MedicalResearch.com Interview with:
Dr. Arthur Reynolds PhD, Professor
Institute of Child Development
Humphrey School of Public Affairs
University of Minnesota
Medical Research:What is the background for this study? What are the main findings?Dr. Reynolds: Given the high national priority on enhancing early childhood development, evidence about the relationship between full-day preschool participation and school readiness is meager.
The study found that among about 1000 children attending 11 schools in low-income neighborhood. participation in full-day preschool at ages 3 or 4 for 7 hours per day was associated with significantly higher school readiness skills at the end of preschool in language and literacy, socio-emotional development, math, and physical health than part-day participation for 3 hours per day. This translate to about a half of a year of growth in learning. Full-day preschool was also associated with significantly higher attendance and lower rates of chronic absences. No differences were found in parent involvement in school.
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MedicalResearch.com Interview with
Dr. Mary T. Hawn MD
Center for Surgical, Medical Acute Care Research, and Transitions,
Birmingham Veterans Affairs Medical Center
University of Alabama at Birmingham, BirminghamMedical Research: What are the main findings?Dr. Hawn: The main findings of the study are that the recommendations made in the guidelines published by the American College of Cardiology / American Heart Association in 2007 were effective at reducing postoperative major adverse cardiac events following noncardiac surgery in patients with a cardiac stent.1 These guidelines recommended the delay of noncardiac surgeries in patients with a drug-eluting stent for 365 days if the surgery was not emergent or the delay of surgery for 4 to 6 weeks among patients with a bare metal stent. In addition to a 26% reduction in postoperative major adverse cardiac events, we also found an increase in the time between drug-eluting stent placement and non-cardiac surgery consistent with the guideline recommendations.
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MedicalResearch.com Interview with:
Matthew D. Ritchey, DPT
Division for Heart Disease and Stroke Prevention
US Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?Dr. Ritchey: This study analyzes the contribution of heart disease subtypes – such as coronary heart disease, heart failure, hypertensive heart disease and arrhythmia – to overall trends in heart disease death rates between 2000 and 2010. Our research revealed that overall heart disease-related deaths declined during that time frame at a rate of almost four percent annually. Most of this decline appears to be driven by decreases in coronary heart disease mortality, which includes deaths due to heart attacks.
However, not all heart disease subtypes saw similar decreases. Arrhythmia and hypertensive heart disease death rates increased annually during this period. In addition, there were differences depending on age group, subtype, gender and race/ethnicity. For example, hypertensive heart disease rates were much higher (more than double) among non-Hispanic blacks in 2010 than among non-Hispanic whites. That could be due to factors including uncontrolled blood pressure and obesity among younger adults. Also, the increase in arrhythmia mortality was highest among non-Hispanic whites, women and adults age 75 and over. That increase might be linked to the growing aging population, the result of individuals living longer with heart failure, increases in chronic kidney disease and hypertensive heart disease prevalence and changes in how the condition is reported.
To determine these findings, we examined de-identified death certificates of U.S. residents ages 35 and up who died from 2000 to 2010. The data was pulled from the CDC WONDER database, which contains death certificate information from every U.S. state and the District of Columbia.
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MedicalResearch.com Interview with:Sheila E. Harvey, Ph.D.
CTU Manager/Senior Research Fellow
ICNARC
Napier House London
Medical Research: What is the background for this study? Dr. Harvey: The CALORIES trial was set-up in the context of concerns about malnutrition in critically ill patients in NHS hospitals and conflicting evidence as to the optimal route for delivery of early nutritional support to critically ill patients. The enteral route is the mainstay of nutritional support in the critically ill but it is frequently associated with gastrointestinal intolerance and underfeeding. In contrast, the parenteral route, though more invasive and expensive, is more likely to secure delivery of the intended nutrition but has been associated with more risks and complications (e.g. infectious complications) compared with the enteral route.
In light of the uncertainty surrounding the most effective route for delivery of early nutritional support and, given recent improvements in the delivery, formulation and monitoring of parenteral nutrition, the UK National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme put out a “call” for a large pragmatic randomised controlled trial to be conducted in critically ill patients to determine the optimal route of delivery of early nutritional support. CALORIES was set up to test the hypothesis that early nutritional support delivered via the parenteral route is superior to early nutritional support delivered via the enteral route in adults who had an unplanned admission to an intensive care unit and who could be fed via either route.
