Medical Research Journals

29 Mar

Posted at 18:12h in Author Interviews, JAMA, Smoking, Tobacco Research
MedicalResearch.com Interview with: Jidong Huang, PhD Associate Professor Department of Health Policy & Behavioral Sciences School of Public Health, Georgia State University Atlanta, GA 30303 MedicalResearch.com: What is the background for this study?   Response: The US tobacco market has been transformed in the past decade by a rapid increase in awareness and use of e-cigarettes among youth and adults. This transformation has been accelerated in recent years by the emergence of new generations of e-cigarettes, such as JUUL e-cigarettes. The exponential growth in e-cigarettes has prompted a renewed interest in the tobacco harm reduction approach, which aims to rapidly curbing the smoking epidemic by encouraging smokers to switch to low risk tobacco products, such as e-cigarettes. There is an ongoing debate about whether the scientific evidence on the health risks of e-cigarettes in comparison with combustible cigarettes has been accurately communicated to the public. Large representative surveys are needed to examine how the public perceives the health risk of e-cigarettes and how their perception change over time.

28 Mar

Posted at 15:41h in Author Interviews, Brigham & Women's - Harvard, Cancer Research, JAMA
MedicalResearch.com Interview with: [caption id="attachment_48205" align="alignleft" width="125"]Isaac Chua MDInstructor of Medicine at Harvard Medical SchoolBoston, Massachusetts Dr. Chua[/caption] Isaac Chua MD Instructor of Medicine at Harvard Medical School Boston, Massachusetts  MedicalResearch.com: What is the background for this study?   Response: Opioids are routinely prescribed for cancer-related pain, but little is known about the prevalence of opioid-related hospitalizations for patients with cancer. Although opioid addiction among patients with cancer is estimated to be as high as 7.7%, our understanding of opioid misuse is based on small, preliminary studies. In light of the wider opioid epidemic, oncologists and palliative care clinicians frequently balance providing patients with legitimate access to opioids while protecting them and the general public from the risks of prescribing these medications.

28 Mar

Posted at 15:15h in Accidents & Violence, Alzheimer's - Dementia, Author Interviews, JAMA, Mental Health Research
MedicalResearch.com Interview with: [caption id="attachment_48239" align="alignleft" width="200"]Dr. Madeleine Liljegren Dr. Madeleine Liljegren
Photo: Ingemar Walldén[/caption] Madeleine Liljegren, MD Division of Oncology and Pathology Department of Clinical Sciences Lund University Lund, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know from former studies including patients with a clinical diagnosis of dementia, that criminal and socially inappropriate behaviors can be signs of dementia, sometimes even the first signs of a neurodegenerative disorder. We wanted to study this relatively large (n=220) cohort of neuropathologically verified Alzheimer disease (AD) and frontotemporal dementia (FTD) patients, who had been followed clinically by specialists in cognitive medicine or geriatric psychiatry during their disease period, to see if we could confirm results from previous studies. In this paper, we further wanted to study potential differences regarding protein pathology and criminal behavior in frontotemporal dementia patients. This has, to our knowledge, never been done before.

28 Mar

Posted at 14:05h in Author Interviews, Environmental Risks, JAMA, Mental Health Research, Pediatrics
MedicalResearch.com Interview with: “air pollution, beijing” by 大杨 is licensed under CC BY 2.0Joanne B. Newbury, PhD ESRC Postdoctoral Fellow King’s College London Social, Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience London, United Kingdom MedicalResearch.com: What is the background for this study? Response: Urban living is one of the most well-established risk factors for adult psychotic disorders such as schizophrenia. However, less is known about the role of the urban environment in subclinical psychotic experiences in childhood and adolescence, such as hearing voices and extreme paranoia. These early psychotic experiences are a developmental risk factor for adult psychotic disorders and a range of other serious mental health problems such as depression and anxiety. It is therefore important that we understand what factors might contribute to the development of early psychotic experiences so that we might be able to intervene and prevent their onset and progression. In a cohort of over 2000 UK-born children (The Environmental Risk Longitudinal Twin Study), we have previously shown that subclinical psychotic experiences are also around twice as common among children and teenagers raised in urban versus rural settings. We have also shown that this appears to be partly explained by social features in urban neighbourhoods such as higher crime levels and lower levels of social cohesion. However, no studies have examined the potential link between air pollution and psychotic experiences. This is despite air pollution being a major health problem worldwide (particularly in cities), and despite emerging evidence linking air pollution to the brain. 

