Medical Research Journals

25 Jan

Posted at 19:40h in Author Interviews, Heart Disease, JACC, Outcomes & Safety
Herbert Aronow, MDMedicalResearch.com Interview with: Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Governor, American College of Cardiology (ACC) – Michigan Chapter Chair, ACC Peripheral Vascular Disease Section Trustee, Society for Vascular Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Aronow: Psychomotor and cognitive performance may be impaired by sleep deprivation.  Interventional cardiologists perform emergent, middle-of-the-night procedures, and may be sleep-deprived as a consequence.  Whether performance of middle-of-the-night percutaneous coronary intervention (PCI) procedures impacts outcomes associated with PCI procedures performed the following day is not known. 

25 Jan

Posted at 19:29h in Author Interviews, BMJ, Gastrointestinal Disease, Pediatrics
Dr Laila J Tata PhD Associate Professor in Epidemiology Faculty of Medicine & Health Sciences University of NottinghamMedicalResearch.com Interview with: Dr Laila J Tata PhD Associate Professor in Epidemiology Faculty of Medicine & Health Sciences University of Nottingham Medical Research: What is the background for this study? What are the main findings? Response: Over the last decades there has been increased clinical awareness of coeliac disease (CD) partially because of improvements in the accuracy and availability of diagnostic tests, however, we do not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary socioeconomic group. Funded by CORE/Coeliac UK and conducted at the University of Nottingham, this study analysed 2,063,421 children aged less than 18 years who were registered with general practices (primary care doctors) across the United Kingdom contributing to their routine electronic health records to The Health Improvement Network (THIN) database  between 1993 and 2012. The study found 1,247 children were diagnosed with coeliac disease, corresponding to about 1 new case in every 10,000 children each year. Girls consistently had more diagnoses than boys and whilst the incidence of new celiac disease cases among children up to age 2 years remained stable over time, diagnoses in older children almost tripled over the past 20 years. Moreover, the study found a socioeconomic gradient in celiac disease diagnoses, such that children living in less socioeconomically deprived areas were about twice as likely to be diagnosed as those from more deprived areas. This pattern held for boys and girls and for all ages.

23 Jan

Posted at 20:18h in Author Interviews, Diabetes, Nature, University of Michigan
MedicalResearch.com Interview with: Martin G. Myers, Jr., M.D., M.P.H. Director, Michigan Diabetes Research & Training Center Associate Professor of Internal Medicine - MEND Division Professor of Molecular & Integrative Physiology Marilyn H. Vincent Professor of Diabetes Research and Department of Pharmacology, University of Cambridge, Cambridge, UK.MedicalResearch.com Interview with: Martin G. Myers, Jr., M.D., M.P.H. Director, Michigan Diabetes Research & Training Center Associate Professor of Internal Medicine - MEND Division Professor of Molecular & Integrative Physiology Marilyn H. Vincent Professor of Diabetes Research and Department of Pharmacology, University of Cambridge, Cambridge Medical Research: What is the background for this study? What are the main findings? Dr. Myers: Diabetic people who take insulin to treat their diabetes are at risk of low blood sugar, which can cause serious consequences (including death).  This risk increases as blood sugar control improves, and so this risk limits the ability to control blood sugar.  The body has a system (the counter-regulatory response) that acts to prevent blood sugar from going too low, but this is often impaired in diabetic patients. We identified a brain circuit that senses and responds to falling blood sugar, and which acts to increase blood sugar.  Furthermore, we showed that the hormone leptin modulates the sensitivity of this circuit, and identified the neurotransmitter (CCK) that acts in this circuit to increase blood sugar.  Thus, we have identified several potential drug targets that could be used to prevent or treat low blood sugar in insulin-treated diabetics.  If we are able to pharmacologically modulate the activity of this brain circuit, it could improve the treatment of these patients.