The primary outcome was all-cause mortality at 30 days. The secondary outcomes included infectious and non-infectious complications (hypoglycaemia, elevated liver enzymes, nausea requiring treatment, abdominal distension, vomiting, new or substantially worsened pressure ulcers).
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MedicalResearch.com Interview with:
Christina Nelson, MD, MPH, FAAP
Medical Epidemiologist
Centers for Disease Control and Prevention
Division of Vector-Borne Diseases | Bacterial Diseases Branch
Fort Collins, CO
Medical Research: What is the background for this study? Dr. Nelson: Evidence-based guidelines for the diagnosis and treatment of Lyme disease have been provided by the Infectious Diseases Society of America for many years. These comprehensive guidelines have been vetted by external review panels as the best option for patient care. In endemic areas, patients with the typical rash (erythema migrans) can be diagnosed with Lyme disease clinically. Otherwise, the guidelines recommend that diagnosis be based on a history of possible exposure, compatible clinical features, and positive two-tier serologic testing.
Some patients who have been treated for Lyme disease may develop post-treatment Lyme disease syndrome (PTLDS) – fatigue, arthralgias, or other symptoms that persist after completing antibiotic treatment. Although the exact cause of post-treatment Lyme disease syndrome is unknown, it is thought to be due to an altered immune response or residual damage to tissues during the acute infection. A diagnosis of exclusion, PTLDS should only be diagnosed after the patient has been thoroughly evaluated and other potential causes of symptoms ruled out.
On the other hand, “chronic Lyme disease” is a loosely defined diagnosis that has been used to describe a variety of ailments. A small cadre of providers use unconventional methods to diagnose patients with chronic Lyme disease, and sometimes there is no objective evidence that the patient ever had Lyme disease. Multiple factors contribute to this phenomenon, including misconceptions about serologic testing, use of unvalidated diagnostic tests, and clinical diagnosis of Lyme disease based on nonspecific symptoms alone.
We know that patients have been – and continue to be – harmed by treatments for chronic Lyme disease. Patients have suffered from emboli, severe allergic reactions to antibiotics, neutropenia, and infections such as Clostridium difficile. This is terrible and should never happen. However, there is another important danger related to these alternative practices. Some patients who have been diagnosed and treated for chronic Lyme disease later discover that another condition is the root of their physical problem. We wanted to highlight some of these cases in order to help educate providers and patients about this issue.
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MedicalResearch.com Interview with:
Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger
Center for Stroke Research Berlin (CSB)
Charité - Universitätsmedizin Berlin | CCM
Berlin | Germany
Medical Research: What is the background for this study? What are the main findings?
Response: Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That's because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial - both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.
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MedicalResearch.com Interview with:
Dr. Martin Thornhill PhD
Department of Cardiology, Taunton and Somerset NHS Trust
Taunton, Somerset, UK
Medical Research:What is the background for this study? What are the main findings?Dr. Thornhill: In 2008 NICE introduced controversial new guidance recommending that antibiotic prophylaxis to prevent infective endocarditis should no longer be used. It was a rational decision, given the evidence for the effectiveness of antibiotic prophylaxis and potential concerns about costs, the development of antibiotic resistance and possible side effects from antibiotics, but it went against other guidelines from around the world that existed at the time.
The main findings are that in England:
There has been a large and significant decline in the use of antibiotic prophylaxis.
There has been a significant increase in the number of cases of infective endocarditis, above the baseline trend, using hospital coding data, corrected for changes in the size of the English population.
MedicalResearch.com Interview with:
Naveed Nosrati MD
Indiana University School of Medicine
Staff Surgeon, Roudebush VAMC
Medical Research: What is the background for this study? Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure.
Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results.
Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance.