28 Mar

Posted at 12:28h in Author Interviews, Lancet, OBGYNE, Pediatrics, Weight Research
MedicalResearch.com Interview with: [caption id="attachment_48229" align="alignleft" width="200"]Liv Guro Engen Hanem, PhD CandidateDepartment of Clinical and Molecular MedicineNorwegian University of Science and Technology Liv Guro Engen Hanem[/caption] Liv Guro Engen Hanem, PhD Candidate Department of Clinical and Molecular Medicine Norwegian University of Science and Technology MedicalResearch.com: What is the background for this study?   Response: The antidiabetic drug metformin is increasingly used in pregnancy: to treat gestational diabetes and type 2 diabetes, and to prevent pregnancy complications related to polycystic ovary syndrome (PCOS) and obesity. Metformin passes the placenta, and the fetus is thus exposed to the drug. Although no teratogenicity has been reported, metformin might have long-term effects on offspring health. This study is a follow-up of cardiometabolic risk factors of 141 5- to 10-year-old children born in the PregMet study. This study was a double-blind, randomized controlled trial (RCT) designed to test the hypothesis that metformin given throughout pregnancy reduces the prevalence of pregnancy complications that are associated with the common endocrine disorder PCOS. Pregnant women with PCOS were randomized to receive metformin or placebo throughout pregnancy. 

28 Mar

Posted at 11:23h in Author Interviews, Brigham & Women's - Harvard, Ebola, Global Health, Lancet
MedicalResearch.com Interview with: [caption id="attachment_48164" align="alignleft" width="142"]Patrick Vinck, PhDResearch Director, Harvard Humanitarian InitiativeAssistant Professor, Global Health and Population T.H. Chan Harvard School of Public Health; Emergency MedicineHarvard Medical SchoolLead Investigator, Brigham & Women's Hospital  Dr. Vinck[/caption] Patrick Vinck, PhD Research Director, Harvard Humanitarian Initiative Assistant Professor, Global Health and Population T.H. Chan Harvard School of Public Health; Emergency Medicine Harvard Medical School Lead Investigator, Brigham & Women's Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The second worst epidemic of Ebola on record is currently unfolding in the eastern part of the Democratic Republic of the Congo. Whether or not safe practices are implemented to prevent the spread of the epidemic is influenced by the behavior of individuals at-risk of contracting the Ebola Virus Disease (EVD) - Will they follow the recommendations of health professionals? Will they report suspected cases and deaths? Will they seek treatment from health professionals? Will they accept vaccines and adopt preventive behaviors? We find that belief in misinformation about Ebola is widespread and trust in authorities is generally low, likely as a result of decades of violence and poor governance and, more recently, the politicization of the Ebola response. Our analysis shows that trust and (mis-)information influence adherence to risk avoidance behavior and acceptance of vaccination.

28 Mar

Posted at 00:22h in Author Interviews, Cannabis, JAMA, Mental Health Research, OBGYNE
MedicalResearch.com Interview with: [caption id="attachment_48215" align="alignleft" width="160"]Jeremy FineB.A. in Philosophy, Neuroscience, and PsychologyWashington University in St. Louis, Class of 2019 Jeremy Fine[/caption] Jeremy Fine B.A. in Philosophy, Neuroscience, and Psychology Washington University in St. Louis, Class of 201 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Alongside increasingly permissive marijuana use attitudes and laws, the prevalence of marijuana use among pregnant mothers has increased substantially (by 75% between 2002 and 2016), with some evidence that pregnant women may be using cannabis to combat pregnancy-related nausea. Our data came from the Adolescent Brain Cognitive Development (ABCD) Study, which included over 4,000 subjects with data on maternal marijuana use during pregnancy. Our main finding was that the children of mothers who used marijuana after learning they were pregnant had a small but significant increase in risk for psychosis in their future.