23 Jan

Posted at 17:24h in Asthma, Author Interviews, CHEST, Omega-3 Fatty Acids
John Brannan PhD Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, CanadaMedicalResearch.com Interview with: John Brannan PhD Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, Canada Medical Research: What is the background for this study? Response: The use of omega-3 acid supplements as treatments for allergic diseases including asthma is controversial. Studies by investigators from Indiana University in the USA have repeatedly demonstrated a beneficial effect of high dose omega-3 fatty acid supplements over 3 weeks in attenuating exercise-induced bronchoconstriction (EIB) similar or possibly better in potency to what may be expected with a regular inhaled corticosteroids. The study by Brannan et al. attempted to validate these findings by using inhaled mannitol, a bronchial provocation test that was derived from the understanding of exercise-induced bronchoconstriction and which has demonstrated experimentally to be a useful model for exercise-induced bronchoconstriction. All pharmacotherapies that modify exercise-induced bronchoconstriction can modify the airway sensitivity to inhaled mannitol in persons with asthma, thus it was of interest to see if an 'alternative' treatment that demonstrated efficacy in exercise-induced bronchoconstriction could too modify the airway response to mannitol. Medical Research: What are the main findings? Response: The main findings were, to our surprise, there was no benefit of high dose omega-3 fatty acid supplements on bronchial hyperresponsiveness to mannitol over 3 weeks. This was associated with no changes in airway inflammation (sputum eosinophils), lung function or asthma symptom control. We also found no benefit on resting urinary mast cell metabolites, in contrast to the findings in studies showing a benefit of omega-3 fatty acids on EIB. Our findings suggest that omega-3 supplements in tissues may not be able to penetrate tissue and/or modify the substrate flow of eicosanoids in tissue such as the airways of the asthmatic. We did observed the expected reductions in blood triglycerides which suggests that these doses of omega-3s can modify metabolism in the blood or to some extent tissues that are highly perfused.

23 Jan

Posted at 12:43h in Author Interviews, BMJ, Exercise - Fitness
Sarah Hanson Norwich Medical School University of East AngliaMedicalResearch.com Interview with: Sarah Hanson Norwich Medical School University of East Anglia Medical Research: What is the background for this study? What are the main findings? Response: Physical inactivity is a global problem. Walking is an easy way to increase physical activity. One way to increase physical activity may be through the use of outdoor walking groups. Walking groups are increasingly popular but until now we have not known if there are wider health benefits from walking groups, apart from increasing physical activity. Medical Research: What was the study method? Response: A systematic review and meta-analysis of outdoor walking group interventions found 42 studies which met the eligibility criteria. These studies involved 1,843 participants in 14 countries doing approximately 74,000 hours of walking.

23 Jan

Posted at 00:54h in Author Interviews, Diabetes, PLoS
Dr. Holger Rehmann Department of Molecular Cancer Research UMC Utrecht The NetherlandsMedicalResearch.com Interview with: Dr. Holger Rehmann Department of Molecular Cancer Research UMC Utrecht The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Rehmann: We have developed a chemical modified version of the second messenger cAMP, Sp-8-BnT-cAMPS that allows selective activation of Epac2, a protein that augments glucose induced insulin secretion. The second messenger cAMP activates a couple of receptor proteins, which controls such divergent physiological effects as gene transcription, pacemaker activity, olfaction, and cell adhesion. Almost any cell responses in one or the other way to cAMP and thus selective action on only one cAMP receptor would be a requirement for a drug to induce specific effects. The study confirms that it is possible to pharmacologically discriminate between structurally highly related cAMP receptors. And indeed, Sp-8-BnT-cAMPS augments glucose induced insulin secretion in primary human islets. Epac2 is thus a putative target for the development of an antidiabetic drug.

23 Jan

Posted at 00:50h in Author Interviews, BMJ, Exercise - Fitness, Global Health

MedicalResearch.com Interview with: Philipe de Souto Barreto (PhD) Toulouse University Hospital (CHU Toulouse) Gérontopole of Toulouse - Head of Department: Prof Bruno Vellas Medical Research: What is the background for this study? What are the main findings? Dr. Barreto: This study discusses about the importance of physical activity for health promotion globally. The main argument...

23 Jan

Posted at 00:35h in Author Interviews, JAMA, Mental Health Research
MedicalResearch.com Interview with: David P.G. van den Berg PhD student Clinical Psychologist Cognitive behavioural therapist Parnassia Psychiatric Institute Early Detection and Intervention Team (EDIT) Zoutkeetsingel, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The last decade it has become clear that many people with psychotic disorders suffered severe childhood trauma. These experiences enhance chances of developing psychosis, but also result in comorbid posttraumatic stress disorder (PTSD). PTSD is highly prevalent in patients with psychotic disorders and negatively influences prognosis and wellbeing. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective treatments and recommended as first choice treatments in PTSD guidelines worldwide. Although there is no evidence to support this, patients with psychosis are excluded from PTSD treatment due to fear of destabilization or psychotic decompensation. Moreover, psychosis is the most used exclusion criterion in PTSD trials. This is the first randomized clinical trial (RCT) of the efficacy of PTSD treatment in psychosis. In this RCT 155 patients with a psychotic disorder and comorbid PTSD were randomly assigned to PE, EMDR or Waiting List (WL). In the treatment conditions participants received 8 sessions of 90-minutes therapy. Standard protocols were used. Treatment was not preceded by stabilizing psychotherapeutic interventions or skills training. The first session comprised psycho-education about PTSD and target selection. In sessions 2 to 8 traumas were treated, starting with the most distressing experience. Baseline, post-treatment and 6-month follow-up assessments were made. Participants in both PE and EMDR showed greater reduction of PTSD symptoms than those in WL. Between group effect sizes were large. About sixty percent of the participants in the treatment groups achieved loss of diagnosis. Treatment effects were maintained at six-month follow-up for both PE and EMDR. Treatments did not result in serious adversities.