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MedicalResearch.com with:
Giulio Conte MD
Heart Rhythm Management Centre
UZ-VUB Brussel, Belgium
Medical Research: What is the background for this study? What are the main findings?Dr. Conte: The evolution of Brugada syndrome from pediatric to adult age has not been previously evaluated. It has been shown that the electrocardiographic phenotype of Brugada syndrome do not manifest during childhood in the large majority of cases. Drug challenge with ajmaline is recommended to unmask the diagnostic electrocardiogram in patients with family history of Brugada syndrome and normal electrocardiograms. However, the ideal age to perform such screening has not been established yet. With this study we aimed to investigate the clinical value of repeating ajmaline challenge after puberty in pediatric family members with an initial negative drug test. Repeat ajmaline challenge after puberty unmasked Brugada syndrome in 23% of family members with a previously negative drug test. Of the newly positive patients, 30% developed symptoms, 10% ventricular fibrillation and 10% spontaneous Brugada type 1 electrocardiogram.
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MedicalResearch.com Interview with:Karin B. Michels, ScD, PhD
Associate Professor of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Medical Research:What is the background for this study? What are the main findings?Dr. Michels: We were interested in studying the long-term effects of oral contraceptive use on mortality. Given the widespread use of oral contraceptives, this is an important question pertaining to millions of women worldwide. We explored this question in the large Nurses’ Health Study, a cohort of 121,700 women in the US, who have been followed for 38 years. We found that oral contraceptive use does not impact overall mortality. However, breast cancer mortality was slightly increased, especially with long-term use of oral contraceptives.
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MedicalResearch.com Interview with: Vijay Ramanan, PhD
Indiana University Center for Neuroimaging (CfN)
Department of Radiology
Indianapolis, IN 46202
Medical Research: What is the background for this study? What are the main findings?Dr. Ramanan: Impairment in episodic memory is one of the first clinical deficits in early Alzheimer’s disease, the most common cause of dementia. Among other examples, this might be reflected as an inability to recall an article recently read or as difficulty remembering what one had for dinner last night. Unfortunately, the genetic and environmental mechanisms underlying these deficits are not fully understood. Our goal was to discover new genes and pathways underlying memory performance to help identify potential drug targets for protecting against and ultimately reversing memory loss in dementia and normal aging.
Through studying a large representative sample of older Americans, we discovered a variant (single nucleotide polymorphism or SNP) in the FASTKD2 gene associated with better memory performance and replicated this finding in independent samples. We then integrated additional data to extend our understanding of the effect of this SNP. For example, we know that the hippocampus is a vital brain structure for encoding and retrieving memories and it is well-understood that decreased hippocampal volume is a key early marker of Alzheimer’s disease and one that can be measured noninvasively through magnetic resonance imaging (MRI). We predicted that this new memory-protective SNP would be associated with increased hippocampal volume and this turned out to be true. We also discovered that carriers of this memory-protective SNP exhibited lower levels of proteins involved in cell death in the cerebrospinal fluid bathing the brain and spinal cord, a striking finding given that FASTKD2 encodes a protein that appears to promote apoptosis (i.e., programmed cell death). Together, these convergent findings are consistent with a neuroprotective effect of this novel SNP discovery. More broadly, our results nominate FASTKD2 and its functional pathways as potential targets for modulating neurodegeneration to combat memory loss in older adults.
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MedicalResearch.com Interview with:
Meera Viswanathan, PhD
RTI International, Research Triangle ParkNorth CarolinaMedical Research: What is the background for this study? What are the main findings?Dr. Viswanathan: Medications, when used appropriately, can alleviate symptoms. Often, however, they result in side effects, interact with one another, are prescribed incorrectly, or are taken incorrectly. These problems are particularly pronounced for the elderly who may have multiple chronic conditions and may be on numerous medications. We evaluated a variety of research studies and program evaluations regarding a distinct type of health care service known as Medication Therapy Management or “MTM.” The goals of MTM services are to help patients and their clinicians to optimize prescription and nonprescription drug regimens, thereby achieving better health outcomes from drug therapy, and. at the same time to minimize the potential for harms, such as incorrect dosing and duplicate medications. Some have proposed that optimizing drug regimens and preventing adverse drug events may reduce health-care-related costs.