27 Mar

Posted at 21:30h in Accidents & Violence, Author Interviews, Emergency Care, NEJM, University Texas
MedicalResearch.com Interview with: [caption id="attachment_48175" align="alignleft" width="200"]Jeffrey Howard, PhDAssistant ProfessorDepartment of Kinesiology, Health and NutritionUniversity of Texas at San AntonioSan Antonio, TX 78249 Dr. Howard[/caption] Jeffrey Howard, PhD Assistant Professor Department of Kinesiology, Health and Nutrition University of Texas at San Antonio San Antonio, TX 78249 MedicalResearch.com: What is the background for this study? Response:  There is a saying that “the only winner in war is medicine”, which is the first sentence in the article.  The point of that quote is that many medical advances over the last 500 years or more have been learned or propagated as a result of war. With that as the backdrop, the purpose of our study was to provide a more comprehensive assessment of the trauma system than previous work.  We accomplished this by compiling the most complete data to-date on the conflicts, using data from both Afghanistan and Iraq, and analyzing multiple interventions/policy changes simultaneously rather than in isolation.  Previous work had focused primarily on single interventions and within more narrow timeframes.  We wanted to expand the scope to include multiple interventions and encompass the entirety of the conflicts through the end of 2017. 

27 Mar

Posted at 21:27h in Author Interviews, Breast Cancer, Chemotherapy, NEJM
MedicalResearch.com Interview with: [caption id="attachment_48191" align="alignleft" width="150"]Rita Mehta, MD, HS Clinical Professor,Chao Family Comprehensive Cancer CenterUniversity of California School of Medicine, Irvine  Dr. Mehta[/caption] Rita Mehta, MD, HS Clinical Professor, Chao Family Comprehensive Cancer Center University of California School of Medicine, Irvine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Most patients with HR-positive breast cancer become resistant to hormonal therapies like aromatase inhibitor-anastrozole over time, and downregulating estrogen receptor was identified as a mechanism for overcoming or delaying resistance to hormonal therapy in advanced HR-positive breast cancer. The prospective, randomized phase III S0226 trial, first reported by us in NEJM 2012, showed that the selective estrogen receptor degrader fulvestrant in combination with anastrozole significantly improved progression-free survival in 707 women with HR-positive metastatic breast cancer in first-line setting. Treatment with the selective estrogen receptor degrader (SERD) fulvestrant achieved a clinically significant and meaningful improvement in overall survival in patients with hormone receptor (HR)-positive advanced breast cancer in first-line therapy, according to the final analysis of overall survival results from the S0226 study reported by us (Mehta et al. NEJM 2019)
  • Results showed that median overall survival improved by 7.8 months with anastrozole plus fulvestrant (median overall survival = 49.8 months) compared to anastrozole (median overall survival = 42.0 months).
  • The improvement was even greater in patients with endocrine naive disease, with an absolute improvement in median overall survival of 11.9 months.
  • No new safety signals were observed with longer follow-up. 

27 Mar

Posted at 21:22h in Anesthesiology, Author Interviews, Heart Disease, NEJM, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_48112" align="alignleft" width="200"]Dr. Giovanni LandoniIntensive Care and Anesthesia Unit Associate professorUniversità Vita-Salute San Raffaele Dr. Landoni[/caption] Dr. Giovanni Landoni Intensive Care and Anesthesia Unit Associate professor Università Vita-Salute San Raffaele  MedicalResearch.com: What is the background for this study?   Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data.

27 Mar

Posted at 15:23h in Author Interviews, Brigham & Women's - Harvard, Dermatology, Heart Disease, JAMA
MedicalResearch.com Interview with: [caption id="attachment_48184" align="alignleft" width="200"]Seoyoung C. Kim, MD, ScD, MSCEDirector, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology Associate Professor of MedicineDivision of Pharmacoepidemiology & PharmacoeconomicsDivision of Rheumatology, Immunology and Allergy Brigham and Women's Hospital, Harvard Medical School Dr. Kim[/caption] Seoyoung C. Kim, MD, ScD, MSCE Director, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology Associate Professor of Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Division of Rheumatology, Immunology and Allergy Brigham and Women's Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Given a high cardiovascular (CV) risk among patients with psoriasis and psoriatic arthritis, it is important to have more information with regard to potential effect of different treatment agents on CV risk. As the number of treatment options for psoriasis and psoriatic arthritis has been rising over the few decades, it is even more crucial to have high-quality evidence on comparative safety of different treatment options so physicians and patients can choose an agent based on the benefit-risk profile of each drug they are considering.