22 Jan

Posted at 01:43h in Author Interviews, Emory, NEJM
Ravi Mangal Patel, MD MSc Assistant Professor of Pediatrics Division of Neonatology Emory University School of MedicineMedicalResearch.com Interview with: Ravi Mangal Patel, MD MSc Assistant Professor of Pediatrics Division of Neonatology Emory University School of Medicine Medical Research: What is the background for this study? Response: We sought to understand the major causes of death and when these deaths occur among extremely premature infants (those born at 22 0/7 to 28 6/7 weeks of gestation). We evaluated a cohort of 22,248 extremely premature infants born at hospitals that were part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, a research network comprised of academic medical centers across the United States. We evaluated changes over time in survival by comparing in-hospital deaths among live births during three periods from 2000 to 2011.

21 Jan

Posted at 23:01h in Author Interviews, JAMA, Ophthalmology

MedicalResearch.com Interview with: Pravin U. Dugel MD Managing Partner, Retinal Consultants of Arizona Phoenix AZ Clinical Professor  USC Eye Institute Keck School of Medicine  Los Angeles CA   Medical Research: What is the background for this study? What are the main findings? Dr. Dugel: Endophthalmitis is one of the most feared complications in ophthalmology. It is potentially...

21 Jan

Posted at 22:15h in Author Interviews, Genetic Research, JAMA, Ophthalmology
Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne UniversityMedicalResearch.com Interview with: Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne University MedicalResearch: What is the background for this study? What are the main findings? Prof. Mackey: Too much or too little sun? Excessive sun exposure is associated with the eye disease pterygium, while lack of outdoor activity in childhood increases the risk of myopia (short sightedness). Measuring the amount of early sun damage to a person’s eyes would be of great use to researchers and potential use in clinical practice. Over the last few years we have developed a biomarker for sun exposure to the eye by photographing Conjunctival UV Auto-Fluorescence (CUVAF). The study published in JAMA Ophthalmology looked at the genetic and environmental factors that contribute to CUVAF levels in three Australian studies from Tasmania, Perth and Brisbane. People who live in sunnier environments closer to the equator have more evidence of sun damage using CUVAF.  However, genetic factors also play a role.

21 Jan

Posted at 19:48h in Author Interviews, Coffee, JNCI, Melanoma, NIH, Yale
MedicalResearch.com Interview with: Erikka Loftfield Doctoral student at the Yale School of Public Health Fellow at the National Cancer Institute Medical Research: What is the background for this study? What are the main findings? Response: Previous studies have reported conflicting results on the association between coffee drinking and melanoma. We sought to clarify this relationship using data from the large NIH-AARP Diet and Health Study. We followed over 400,000 retirees aged 50 to 71 years at study entry for an average of 10 years. Participants were asked to report typical coffee intake. During the course of follow-up nearly 3,000 cases of malignant melanoma occurred. In our study, we observed that individuals who reported the highest total coffee intake (4 cups/day) had about 20% lower risk of malignant melanoma compared with those who did not consume coffee.

21 Jan

Posted at 18:37h in Author Interviews, Brigham & Women's - Harvard, Geriatrics, Hospital Readmissions, JAMA, Surgical Research
Thomas C. Tsai, MD, MPH Departments of Surgery and Health Policy and Management Harvard School of Public Health, Boston, Massachusetts MedicalResearch.com Interview with: Thomas C. Tsai, MD, MPH Departments of Surgery and Health Policy and Management Harvard School of Public Health, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Dr. Tsai: Emerging evidence is suggesting that fragmented care is associated with higher costs and lower quality. For elderly patients undergoing major surgical procedures, fragmentation of care in the post-discharge period may be especially problematic. We therefore hypothesized that elderly patients receiving fragmented post-discharge care would have worse outcomes. We found that among Medicare patients who are readmitted after a major surgical operation, one in four are readmitted to a different hospital than the one where the original operation was performed. Even taking distance traveled into account, we find that this type of postsurgical care fragmentation is associated with a substantially higher risk of death.