Medication Therapy Management services are most often provided directly to patients by pharmacists. Sometimes the same pharmacists who dispense medications to patients offer Medication Therapy Management services as well; in other models, pharmacists working in a nondispensing role within a health care system, health insurance plan administering a prescription drug benefit program, or a centralized pharmacy call center may offer such services Although Medication Therapy Management can vary quite substantially in specifics, Medication Therapy Management programs in general share common elements; these include medication therapy review of all prescription drugs, over-the-counter products, and herbal or dietary supplements; patient education and counseling to solve issues with the drug regimen that a patient may be experiencing, such as side effects or difficulty remembering to take medications; and coordination and communication with the prescribing provider. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allowed Medicare to expand access to Medication Therapy Management services for selected patients through Medicare Part D prescription drug benefits.
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MedicalResearch.com Interview with:
Dr. Kristy Lynn Kummerow MD
Division of Surgical Oncology and Endocrine Surgery
Vanderbilt University Medical Center
Tennessee Valley Healthcare System, Veterans Affairs Medical Center
Geriatric Research, Education, and Clinical Center
Nashville, Tenn
Medical Research: What is the background for this study? What are the main findings?Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer. It is helpful to understand the historical context of how we treat early breast cancer. Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area. Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation. In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer. However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women. This has been found in other institutions as well, and is supported by smaller national studies. We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States.
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MedicalResearch.com Interview with:
Børge G Nordestgaard, MD, DMSc
Professor, University of Copenhagen
Chief Physician, Herlev Hospital, Copenhagen University Hospital
Dept. Clinical Biochemistry Herlev Ringvej Herlev, Denmark
Medical Research: What is the background for this study? What are the main findings?Prof. Nordestgaard: Many people take vitamin D supplements with the hope of reducing morbidity and mortality. However, it is unclear whether low vitamin D per se is a direct cause of increased mortality or whether it is simply a marker of poor lifestyle in general and/or underlying hidden disease. Our study involved 95,766 white participants of Danish descent from three cohorts in Copenhagen, who had genetic variants known to affect vitamin D levels. We found that genetically low vitamin D levels were associated with increased all-cause mortality, cancer mortality, and other mortality, but not with cardiovascular mortality. This is important as such genetics studies cannot be explained by poor lifestyle or hidden disease, as neither can change your genes.
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MedicalResearch.com Interview with:
Vasileia Varvarigou MD, Visiting Scientist at Harvard School of Public Health and Senior Medical Resident, St Elizabeth’s Medical Center, Tufts Medical School and
Stefanos N Kales MD, MPH, Associate Professor, Harvard School of Public Health, Division Chief of Occupational Medicine, Cambridge Health Alliance/ Harvard Medical School
Medical Research: What is the background for this study?
Response: Previous epidemiologic studies of firefighters have documented markedly increased risks of acute death from heart disease during strenuous activities such as fire suppression as compared to non-emergency duties. We hypothesized that certain law enforcement tasks could serve as an occupational trigger in susceptible police officers, leading to an increased frequency of sudden cardiac death during stressful duties.
Our main objective therefore, was to assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties.
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MedicalResearch.com Interview with: Weian Zhao PhD
Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine.
Medical Research:What is the background for this study?Dr. Zhao: Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The extremely high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages. The present gold standard to detect a blood infections, is a blood culture and it takes 2-5 days for the detection and the identification of the bacteria. Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with blood infections. Therefore, less expensive and less technically demanding methods are urgently needed for the rapid and sensitive identification of blood infections.
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MedicalResearch.com Interview with:
Dr. Lars H. Lund
Department of Medicine, Karolinska Institutet
Department of Cardiology, Karolinska University Hospital
Stockholm, Sweden
Medical Research: What is the background for this study?Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and there is no therapy.
Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction.
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MedicalResearch.com Interview with:Dr. Abhay Lodha, MBBS, MD, DM, MSC
Assistant Professor, Department of Pediatrics and Community Health Sciences, University of Calgary,
Staff Neonatologist and Clinical Epidemiologist, Section of Neonatology, Alberta Health Services, Chairman, CME
Foothills Medical Centre, Calgary, Alberta, Canada
Medical Research:What is the background for this study? What are the main findings?Dr. Lodha: Apneic episodes (cessation of breathing) occur in the premature infants. Caffeine is the most commonly used medication for apnea of prematurity. Normally caffeine started on day 3 of life for apnea. However, there is no strong evidence that starting caffeine on day 1 or 2 life has some extra advantages in premature infants. Our study has a large number of premature infants. Our study determined the association of early initiation of caffeine therapy in very preterm neonates and neonatal outcomes.