27 Mar

Posted at 15:13h in Author Interviews, Brigham & Women's - Harvard, Flu - Influenza, Heart Disease, JAMA
MedicalResearch.com Interview with: [caption id="attachment_48142" align="alignleft" width="150"]Sonja Kytomaa MAResearch AssociateBrigham and Women’s Hospital Sonja Kytomaa[/caption] Sonja Kytomaa MA Research Associate Brigham and Women’s Hospital [caption id="attachment_48143" align="alignleft" width="126"]Scott D. Solomon, MDThe Edward D. Frohlich Distinguished ChairProfessor of MedicineHarvard Medical SchoolSenior PhysicianBrigham and Women’s HospitalInternational Associate Editor, European Heart Journal Dr. Scott Solomon[/caption] Scott D. Solomon, MD The Edward D. Frohlich Distinguished Chair Professor of Medicine Harvard Medical School Senior Physician Brigham and Women’s Hospital International Associate Editor, European Heart Journal   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Influenza is associated with an increased risk of cardiovascular events, yet few studies have explored the temporal association between influenza activity and hospitalizations, especially due to heart failure (HF). Our aim with this study was to explore the temporal association between influenza activity and hospitalizations for HF and myocardial infarction (MI) in the general population. We related the number of MI and HF hospitalizations by month, which were sampled from 4 US communities and adjudicated in the surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, to monthly influenza-like illness activity, as reported by the Centers for Disease Control and Prevention. We found that a 5% increase in influenza activity was associated with a 24% increase in HF hospitalizations rates, while overall influenza was not significantly associated with MI hospitalizations. Influenza activity in the months before hospitalization was not associated with either outcome.

26 Mar

Posted at 19:38h in Author Interviews, JAMA, Karolinski Institute, Pediatrics
MedicalResearch.com Interview with: [caption id="attachment_48081" align="alignleft" width="150"]Mikael Norman, MD, PhD, ProfessorKarolinska Institutet & Karolinska University HospitalStockholm, Sweden  Dr. Norman[/caption] Mikael Norman, MD, PhD, Professor Karolinska Institutet & Karolinska University Hospital Stockholm, Sweden  MedicalResearch.com: What is the background for this study? Response: So far, preterm birth has been difficult to predict and prevent. In particular, extremely preterm birth has continued to be an issue in terms of optimal care before and after birth, costs and long term health outcomes. Therefore, studies on how the management and outcome varies over time in these patients are important.

26 Mar

Posted at 15:42h in Author Interviews, Heart Disease, JAMA, Stem Cells
MedicalResearch.com Interview with: [caption id="attachment_48147" align="alignleft" width="114"]Annetine C. Gelijns, PhDChair, Department of Population Health Science & PolicyEdmond A. Guggenheim Professor of Health PolicyCo-Director, InCHOIR Dr. Gelijns[/caption] Annetine C. Gelijns, PhD Professor and System Chair Population Health Science and Policy Icahn School of Medicine at Mount Sinai [caption id="attachment_48148" align="alignleft" width="114"]Alan J Moskowitz, MDProfessor, Population Health Science and PolicyDepartment of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew York, NY 10029-6574 Dr. Moskowitz[/caption] Alan J Moskowitz, MD Professor of Population Health Science and Policy Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Where do these mesenchymal cells come from?  Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery. Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients.