21 Jan

Posted at 17:03h in Author Interviews, Baylor College of Medicine Houston, JAMA, Mental Health Research
M. Justin Coffey MD Associate Professor Menninger Department of Psychiatry & Behavioral Sciences Baylor College of MedicineMedicalResearch.com Interview with: M. Justin Coffey MD Associate Professor Menninger Department of Psychiatry & Behavioral Sciences Baylor College of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Coffey: Although both the US Surgeon General and the Institute of Medicine have called on health care systems to reduce suicide, the few assessments of suicide in such systems have examined only specific patient groups and not the entire population of health plan members. Our study reports the first information on suicide for the entire membership of a large health maintenance organization (HMO). The findings provide a previously unavailable baseline data for health care systems who are engaged in important efforts to measure and prevent suicide. We identified all suicides among the entire membership of our HMO network between 1999 and 2010, determining the date and cause of death using official state mortality records. In our sample, the annual suicide rate among all HMO members (including non-patient members) did not change over time, whereas the annual suicide rate in the general population of the state of Michigan increased significantly. Importantly, suicides actually decreased among HMO members who received specialty mental health services, whereas suicides increased among HMO members who accessed general medical services but not specialty mental health services.  

21 Jan

Posted at 01:34h in Author Interviews, Education, JAMA
Dr. Juliane Kämmer Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality Berlin GermanyMedicalResearch.com Interview with: Dr. Juliane Kämmer  Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality  Berlin Germany Medical Research: What is the background for this study? What are the main findings? Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy). In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error.

20 Jan

Posted at 22:43h in Author Interviews, CDC, JAMA, OBGYNE
Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention, Atlanta, GeorgiaMedicalResearch.com Interview with: Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Boulet:  Intracytoplasmic Sperm Injection is generally considered a safe and effective treatment for male factor infertility; however, some studies have shown that ICSI is increasingly used in patients without male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). In addition to increasing the cost of an IVF cycle, use of  Intracytoplasmic Sperm Injection has been found to increase the risk for adverse infant outcomes such as birth defects, chromosomal abnormalities and autism. Using data from CDC’s National Assisted Reproductive Technology Surveillance System, we found that use of ICSI increased by fourfold from 1996 through 2012 (from 15.4% to 66.9%). Furthermore, we found that use of  Intracytoplasmic Sperm Injection did not improve reproductive outcomes such as rates of pregnancy, miscarriage and live birth, when compared with conventional IVF, regardless of whether male factor infertility was present.

20 Jan

Posted at 22:28h in Author Interviews, Lancet, Stroke
MedicalResearch.com Interview with: Prof. dr. Diederik van de Beek Department of Neurology, Academic Medical Center, University of Amsterdam The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Dr. van de Beek: In adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. In the Preventive Antibiotics in Stroke Study (PASS) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke. PASS is an investigator-initiated, randomised, open-label, masked-endpoint trial that was undertaken between 2010 and 2014 in 30 Dutch centres and enrolled 2550 patients with ischaemic or haemorrhagic stroke. Randomly assigned in a 1:1 ratio to either preventive antibiotic therapy or a control group, all patients received standard stroke unit care. Starting within 24 h after stroke onset, patients in the preventive antibiotic group were given additional treatment with ceftriaxone administered intravenously at a dose of 2 g every 24 h for 4 days. The main findings were that preventive ceftriaxone did not improve 3-month functional outcome on the modified Rankin Scale (adjusted common odds ratio 0·95 [95% CI 0·82–1·09]); however, clinically diagnosed post-stroke infections were significantly reduced (adjusted odds ratio 0·55 [0·44–0·70]). Preventive antibiotic therapy with ceftriaxone is a safe treatment.

20 Jan

Posted at 00:19h in Author Interviews, Heart Disease, JACC, Statins
Dr. Robert S. Rosenson, MD Professor, Cardiology Icahn School of Medicine at Mount Sinai Cardiovascular Institute New York, New York 10029MedicalResearch.com Interview with: Dr. Robert S. Rosenson, MD Professor, Cardiology Icahn School of Medicine at Mount Sinai Cardiovascular Institute New York, New York 10029 Medical Research: What is the background for this study? What are the main findings? Dr. Rosenson: High intensity statin therapy is evidence-based and guideline directed for patients with acute coronary syndromes.  In a 5 percent random sample of Medicare patients, we investigated the utilization of high vs low-moderate dosage statin in older adjusts who were admitted with an acute myocardial infarction of severe myocardial ischemia requiring hospitalization for a revascularization procedure (PCI or CABG). We report that only 27 percent of hospitalized patients received high-intensity statin therapy based on their first outpatient fill for a statin medication.  The most important determinant for the utilization of statin therapy is the dosage of the statin previously prescribed as an outpatient.  When patients were started on a high-intensity statin, the continued use diminished in the ensuing year