The main finding of our study was that early use of caffeine was associated with a reduction in the rate of death or bronchopulmonary dysplasia and patent ductus arteriosus. We did not find any adverse impact on any other outcomes.
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MedicalResearch.com Interview with:Dr. Mike Miedema MD, MPH
Minneapolis Heart Institute
Medical Research: What is the background for this study? What are the main findings?Dr. Miedema: " Released in November 2013, the ACC/AHA guidelines for the treatment of blood cholesterol attempt to target individuals that are most likely to benefit from cholesterol-lowering statin therapy. These guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat. Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits. In addition to recommending statin therapy for individuals with known cardiovascular disease, diabetes, or markedly elevated cholesterol levels, they also recommend statin therapy for individuals without these conditions but with an elevated estimated risk of a heart attack or stroke in the next 10-year based on a risk calculator that factors in an individual’s age, gender, race, and risk factors. Patients with an estimated 10-year risk > 7.5% are recommended to consider statin therapy. While I believe the scientific evidence supports this “risk-based” approach, one potential concern is that the risk-calculator relies heavily on age to determine an individual’s risk, so we wanted to examine the implications for these guidelines in an older sample of adults."
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MedicalResearch.com Interview with:Todd Lee MD MPH FRCPC
Consultant in Internal Medicine and Infectious Diseases
Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit,
McGill University Health Centre
Medical Research: What is the background for this study? What are the main findings?Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs. Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use. Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy. Sometimes this means that no antibiotics should be given.
In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions.
Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship". This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist. These audits were performed by our senior resident physicians in the context of providing their routine clinical care. We also provided local antibiotic guidelines and regular educational sessions once a rotation.
We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority. We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested.
Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
MedicalResearch.com Interview with:
Prof Gavin D. Perkins MD
Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research;
Warwick Medical School and Heart of England NHS Foundation Trust
Medical Research: What is the background for this study?Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital cardiac arrests and less than one in twelve of those returns home alive. Early high quality Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to survival. However maintaining high quality chest compressions during resuscitation is difficult for crews of emergency vehicles, especially if they are on their own, because of fatigue and the need to perform other actions. Chest compression is particularly difficult in moving vehicles.
A number of mechanical devices, suitable for out of hospital use, have been developed over the years to improve the quality of chest compressions and therefore attempt to improve patient outcomes. Some NHS organisations decided to purchase devices to use although there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS would cost tens of millions of pounds plus costs for on-going training and maintenance. This prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the purchase of further mechanical chest compression devices until further research had been carried out.
The aim of this trial was to compare the effects of the mechanical chest compressions (LUCAS-2) device versus standard manual chest compressions (crew using their hands) on survival.
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MedicalResearch.com Interview with:
Pietro Cottone, Ph.D.
Associate Professor
Departments of Pharmacology and Psychiatry
Laboratory of Addictive Disorders
Boston University School of Medicine Boston, MA 02118
Medical Research: What is the background for this study? What are the main findings?Dr. Cottone: Binge-eating disorder affects over ten million people in the USA and it is characterized by excessive consumption of junk food within brief periods of time, accompanied by loss of control, uncomfortable fullness and intense feelings of disgust and embarrassment. Increasing evidence suggests that binge-eating disorder can be regarded as an addiction behavior.
Memantine, a neuroprotective drug which blocks the glutamatergic system in the brain, is an Alzheimer's disease medication, and it has been shown potential to treat a variety of addictive disorders.
We first developed a rodent model of binge eating by providing a sugary, chocolate diet only for one hour a day, while the control group was given the standard laboratory diet. Rats exposed to the sugary diet rapidly develop binge eating behavior, observed as a 4 fold increase in food intake compared to controls. Furthermore, binge eating rats are willing to work to a much greater extent to obtain just the cue associated with the sugary food (not the actual food), as compared to controls. In addition, binge eating subjects exhibit compulsive behavior by putting themselves in a potentially risky situation in order to get to the sugary food, while the control group obviously avoids that risk.
We then tested whether administering memantine could reduce binge eating of the sugary diet, the strength of cues associated with junk food as well as the compulsiveness associated with binge eating. In addition, we studied which area of the brain was mediating the effects of memantine, by injecting the drug directly into the brain of binge eating rats.