26 Mar

Posted at 14:52h in Author Interviews, JAMA, Pediatrics, Stanford, Technology
MedicalResearch.com Interview with: [caption id="attachment_48138" align="alignleft" width="200"]Dennis P. Wall, PhDAssociate ProfessorDepartments of Pediatrics, Psychiatry (by courtesy) and Biomedical Data ScienceStanford University Dr. Wall[/caption] Dennis P. Wall, PhD Associate Professor Departments of Pediatrics, Psychiatry (by courtesy) and Biomedical Data Science Stanford University  MedicalResearch.com: What did we already know about the potential for apps and wearables to help kids with autism improve their social skills, and how do the current study findings add to our understanding? What’s new/surprising here and why does it matter for children and families?  Response: We have clinically tested apps/AI for diagnosis (e.g.  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002705) in a number of studies. This RCT is a third phase of a phased approach to establish feasibility and engagement through in-lab and at-home codesign with families with children with autism. This stepwise process is quite important to bring a wearable form of therapy running AI into the homes in a way that is clinically effective. What’s new here, aside from being a first in the field, is the rigorous statistical approach we take with an intent-to-treat style of analysis. This approach ensures that the effect of the changes are adjusted to ensure that any significance observed is due to the treatment.  Thus, with this, it is surprising and encouraging to see an effect on the VABS socialization sub-scale. This supports the hypothesis that the intervention has a true treatment effect and increases the social acuity of the child. With it being a home format for intervention that can operate with or without a clinical practitioner, it increases options and can help bridge gaps in access to care, such as when on waiting lists or if the care process is inconsistent.  

26 Mar

Posted at 13:59h in Author Interviews, JAMA, Pediatrics
MedicalResearch.com Interview with: [caption id="attachment_48084" align="alignleft" width="133"]Edward Bell, MDVice Chair for Faculty DevelopmentDepartment of PediatricsProfessor of Pediatrics - NeonatologyCarver College of MedicineUniversity of Iowa Health Care Dr. Bell[/caption] Edward Bell, MD Vice Chair for Faculty Development Department of Pediatrics Professor of Pediatrics - Neonatology Carver College of Medicine University of Iowa Health Care  MedicalResearch.com: What is the background for this study? Response: The study is an analysis of what happened to the 205 babies with birth weigh below 400 grams and gestational age of 22 through 26 weeks who were born between 2008 and 2016 at 21 academic medical centers that are members of the National Institute of Child Health and Human Development Neonatal Research Network. The Network exists to collaborate in finding ways to improve the survival and health of premature and other critically-ill newborn infants. 400 grams is very small. By comparison, 1 pound is 454 grams.

26 Mar

Posted at 00:39h in Author Interviews, BMJ, OBGYNE, Occupational Health
MedicalResearch.com Interview with: [caption id="attachment_48133" align="alignleft" width="200"]Luise Mølenberg BegtrupInstitute of Public HealthUniversity of Southern Denmark | SDU Luise Mølenberg Begtrup[/caption] Luise Mølenberg Begtrup Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are indications that working fixed night shifts is associated with a higher risk of miscarriage. Since many women work rotating shifts including night shifts, we were interested in examining the association between the amount of night work and miscarriage. We were able to do this by use of detailed exposure data based on payroll data.

26 Mar

Posted at 00:28h in Author Interviews, Dermatology, JAMA, Pediatrics, Sleep Disorders, UCSF
MedicalResearch.com Interview with: [caption id="attachment_48079" align="alignleft" width="135"]Dr. Katrina Abuabara Dr. Abuabara[/caption] Dr. Katrina Abuabara, MD, MA, MSCE Department of Dermatology Program for Clinical Research, University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: The wellbeing and development of children is strongly influenced by parents’ physical and psychosocial health. Parents of children with chronic illness, in particular, are susceptible to poor sleep, and previous studies have found major sleep impairments among parents of children with ventilator dependency and cystic fibrosis, but few studies have examined sleep patterns among parents of children with more common chronic illnesses like atopic dermatitis (also known as eczema).

