHS, the disparity in mortality was explained by accounting for differences in receipt of evidence based care by race.
Author Interviews, BMJ, Pediatrics, Weight Research / 30.01.2015

Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford, Department of Primary Care and Public Health Sciences King’s College London, London, UKMedicalResearch.com Interview with: Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford Department of Primary Care and Public Health Sciences King’s College London, London, UK Medical Research: What is the background for this study? What are the main findings? Response: Overweight and obesity in children have increased dramatically since the 1960s with important clinical and economic impacts, especially among those who become obese adults. Consequently, understanding trends in obesity is of increasing importance for monitoring population health and informing policy initiatives. Current trends suggest that a majority of the world’s population will be either overweight or obese by 2030. However, recent reports suggest that the increasing trend in overweight and obesity in children may have leveled off since 2000. But, in many countries data are based on a limited number of time points and relatively small surveys, limiting definitive conclusions and not allowing examining trends in subgroups by sex and age. Moreover, only a few countries have data on younger children (aged under 6 years). Our study aimed to use primary care electronic health records to examine prevalence of overweight and obesity in 2 to 15 year old children in England and to compare trends over two decades, from 1994 to 2003 and from 2004 to 2013. Medical Research: What are the main findings? Response: We found that currently about a third of children in the UK are overweight or obese. We also found that overweight and obesity prevalence increased during decade 1 (1994-2003) but stabilized in decade 2 (2004-2013). This was observed in both sexes and the in younger age groups (2-5 year and 6-10 year). However, rates continued to increase in older children (11-15 year), albeit at a slower speed than in decade 1 (1994-2003).