Our data show that memantine was able to block binge eating of the sugary diet, the willingness to work to obtain a cue associated with junk food, as well as the risky behavior of rats when the sugary diet was provided in a potentially unsafe environment. When we injected the drug directly into the nucleus accumbens of rats, they stopped binge eating. Importantly, the drug had no effects in control rats eating a standard laboratory diet.
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MedicalResearch.com Interview with:
Manesh Patel, MD
Associate Professor of Medicine
Director Interventional Cardiology and Catheterization Labs
Duke University Health System
Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?Dr. Patel: In clinical practice, patients with acute myocardial infarction are found to have non-IRA disease of varying significant and location. The current recommendations are to have patients recover from the acute myocardial infarction and get non-invasive testing to determine revascualrization after 4-6 six weeks in uncomplicated patients. These data demonstrate that non-IRA disease is common (>50% of STEMI patients) and that these patients have an elevated 30-day mortality.
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MedicalResearch.com Interview with: Professor Tom Solomon, FRCP PhD
Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections
Director, Institute of Infection and Global Health, University of Liverpool
Medical Research: What is the background for this study? What are the main findings?Dr. Solomon: Since the Ebola outbreak began there has been concern about transmission to new countries by airline passengers who were infected, but didn’t know it. This was underscored by such transmission to Nigeria, and to USA. Screening for symptoms of Ebola virus disease in airline passengers whose journeys originated from the three most affected countries—Guinea, Liberia, and Sierra Leone—has recently been introduced at some airports.
We examined the current growth rate of the epidemic in West Africa, and airline travel patterns to predict how many people with Ebola are likely to attempt to fly. Our research showed that we can expect approximately 29 infected passengers to try and leave West Africa by the end of the year. Based on the incubation period of the virus, and looking at how long people have symptoms before they are hospitalised, we estimated ten of these people with Ebola would have symptoms of the disease as they leave the affected countries, and so would be detected by exit screening. Of the remaining 19, one to two would be expected to fly to the UK, and up to three to the USA, based on current airline passenger data. At most one of these passengers would have developed symptoms by the time they arrive in the UK or USA, and thus would be detected by entry screening
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MedicalResearch.com Interview with:
Charles Tzu Chi Lee, PhD
Associate Prof., Department of Public Health
Kaohsiung Medical University, Kaohsiung, Taiwan
Sanmin District, Kaohsiung City Taiwan
Medical Research: What is the background for this study? What are the main findings?Dr. Lee: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease and most patients die within three to five years after symptoms appear. Studies have suggested angiotensin-converting enzyme inhibitors (ACEIs) may decrease the risk for developing neurodegenerative diseases. But there was still no human study discussing ACEIs use and ALS risk in literature. The study results indicate that when compared with patients who did not use ACEIs, the risk reduction was 17 percent (adjusted odds ratio of 0.83) for the group prescribed ACEIs lower than 449.5 cumulative defined daily dose (cDDD) and 57 percent (adjusted odds ratio 0.43) for the group prescribed ACEIs greater than 449.5 cDDD.
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MedicalResearch.com Interview with:Marco Valgimigli, MD, PhD
Associate Professor of Medicine
Erasmus MC, Thoraxcenter,
Rotterdam The Netherlands
Medical Research: What is the background for this study? What are the main findings?Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to Bare Metal Stents. We have pooled all available datasets comparing a specific second generation Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal Stents and found that cardiac mortality along with all other non-fatal endpoints investigated, including myocardial infarction or stent thrombosis were reduced after co-Cr EES.
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MedicalResearch.com Interview Elyse O. Kharbanda MD MPH
HealthPartners Medical and Dental Group
Medical Research: What is the background for this study? What are the main findings?Dr. Kharbanda: In 2010, due to a pertussis outbreak and neonatal deaths, the California Department of Public Health recommended that the Tdap vaccine be administered during pregnancy. Tdap is now recommended by the Advisory Committee on Immunization Practices (ACIP) for all pregnant women during each pregnancy. We wanted to assess the impact of this recommendation.