25 Mar

Posted at 15:21h in Author Interviews, Gender Differences, JAMA, Pediatrics
MedicalResearch.com Interview with: Dr. David Klein MD MPH Associate Program Director National Capital Consortium (NCC) Family Medicine Residency Fort Belvoir Community Hospital Dr. Elizabeth Hisle-Gorman MSW, PhD Assistant Professor, Uniformed Services University  MedicalResearch.com: What is the background for this study?  Response: Our study, “Transgender Children and Adolescents Receiving Care in the U.S. Military Healthcare System: A Descriptive Study,” sought to analyze the number of military dependent children and adolescents who have a transgender or gender-diverse identity and receive medical care in the Military Health System (MHS), recognizing that the number has been increasing, but not knowing to what extent. Ultimately, in studying this data, we hoped to document the needs of transgender children in military families to support provision of adequate and appropriate high-quality care.

24 Mar

Posted at 22:22h in Author Interviews, Health Care Systems, JAMA
MedicalResearch.com Interview with: [caption id="attachment_48108" align="alignleft" width="160"]Maryam Guiahi, MDAssociate Professor, Ob/GynSchool of MedicineUniversity of Colorado Dr. Guiahi[/caption] Maryam Guiahi, MD Associate Professor, Ob/Gyn School of Medicine University of Colorado  MedicalResearch.com: What is the background for this study? Response: The United States Conference of Catholic Bishops expects providers in Catholic Health Care Facilities to follow the Ethical and Religious Directives for Catholic Health Care Services, which places limits on reproductive and end-of-life care. Prior research has demonstrated that many patients do not anticipate religious health care restrictions, yet often face conflicts in care. We were interested in whether Catholic hospitals disclose their religious affiliation and explain to patients how this affiliation may impact the care they are offered.

21 Mar

Posted at 23:38h in Author Interviews, Clots - Coagulation, Duke, Heart Disease, NEJM
MedicalResearch.com Interview with: [caption id="attachment_20394" align="alignleft" width="200"]Renato D. Lopes MD, MHS, PhD Duke University Medical Center Duke Clinical Research Institute Durham, NC 27705 Dr. Renato Lopes[/caption] Renato D. Lopes MD, MHS, PhD Professor of Medicine Division of Cardiology Duke University Medical Center Duke Clinical Research Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: In patients with acute coronary syndromes (ACS), approximately 20% to 30% of those with nonvalvular atrial fibrillation (NVAF) have concomitant coronary artery disease (CAD), and 5 to 10% of patients who undergo PCI have NVAF. These patients often receive both antiplatelet therapy and oral anticoagulants; and how best to combine these agents to minimize bleeding risk without compromising protection against thrombosis is an important unanswered question. Analysis of results for bleeding indicated no significant interaction between the two randomization factors permitting independent analysis of results for the two key comparisons. The first showed that apixaban was both non-inferior and significantly superior to VKA for the primary outcome with a 31% reduction in the relative risk for bleeding. Aspirin significantly increased the relative risk for bleeding versus placebo by 89%. Results for the composite of death and hospitalization showed that apixaban resulted in a relative risk reduction of 17%, primarily driven by a reduction in all cause hospitalization. There was no significant difference between results for aspirin versus placebo for this outcome. Analysis of the composite of death and ischemic events indicated no significant differences in results for apixaban versus VKA or aspirin versus placebo.

21 Mar

Posted at 23:21h in Author Interviews, Duke, Heart Disease, JAMA
MedicalResearch.com Interview with: Renato D. Lopes MD, MHS, PhD Professor of Medicine Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Alexander C. Fanaroff, MD, MHS Division of Cardiology and Duke Clinical Research Institute Duke University, Durham, North Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: About ten years ago, a group of researchers examined the evidence supporting guideline recommendations in cardiology for the first time. Quite surprisingly, they found that only 11% of recommendations in American College of Cardiology/American Heart Association (ACC/AHA) guidelines were supported by evidence from randomized controlled trials, the highest level of evidence. The researchers called for greater collaboration among investigators and funders in identifying key research questions, development of streamlined clinical trial methods, and expansion of funding for clinical research. Over the past 10 years, some of these steps have been taken, but it is unclear how the evidence supporting guideline recommendations has changed. We therefore analyzed the 51 current cardiovascular guideline documents -- 26 from the ACC/AHA and 25 from the European Society of Cardiology (ESC) -- including 6,329 recommendations. Overall, 8.5% of recommendations in ACC/AHA guidelines and 14.3% of recommendations in ESC guidelines were supported by evidence from randomized controlled trials. When looking specifically at guidelines that have been updated, we found no significant changes in the proportion of recommendations supported by evidence from randomized controlled trials.