20 Jan

Posted at 00:06h in Annals Internal Medicine, Author Interviews, Exercise - Fitness, Lifestyle & Health
David Alter, MD, PhD FRCPC Senior Scientist Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation InstituteMedicalResearch.com Interview with: David Alter, MD, PhD FRCPC Senior Scientist Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation Institute   Medical Research: What is the background for this study? What are the main findings? Dr. Alter: We knew going into the study that exercise was an important lifestyle factor that improved health. We also knew from studies that sedentary time was associated with deleterious health-effects. What we didn’t know was whether the health-outcome effects of sedentary time and exercise were really one and the same (i.e., albeit opposite ends of the same spectrum) or alternatively, whether the health effects of each were independent of one another.  We explored over 9000 published studies to quantify the health-outcome effects associated with sedentary behaviour and extracted only those which took into account both sedentary time and exercise. We found a consistent association between sedentary time and a host of health outcomes independent of exercise. Specifically, after controlling for an individual’s exercising behaviour, sitting-time was associated with a 15-20% higher risk of death, heart-disease, death from heart disease, cancer-incidence, and death from cancer. Sitting time was also independently  associated with a marked (i.e., 90% increase) in the risk for diabetes after controlling for exercise. In short, sedentary times and exercise are each independently associated with health outcomes. We hypothesize that the two may have different mechanism, and may require different therapeutic strategies. But, the health-outcome implications of both are each important in their own right.

19 Jan

Posted at 22:05h in Author Interviews, Cost of Health Care, Heart Disease, JACC, Outcomes & Safety
Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220.MedicalResearch.com Interview with: Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220. Medical Research: What is the background for this study? What are the main findings? Dr. Ho: There is increasing interest in measuring health care value, particularly as the healthcare system moves towards accountable care. Value in health care focuses on measuring outcomes achieved relative to costs for a cycle of care. Attaining high value care - good clinical outcomes at low costs - is of interest to patients, providers, health systems, and payers. To date, value assessments have not been operationalized and applied to specific patient populations. We focused on percutaneous coronary intervention (PCI) because it is an important aspect of care for patients with ischemic heart disease, is commonly performed and is a costly procedure. In this study, we evaluated 1-year risk-adjusted mortality and 1-year risk-standardized costs of care for all patients who underwent PCI in the VA healthcare system from 2008 to 2010. We found that median one-year unadjusted hospital mortality rate was 6.13% (interquartile range 4.51% to 7.34% across hospitals). Four hospitals were significantly above the one-year risk standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28; no hospitals were significantly below median mortality. Median 1-year total unadjusted hospital costs were $46,302 (IQR of $37,291 to $57,886) per patient. There were 16 hospitals above and 19 hospitals below the risk standardized average cost, with risk standardized ratios ranging from 0.45 to 2.09 reflecting much larger magnitude of variability in costs compared to mortality. These findings suggest that there are opportunities to improve PCI healthcare by reducing costs without compromising outcomes. This approach of evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement.

19 Jan

Posted at 21:54h in Aging, Author Interviews, Heart Disease, JAMA, Salt-Sodium
Andreas Kalogeropoulos, MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Emory Clinical Cardiovascular Research Institute Atlanta GA 30322MedicalResearch.com Interview with: Andreas Kalogeropoulos, MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Emory Clinical Cardiovascular Research Institute Atlanta GA 30322 Medical Research: What is the background for this study? What are the main findings? Dr. Kalogeropoulos: There is ongoing debate on how low should we go when it comes to dietary sodium (salt) restriction recommendations. In this study, we examined the association between self-reported dietary sodium intake and 10-year risk for death, cardiovascular disease, and heart failure in approximately 2,600 adults 71-80 years old. The subjects (women: 51.2%; white: 61.7%; black: 38.3%) were participants of the community-based Health, Aging, and Body Composition Study, which is sponsored by NIH and focuses on aging processes, i.e. was not specifically designed to address the issue of dietary salt intake. Also, it is important to note that salt intake was self-reported (not objectively measured) using a food frequency questionnaire, which underestimates salt intake. Keeping these limitations in mind, we did not observe a significant association between self-reported sodium intake and 10-year mortality, cardiovascular disease, and heart failure. Ten-year mortality was lower in the group reporting 1500–2300 mg daily sodium intake (30.7%) compared to those reporting daily intake less than 1500 mg (33.8%) or over 2300 mg (35.2%); however, this difference was not statistically significant. The 10-year event rates for cardiovascular disease (28.5%, 28.2%, and 29.7%) and heart failure (15.7%, 14.3%, and 15.5%) were also comparable across the <1500-mg, 1500-2300-mg, and >2300-mg dietary sodium intake groups.

19 Jan

Posted at 21:42h in Author Interviews, Columbia, JAMA, Neurological Disorders
Jose Gutierrez MD, MPH Assistant Professor of Neurology Division of Stroke and Cerebrovascular Disease Columbia University Medical Center NY, NYMedicalResearch.com Interview with: Jose Gutierrez MD, MPH Assistant Professor of Neurology Division of Stroke and Cerebrovascular Disease Columbia University Medical Center NY, NY Medical Research: What is the background for this study? What are the main findings? Dr. Gutierrez: There is growing interest in the effects of vascular health in cognition. The prevailing thought is that vascular disease leads to worse cognition due to direct structural damage of the brain, as in the case of brain infarcts, microhemorrhages or white matter hyperintensities, which are themselves associated with traditional cardiovascular risk factors such as hypertension, diabetes, smoking etc. Arterial stiffness, particularly of the aorta, has gained interest among researchers as predictors of vascular disease and worse cognition, but it is not clear whether arterial stiffness in the absence of traditional definition of vascular disease may be associated with worse cognition. We investigated in a representative sample of the US among adults 60 years or older who underwent cognitive testing with the Digit Symbol Subtraction test and who also had other measures of vascular disease, including blood workup, blood pressure measurement and Pulse pressure. We hypothesized that indirect measures of arterial stiffness such as ABI > 1.3 or pulse pressure would be associated with worse cognition, even among those without any clinical vascular disease or traditional vascular risk factors. We Included 2573 US adults in the sample, segregated those with any self-reported vascular disease or vascular risk factors and we found that among those without vascular disease or risk factors, an ABI > 1.3 and increased intra-visit blood pressure variability were predictors of worse cognitive performance compared with those without these indicators. Among participants with both indirect markers of arterial stiffness, their cognitive performance was worse that having only one of them suggesting additive effects of these two variables.

19 Jan

Posted at 21:26h in Aging, Author Interviews, JAMA, Lifestyle & Health
Jane Wardle University College London MedicalResearch.com Interview with: Jane Wardle University College London Medical Research: What is the background for this study? What are the main findings? Dr. Wardle: Previous studies have shown that couples tend to have similar health behaviours to one another, but no studies had compared having a partner who takes up a healthy behaviour (e.g. quits smoking) with having one whose behaviour is consistently healthy (e.g. never smoked). Nor have there been other studies in the older age group – our participants were over 60 on average.  We used data from 3722 couples participating in the English Longitudinal Study of Ageing (ELSA) to explore this issue for three behaviours: smoking, physical activity, and weight loss. For each behaviour, we found that when one partner changed their behaviour, the other partner was more likely to make a positive change, and the effect was stronger than having a partner whose behaviour was consistently healthy (i.e. never smoked/always exercised).

19 Jan

Posted at 21:20h in Author Interviews, Brigham & Women's - Harvard, Diabetes, Diabetes Care, Nutrition
Jinnie J. Rhee Department of Epidemiology, Harvard School of Public Health, Boston, MAMedicalResearch.com Interview with: Jinnie J. Rhee MSc, ScD Department of Medicine, Stanford University School of Medicine Palo Alto, CA Medical Research: What is the background for this study? What are the main findings? Response: The goal of this study was to see if the dietary determinants of type 2 diabetes observed in predominantly white populations were similar to those in other racial and ethnic groups.  We created a dietary diabetes risk reduction score using eight different dietary factors found to be associated with risk of type 2 diabetes, where a higher score indicates a healthier overall diet (A higher score included low intakes trans fat, sugar-sweetened beverages, and red and processed meats; lower glycemic index; and higher intakes of cereal fiber, nuts, and coffee; and higher polyunsaturated to saturated fat ratio).  We found a protective association of similar magnitude between a healthy overall diet and type 2 diabetes risk in all racial and ethnic groups.  However, in terms of the actual number of preventable cases, a healthier diet conferred even greater benefit for minority women because they were initially at higher risk than white women. This study is significant because diabetes is a rapidly growing epidemic in most parts of the world, but most previous studies of diet and diabetes have been conducted in populations of European origin.  This analysis was very powerful because it combined two large populations with a total of 156,030 women who were followed for up to 28 years with many repeated assessments of diet.  This allowed us to conduct detailed analyses within specific racial and ethnic groups.

19 Jan

Posted at 13:09h in Author Interviews, Brigham & Women's - Harvard, Cancer Research, Science
Lee Zou, Ph.D. Professor of Pathology, Harvard Medical School The Jim & Ann Orr MGH Research Scholar Associate Scientific Director, MGH Cancer CenterMedicalResearch.com Interview with: Lee Zou, Ph.D. Professor of Pathology, Harvard Medical School The Jim & Ann Orr MGH Research Scholar Associate Scientific Director, MGH Cancer Center Medical Research: What is the background for this study? What are the main findings? Dr. Lee Zou: Cancer cells must rely on telomerase or the alternative lengthening of telomere (ALT) pathway to maintain telomeres and bypass replicative senescence. The ALT pathway is active in about 10-15% of human cancers, and it is particularly prevalent in specific cancer types, such as osteosarcoma, glioblastoma, and neuroendocrine pancreatic tumors. ALT is a recombination-mediated process. Whether the reliance of cancer cells on  alternative lengthening of telomere can be exploited therapeutically was not known. In our study, we discovered that the ATR kinase is a key regulator of alternative lengthening of telomere. We found that ATR inhibitors disrupt ALT effectively. Furthermore, we found that ATR inhibitors selectively kill ALT-positive cancer cells in a panel of caner cell lines. These findings have suggested the first rational therapeutic strategy for the treatment of ALT-positive cancer.

19 Jan

Posted at 12:51h in Author Interviews, Kidney Disease, NEJM
MedicalResearch.com Interview with: David K. Packham, M.B., B.S., M.D Royal Melbourne Hospital Melbourne Renal Research Group VIC 3073, Australia, Medical Research: What is the background for this study? What are the main findings? Dr. Packham:  ZS-9 represents a new mechanism of action for addressing hyperkalemia. Unlike traditional nonspecific organic polymer cationexchangers, ZS-9 is a non-absorbed, inorganic crystalline potassium-selective cation exchanger that traps excess potassium in the gastrointestinal tract. It has been evaluated in three prospective, randomized, double-blind, placebo-controlled studies with over 1100 patients to date, representing the largest ever clinical development program for hyperkalemia. ZS-003 was the first of two pivotal Phase 3 studies that evaluated the safety and efficacy of ZS-9 in patients with hyperkalemia. In ZS-003, treatment of patients with an oral suspension of ZS-9 (2.5, 5, or 10 grams, three times a day) resulted in statistically significant and clinically meaningful reductions in serum potassium, compared with placebo, during the “acute phase” (first 48 hours), with 99 percent of patients achieving normal potassium levels with the highest 10 gram dose. During the next 12 days of the trial (the “maintenance phase”), ZS-9 (5 or 10 grams) given once daily could maintain the corrected potassium levels achieved during the acute phase. In contrast, patients who were randomized back to placebo after achieving normal potassium reverted back to hyperkalemia. The tolerability profile has been favorable, with adverse event rates from ZS-9 similar to that of placebo.

18 Jan

Posted at 19:06h in Erasmus, General Medicine, Heart Disease, JACC
MedicalResearch.com Interview Invitation Dr. Eric Boersma Associate Professor of Clinical Cardiovascular Epidemiology Thoraxcenter, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands MedicalResearch: What is the background for this study? What are the main findings? Dr. Boersma: Near-infrared spectroscopy (NIRS) is a novel intracoronary imaging technique. The NIRS-derived lipid core burden index (LCBI) quantifies the lipid content within the coronary artery wall. This study was designed to evaluate the prognostic value of LCBI in patients with coronary artery disease (CAD) undergoing coronary catheterization (CAG). We learned that patients with high (above the median) LCBI values had 4 times higher risk of coronary events during 1 year follow-up than those with low values.

18 Jan

Posted at 18:38h in Author Interviews, Brigham & Women's - Harvard, JAMA, Surgical Research
Soko Setoguchi, MD DrPH Assistant Professor of Medicine Harvard Medical School and Harvard School of Public Health Director of Safety and Outcome Research in Cardiology Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s HospitalMedicalResearch.com Interview with: Soko Setoguchi, MD DrPH Assistant Professor of Medicine Harvard Medical School and Harvard School of Public Health Director of Safety and Outcome Research in Cardiology Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Setoguchi: Medicare made a decision to cover Carotid Artery Stenting (CAS) in 2005 after publication of SAPPHIRE, which demonstrated the efficacy of Carotid Artery Stenting (CAS) vs Carotid endarterectomy (CEA) in high risk patients for CEA. Despite the data showing increased carotid artery stenting dissemination following the 2005 National Coverage Determination, peri-procedural and long-term outcomes have not been described among Medicare beneficiaries, who are quite different from trial patients, older and with more comorbidities in general population. Understanding the outcomes in these population is particularly important in the light of more recent study, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which established CAS as a safe and efficacious alternative to CEA among non-high-surgical risk patients that also expanded the clinical indication of carotid artery stenting. Another motivation to study ‘real world outcomes in the general population is expected differences in the proficiency of physicians peforming stenting in trial setting vs. real world practice setting. SAPPHIRE and CREST physicians were enrolled only after having demonstrated CAS proficiency with low complication rates whereas hands-on experience and patient outcomes among real-world physicians and hospitals is likely to be more diverse. We found that unadjusted mortality risks over study period of 5 years with a mean of 2 years of follow-up in our population was 32%.  Much higher mortality risks observed among certain subgroups with older age, symptomatic patients and non-elective hospitalizations.

18 Jan

Posted at 18:25h in Author Interviews, PLoS, Sexual Health
MedicalResearch.com Interview with: Matthew Golden MD, MPH Director, PHSKC HIV/STD Program Professor of Medicine, University of Washington Harborview Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Golden: Gonorrhea and chlamydial infection are the most common reportable infections in the United States and, in women, are associated with pelvic inflammatory disease, ectopic pregnancy, infertility and chronic pelvic pain. One way to decrease the number of cases of gonorrhea and chlamydia is to increase our success in treating the sex partners of persons diagnosed with these infections. Expedited partner therapy (EPT) - treating partners without requiring them to first undergo a medical evaluation - is one way to increase partner treatment. This usually involves giving people medication to give to their partners. Prior randomized trials have found that EPT decreases patients' risk of becoming reinfected. We conducted a community-level randomized trial to evaluate whether making free Expedited partner therapy available to medical providers would increase the use of Expedited Partner Therapy and decrease gonorrhea and chlamydial infections at the population level. We found that a public health program that made Expedited partner therapy widely available could dramatically increase medical providers use of EPT. Although our final result was not statistically significant, our findings suggest that the program likely decreased both gonorrhea and chlamydial infection by about 10% at the population-level.

17 Jan

Posted at 00:35h in AHA Journals, Author Interviews, Heart Disease, Stroke
Jonathan Thigpen, PharmD Assistant Professor Clinical and Administrative Sciences Notre Dame of Maryland University School of PharmacyMedicalResearch.com Interview with: Jonathan Thigpen, PharmD Assistant Professor Clinical and Administrative Sciences Notre Dame of Maryland University School of Pharmacy Medical Research: What is the background for this study? What are the main findings? Dr. Thigpen: This effort assessed the accuracy of International Classification of Disease 9th Edition (ICD-9) stroke codes in identifying valid stroke events in a cohort of atrial fibrillation (AF) patients. The initial electronic search yielded 1,812 events across three stroke centers (Boston Medical Center, Geisinger Health System, and University of Alabama). All ICD-9 identified stroke events were vetted through manual chart review with final adjudication by a stroke neurologist. Atrial fibrillation was verified by evidence via electrocardiogram at stroke admission, 6 months prior to, or 90 days after stroke admission. In addition to assessing the accuracy of the stroke codes alone, we also assessed the accuracy of stroke and Atrial fibrillation codes combined as well as the accuracy of stroke codes when seeking for stroke associated with Atrial fibrillation. These additional steps give readers insight as to the accuracy and reliability of using ICD-9 codes alone to create a stroke plus AF cohort. We feel that this effort is extremely important given the increasing reliance on ICD-9 codes as a means of identifying stroke events and covariates in research, especially research using administrative data. The positive predictive value (PPV) of stroke codes alone was 94.2%. PPVs did not differ across clinical site or by type of event (ischemic vs. intracranial hemorrhage). PPV of stroke codes did differ by event coding position (primary vs. other; 97.2% vs. 83.7%) and by ischemic stroke code (433 vs. 434; 85.2% vs. 94.4%). When combined with validation of Atrial fibrillation codes, the PPV of stroke codes decreased to 82.2%. After excluding ischemic stroke due to a different mechanism (eg, vascular procedure, tumor, sepsis) the PPV dropped further to 72.8%. As a separate exercise, manual review confirmed 33 (7.2%) ischemic strokes in 458 events coded as "without infarction".