The main findings were that Tdap vaccination during pregnancy was not associated with increased risk for hypertensive disorders of pregnancy, preterm birth, or having a baby who is small for his or her gestational age.
The study found a small increased risk for being diagnosed with chorioamnionitis, an inflammation of the fetal membranes caused by bacterial infection. These findings should be interpreted with caution as the magnitude of the risk was small. In addition, there was no associated risk for preterm birth, which often occurs as a result of chorioamnionitis. Furthermore, among the subset of women with a chorioamnionitis diagnosis whose charts were reviewed, many did not have a clinical picture that was clearly consistent with chorioamnionitis.
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MedicalResearch.com Interview with:
Rachel Bhak MS
Department of Veterans Affairs Cooperative Studies Program Coordinating Center
West Haven, Connecticut
Medical Research: What is the background for this study? What are the main findings?Ms. Bhak: Abdominal aortic aneurysms (AAA) and their rupture are potentially fatal, so monitoring and understanding their expansion is of utmost importance. This study sought to characterize factors associated with Abdominal aortic aneurysms expansion, as well as their different growth patterns. The main findings are that current smoking and diastolic blood pressure are associated with increased linear expansion rate, diabetes with a decreased linear expansion rate, and diastolic blood pressure and baseline abdominal aortic aneurysms diameter with an accelerated expansion rate. (more…)
MedicalResearch.com Interview with:
Charles Tzu Chi Lee, PhD
Associate Prof., Department of Public Health
Kaohsiung Medical University, Kaohsiung, Taiwan
Kaohsiung City 80708, Taiwan
Medical Research: What is the background for this study? What are the main findings?Dr. Lee: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease and most patients die within three to five years after symptoms appear. Studies have suggested angiotensin-converting enzyme inhibitors (ACEIs) may decrease the risk for developing neurodegenerative diseases. But. there was still no human study discussing ACEIs use and ALS risk in literature. The study results indicate that when compared with patients who did not use ACEIs, the risk reduction was 17 percent (adjusted odds ratio of 0.83) for the group prescribed ACEIs lower than 449.5 cumulative defined daily dose (cDDD) and 57 percent (adjusted odds ratio 0.43) for the group prescribed angiotensin-converting enzyme inhibitors greater than 449.5 cDDD.
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MedicalResearch.com Interview with:Adriaan J. van der Meer, MD, PhD
Department of Gastroenterology and Hepatology
Erasmus MC University Medical Center Rotterdam,
Rotterdam, the NetherlandsMedical Research: What is the background for this study? What are the main findings?Dr. van der Meer: This study was performed in order to assess the association between the virological response to antiviral therapy and the long-term clinical outcome among patients with advanced liver disease, who have the highest risk of cirrhosis-related complications and death due to their chronic viral infection. At the time this study was initiated there was scarce data on the relation between a sustained virological response (SVR; sustained elimination of hepatitis C RNA) and reduced all-cause mortality, the most definite clinical endpoint. With our large international multicenter cohort study we were able to show this association. After 10 years of follow-up the cumulative mortality rate was 9% among patients with SVR as compared to 26% among patients without SVR after antiviral therapy (p<0.001). The current JAMA research letter concerns a related analyses, in which we compared the survival among patients included in our cohort with that of an age- and sex-matched general population. Importantly, the survival among patients with SVR was comparable to the general population, despite the fact that all these patients had histological proof of advanced hepatic fibrosis. In contrast, the survival among patients without SVR was markedly lower as compared to the general population.
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MedicalResearch.com Interview with:
Dr. Arthur Reynolds PhD, Professor
Institute of Child Development
Humphrey School of Public Affairs
University of Minnesota
Medical Research: What is the background for this study? What are the main findings?
Dr. Reynolds: Given the high national priority on enhancing early childhood development, evidence about the relationship between full-day preschool participation and school readiness is meager.
The study found that among about 1000 children attending 11 schools in low-income neighborhood. participation in full-day preschool at ages 3 or 4 for 7 hours per day was associated with significantly higher school readiness skills at the end of preschool in language and literacy, socio-emotional development, math, and physical health than part-day participation for 3 hours per day. This translate to about a half of a year of growth in learning. Full-day preschool was also associated with significantly higher attendance and lower rates of chronic absences. No differences were found in parent involvement in school.
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