21 Mar

Posted at 18:55h in Author Interviews, Brigham & Women's - Harvard, Critical Care - Intensive Care - ICUs, End of Life Care, JAMA
MedicalResearch.com Interview with: Joanna Paladino, MD Director of Implementation, Serious Illness Care Program | Ariadne Labs Brigham and Women's Hospital | Harvard T.H. Chan School of Public Health Palliative Care | Dana-Farber Cancer Institute Instructor | Harvard Medical School and Dr. Rachelle Bernacki MD MS Director of Quality Initiatives Psychosocial Oncology and Palliative Care Senior Physician, Assistant Professor of Medicine Harvard Medical School Dr. Paladino's responses: MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Paladino: People living with serious illness face many difficult decisions over the course of their medical care. These decisions, and the care patients receive, should be guided by what matters most to patients, including their personal values, priorities, and wishes. These conversations don’t often happen in clinical practice or do so very late in the course of illness, leaving patients exposed to getting care they don’t want. Doctors and nurses want to have these important discussions, but there are real challenges, including insufficient training and uncertainties about when and how to start the conversation. We designed an intervention with clinical tools, clinician training, and systems-changes to address these challenges. When tested in a randomized clinical trial in oncology, we found that the intervention led to more, earlier, and better conversations between oncology clinicians and their patients with life-limiting cancer. These findings demonstrate that it is possible to ensure reliable, timely, and patient-centered serious illness conversations in an outpatient oncology practice.

21 Mar

Posted at 15:58h in Author Interviews, Cancer Research, JAMA
MedicalResearch.com Interview with: [caption id="attachment_48037" align="alignleft" width="150"]Peter R. Dixon, MDDepartment of Otolaryngology-Head & Neck SurgeryInstitute of Health Policy, Management and EvaluationUniversity of TorontoToronto, Ontario, Canada  Dr. DIxon[/caption] Peter R. Dixon, MD Department of Otolaryngology-Head & Neck Surgery Institute of Health Policy, Management and Evaluation University of Toronto Toronto, Ontario, Canada  MedicalResearch.com: What is the background for this study? Response: The word ‘cancer’ is often associated with an aggressive and lethal disease. Innovations in screening and diagnostic tests detect some ‘cancers’ that -- even if left untreated -- pose very low-risk of any symptoms, progression, or mortality. Still, many of these low-risk cancers are treated aggressively and those treatments can have harmful consequences and side-effects. We were interested in determining how influential the word ‘cancer’ is in decisions made by patients about low-risk malignant neoplasms relative to other labels for the same disease.

20 Mar

Posted at 16:17h in Author Interviews, Blood Pressure - Hypertension, NEJM, Race/Ethnic Diversity
MedicalResearch.com Interview with: [caption id="attachment_48022" align="alignleft" width="133"]Dike B. Ojji, M.D., Ph.D, FWACP, FACPDepartment of MedicineFaculty of Clinical SciencesUniversity of Abuja Dr. Ojji[/caption] Dike B. Ojji, M.D., Ph.D, FWACP, FACP Department of Medicine Faculty of Clinical Sciences University of Abuja MedicalResearch.com: What is the background for this study? Response: We decided to do this research because there were no large RCTs before now that have compared the efficacy of contemporary combination therapies among any black populations in spite of the high burden of hypertension and its complications (such as heart failure, cerebrovascular accident and chronic kidney) in this population, and also the fact that majority require 2 or more medications to control their blood pressure.

20 Mar

Posted at 02:04h in Author Interviews, Heart Disease, JACC, Technology
MedicalResearch.com Interview with: [caption id="attachment_48004" align="alignleft" width="130"]Annapoorna Kini, MDZena and Michael A Wiener Professor of MedicineDirector of the Cardiac Catheterization LaboratoryMount Sinai Heart at Mount Sinai Hospital Dr. Kini[/caption] Annapoorna Kini, MD Zena and Michael A Wiener Professor of Medicine Director of the Cardiac Catheterization Laboratory Mount Sinai Heart at Mount Sinai Hospital MedicalResearch.com: What is the background for this study?  
  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called "TAVRcathAID".

19 Mar

Posted at 19:03h in Author Interviews, Heart Disease, JAMA
MedicalResearch.com Interview with: [caption id="attachment_47952" align="alignleft" width="167"]Dr. Carina Blomström-Lundqvist, MDProfessor of CardiologyDepartment of CardioloyInstitution of Medical ScienceUppsala, Sweden Dr. Blomström-Lundqvist[/caption] Dr. Carina Blomström-Lundqvist, MD Professor of Cardiology Department of Cardioloy Institution of Medical Science Uppsala, Sweden MedicalResearch.com: What is the background for this study?   Response: While all previous trials comparing atrial fibrillation (AF) ablation and antiarrhythmic drugs to our best knowledge have evaluated the efficacy of these treatments in terms of atrial fibrillation (AF) recurrences (with an AF episode of 30 seconds duration as standard primary endpoint) we wanted to use quality of Life (QoL) - general health - as primary endpoint, since the indication for treatment is improving QoL. This was important since, despite the fact that the indication for treatment is to improve (QoL) and reduce symptom, all prior trials have used 30 seconds AF episodes as standard primary endpoint, which if occurred it would be defined as a failed treatment. We also wanted to assess effects on various clinical outcome events. We know from registries such as ORBIT AF registry that around 60 % of AF patients have symptoms resulting in repeated hospitalisation visits in at least 30-40% of patients annually, and that only around 5 % of the AF population are being referred for AF ablation. Previous trials have used intermittent 24 hours Holter recordings whioch does not give the true AF burden (% of time in AF). We therefore also wanted to assess and compare treatments effects on true AF burden by implanting an implantable cardiac monitor (ICM) which continuosly records the heart rhythm. We would then be able to prove that improvement in QoL was directly related to a reduction in AF burden and that treatment differences in QoL was related to a difference in reduction in AF burden. We also wanted to study an AF population in their early AF disease state so that we could offer atrial fibrillation ablation to a broader AF population before their atria have become remodelled and too damaged for a pulmonary vein isolation to be effective. 

18 Mar

Posted at 12:59h in Accidents & Violence, Author Interviews, Heart Disease, Inflammation, JACC, Lipids
MedicalResearch.com Interview with: [caption id="attachment_47835" align="alignleft" width="200"]Dr. George Dangas MD PhDProfessor of Medicine, CardiologyMount Sinai Health System Dr. Dangas[/caption] Dr. George Dangas MD PhD Professor of Medicine, Cardiology Mount Sinai Health System MedicalResearch.com: What is the background for this study? Response: Widespread use of statins targeted to decrease levels of low density lipoprotein cholesterol (LDL-C) below 70mg/dL are recommended by guidelines. However, residual cholesterol risk may only be one part of the residual risk equation. Indeed, Biological inflammation has long been known as a pathophysiological mechanism of atherosclerosis and the recent CANTOS trial opened new therapeutic perspective by demonstrating that inflammation modulation via selective interleukin-1β inhibition could result in improved diagnosis in patients with coronary artery disease. However, the prevalence and impact of a residual inflammatory biological syndrome in patients with controlled cholesterol risk is unclear.

18 Mar

Posted at 12:04h in Author Interviews, Biomarkers, BMJ, Heart Disease
MedicalResearch.com Interview with: [caption id="attachment_47901" align="alignleft" width="158"]Prof. Nick Curzen  BM(Hons) PhD FRCPProfessor of Interventional Cardiology/Consultant CardiologistUniversity Hospital SouthamptonSouthampton Prof. Curzen[/caption] Prof. Nick Curzen  BM(Hons) PhD FRCP Professor of Interventional Cardiology/Consultant Cardiologist University Hospital Southampton Southampton MedicalResearch.com: What is the background for this study? Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop).  The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people.  When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack. This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all.  We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason.