Medical Research Journals

11 Mar

Posted at 15:05h in Author Interviews, Dermatology, JAMA, Melanoma
MedicalResearch.com Interview with: [caption id="attachment_40495" align="alignleft" width="200"]Superficial spreading melanoma arising from a dysplastic nevus Superficial spreading melanoma arising from a dysplastic nevus
NCI image[/caption] Aimilios Lallas, PhD First Department of Dermatology, School of Medicine Aristotle University Thessaloniki, Greece MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Our goal today is to recognize melanoma at the earliest stage, ideally before it invades the dermis and acquires metastatic potential. Melanoma-specific dermoscopic criteria have been tested mainly in the context of invasive melanoma. Although they were proven valid melanoma predictors, the question still remains if they are strong enough to diagnose melanoma in situ (MIS). Our aim was to investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of melanoma in situ. We identified 5 main positive dermoscopic indicators of MIS: atypical network, regression, irregular hyperpigmented areas, prominent skin markings and angulated lines. 

10 Mar

Posted at 01:20h in Author Interviews, Heart Disease, Lancet, Menopause, Women's Heart Health
MedicalResearch.com Interview with: [caption id="attachment_40430" align="alignleft" width="100"]Mihir Sanghvi Academic Junior Doctor Barts Health NHS Trust Dr. Sanghvi[/caption] Mihir Sanghvi Academic Junior Doctor Barts Health NHS Trust MedicalResearch.com: What is the background for this study? What are the main findings? Response: The effect of menopausal hormone therapy (MHT), previously known as hormone replacement therapy, on cardiovascular health in post-menopausal women remains controversial and unclear. Extensive observational data had suggested MHT to be cardioprotective, leading to MHT being routinely prescribed for both primary and secondary prevention of coronary heart disease (CHD). However, subsequent data from the Women’s Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) studies cast doubt on the beneficial cardiovascular effects of MHT; this was reflected in learned societies’ clinical guidance concerning MHT’s role in CHD prevention. The most recent randomised trial data on the subject arose from the Danish Osteoporosis Prevention Study, which indicated that women taking menopausal hormone therapy had a reduced risk of the composite endpoint of mortality, heart failure and myocardial infarction but the study has been subject to criticism [10]. In more recent work, again from the WHI, there was no difference in cardiovascular mortality in MHT users compared to placebo, although the authors themselves state that cause-specific mortality data should be interpreted “cautiously”. The UK Biobank is an ongoing, large-scale, population-based study designed to examine determinants of health in middle and old age. Besides extensive collection of health questionnaire data, biological samples and physical measurements, it has incorporated cardiovascular magnetic resonance (CMR) imaging – the gold standard for analysis of cardiac structure and function – to provide detailed imaging phenotypes. At present, there is a paucity of data on the effects of  menopausal hormone therapy on left ventricular (LV) and left atrial (LA) volumes and function, alterations in which are markers of subclinical cardiovascular disease and have prognostic implications. We found that in a large, population-based cohort of post-menopausal women free of cardiovascular disease, use of menopausal hormone therapy is not associated with adverse, subclinical changes in cardiac structure and function. Indeed, we demonstrate significantly smaller LV and LA chamber volumes which have been linked to favorable cardiovascular outcomes in other settings.

10 Mar

Posted at 01:05h in Author Interviews, JAMA, Prostate Cancer
MedicalResearch.com Interview with: [caption id="attachment_40464" align="alignleft" width="200"]Amar U. Kishan, MD Assistant Professor Department of Radiation Oncology University of California, Los Angeles Dr. Kishan[/caption] Amar U. Kishan, MD Assistant Professor Department of Radiation Oncology University of California, Los Angeles MedicalResearch.com: What is the background for this study? Response: Patients with high risk prostate cancer have several curative treatment options: radical prostatectomy, external beam radiotherapy with androgen deprivation therapy, and external beam radiotherapy with a brachytherapy boost, also with androgen deprivation therapy (so-called extremely dose-escalated radiotherapy). Prior attempts at comparing long-term clinical outcomes between these treatment options have been hampered by the fact that standards of care have changed significantly with respect to the appropriate dose of radiation and the usage of androgen deprivation therapy. Therefore, many comparative effectiveness reports are in essence comparing apples with rotten oranges. Further, not all high risk prostate cancers are the same. Gleason score 9-10 disease is a particularly aggressive form of prostate cancer that is much more likely to metastasize and potentially cause death. Thankfully, this is a rarer type of prostate cancer -- but this also means that not much data are available specifically for this type of disease. Therefore, we launched a multi-institutional study of men with Gleason score 9-10 disease, including 1809 men treated across 12 institutions. All men were treated between 2000 and 2013 and therefore were more likely to have treatments that would be commensurate with modern standards. 

09 Mar

Posted at 17:51h in Asthma, Author Interviews, NEJM, Pulmonary Disease
MedicalResearch.com Interview with: “Asthma Inhaler” by NIAID is licensed under CC BY 2.0Timothy Harrison, MBBS, BSc, FRCP, MD, MSc Professor and Honorary Consultant Faculty of Medicine & Health Sciences University of Nottingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: Self management plans are recommend for patients with asthma but previous studies have shown that doubling the dose of inhaled steroids when asthma starts deteriorating is ineffective at preventing the development of an exacerbation. This study shows that quadrupling the dose is effective and in a real-life setting can reduce severe exacerbations by about 20%

07 Mar

Posted at 22:55h in Abuse and Neglect, Hematology, Lancet, Medical Imaging, Transplantation
MedicalResearch.com Interview with: [caption id="attachment_40425" align="alignleft" width="133"]Kirsten Williams, M.D. Blood and marrow transplant specialist Children’s National Health System Dr. Williams[/caption] Kirsten Williams, M.D. Blood and marrow transplant specialist Children’s National Health System  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study addressed a life-threatening complication of bone marrow transplantation called bone marrow failure. Bone marrow transplantation has provided a cure for patients with aggressive leukemias or acquired or genetic marrow dysfunction. The process of bone marrow transplantation involves giving chemotherapy and/or radiation, which removes the diseased blood cells from the bone marrow. After this, new bone marrow stem cells are infused from a healthy individual. They travel to the bone marrow and start the slow process of remaking the blood system. Because these new cells start from infancy, it takes upwards of four to five weeks for new mature healthy cells to emerge into the blood, where they can be identified. Historically, there has been no timely way to determine if the new cells have successfully repopulated unless they can be seen in the blood compartment. This condition of bone marrow failure is life-threatening, because patients don't have white blood cells to protect them from infection. Once bone marrow failure is diagnosed, a second new set of stem cells are infused, often after more chemotherapy is given. However, for many individuals this re-transplantation is too late, because severe infections can be fatal while waiting cells to recover. We were the first group to use a new imaging test to understand how the newly infused bone marrow cells develop inside the patient. We have recently published a way to detect the new bone marrow cell growth as early as five days after the cells are given. We used an investigational nuclear medicine test to reveal this early cell growth, which could be detected weeks before the cells appear in the blood. This radiology test is safe, does not cause any problems and is not invasive. It is called FLT (18F-fluorothymidine) and the contrast is taken up by dividing hematopoietic stem cells. The patients could even see the growth of their new cells inside the bone marrow (which they very much enjoyed while waiting to see recovery of the cells in their blood). We could use the brightness of the image (called SUV) to determine approximately how many weeks remained before the cells were visible in the blood. Finally, we actually could see where the new cells went after they were infused, tracking their settling in various organs and bones. Through this, we could see that cells did not travel directly to all of the bones right away as was previously thought, but rather first went to the liver and spleen, then to the mid-spine (thorax), then to the remainder of the spine and breastplate, and finally to the arms and legs. This pattern of bone marrow development is seen in healthy developing fetuses. In this case, it occurs in a similar pattern in adults undergoing bone marrow transplant.

07 Mar

Posted at 12:28h in Author Interviews, Duke, Heart Disease, JACC
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 Terrace Level, Durham, NC 27705 MedicalResearch.com: What is the background for this study? 1-      Digoxin is used in ≈ 30% of patients with atrial fibrillation (AF) worldwide, despite the lack of randomized clinical trials to assess its efficacy and safety in this setting. 2-      Current AF guidelines recommend digoxin for rate control in patients with AF with and without heart failure (HF). 3-      There are no specific recommendations about serum digoxin concentration monitoring in the atrial fibrillation guidelines.

05 Mar

Posted at 17:45h in Author Interviews, JACC, JAMA, Weight Research
MedicalResearch.com Interview with: “physical-activity-120112-M-2021D-019” by MilitaryHealth is licensed under CC BY 2.0Trine Moholdt, PhD Research Fellow Department of Circulation and Medical Imaging | Exercise, Cardiometabolic Health and Reproduction Norwegian University of Science and Technology MedicalResearch.com: What is the background for this study?   Response: Although obese individuals have an increased risk of cardiovascular disease, evidence from many observational studies shows that in those who already have cardiovascular disease, being overweight or obese is associated with lower risk of mortality compared to their normal weight counterparts. This phenomenon is often called the “obesity paradox”. Recently we observed that in individuals who have a high physical activity level, there is no such obesity paradox and body mass index did not associate with survival time in those who with high physical activity (Moholdt et al, American Journal of Medicine, 2017). 

03 Mar

Posted at 19:36h in Allergies, Author Interviews, Dermatology, JAMA, Stanford, Technology
MedicalResearch.com Interview with: [caption id="attachment_40358" align="alignleft" width="200"]Kavita Sarin, M.D., Ph.D. Dr. Sarin[/caption] Kavita Sarin, M.D., Ph.D. Assistant Professor of Dermatology Stanford University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Drug reactions occur in the majority of patients undergoing cancer therapies. Half of serious drug reactions are detected after market approval which can result in painful complications and interruption in therapy. Post-market drug surveillance platforms such as FDA monitoring rely on medical publications and physician reporting and take time to identify trends. We sought to determine if we could identify trends in patient discussions in internet health forums to more rapidly identify chemotherapeutic drug reactions. We chose skin reactions as a proof-of-principle because patients can more easily describe what they see on their skin. Julia Ransohoff, a medical student, and Azadeh Nikfarham, an informatics postdoctoral fellow trained a computer to recognize when a patient undergoing anti-cancer treatment with PD-1 antagonists or EGFR-inhibitors described a drug reaction in their internet forum posts.

02 Mar

Posted at 17:10h in Author Interviews, JAMA, Occupational Health, PTSD
MedicalResearch.com Interview with: [caption id="attachment_40322" align="alignleft" width="133"]Dr. Lori Davis, MD Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa Tuscaloosa, Alabama Dr. Davis[/caption] Dr. Lori Davis, MD Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa Tuscaloosa, Alabama MedicalResearch.com: What is the background for this study? What are the main findings? Response: Symptoms of posttraumatic stress disorder (PTSD) interfere with a person’s ability to function at work, making it harder to stay employed and establish oneself in a career.  Veterans with PTSD are uniquely challenged given their motivation to serve others, be leaders and not be generally receptive to reaching out for help. Conventional wisdom about PTSD and employment has traditionally been to first commit to treatment, learn coping skills, manage one’s symptoms and then reintegrate into mainstream employment. However, this view is being transformed by our research that suggests a more assertive recovery-oriented approach to the treatment of PTSD that involves returning to meaningful competitive employment as soon as possible. This study compared Evidence-based Supported Employment (also known as Individual Placement and Support or IPS) integrated within PTSD treatment teams to the treatment as usual Transitional Work model offered within the VA. This multisite trial demonstrated significantly greater effectiveness of the IPS-supported employment over stepwise, transitional work vocational rehabilitation for Veterans living with chronic PTSD.

02 Mar

Posted at 13:37h in Author Interviews, ENT, JAMA, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_40303" align="alignleft" width="142"]Boris Paskhover, MD Rutgers New Jersey Medical School Adjunct Instructor,Department of Otolaryngology-Head and Neck Surgery NYU Langone Medical Center Dr. Paskhover[/caption] Boris Paskhover, MD Rutgers New Jersey Medical School Adjunct Instructor,Department of Otolaryngology-Head and Neck Surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Patient's and the general public routinely mention that their nose appears large, especially when they look at photos taken with their phone. I realized that patients in general are taking selfies more often nowadays. In my training, we routinely would tell patient’s not to use selfies as a marker of how they look, and we instead would take a 5ft distance photograph since we knew that is more realistic. I looked through the medical literature, and it appeared to me that no one had thoroughly discussed why selfies are a bad when evaluating the nose. I contacted a colleague at Stanford who has a PhD with interest in computer graphics and we developed a model for the face/nose.

01 Mar

Posted at 12:36h in Author Interviews, Critical Care - Intensive Care - ICUs, NEJM, Vanderbilt
MedicalResearch.com Interview with: [caption id="attachment_40231" align="alignleft" width="150"]Todd W. Rice, MD, MSc Associate Professor of Medicine Director, Vanderbilt University Hospital Medical Intensive Care Unit Division of Allergy, Pulmonary, and Critical Care Medicine Nashville, TN   Dr. Rice[/caption] Todd W. Rice, MD, MSc Associate Professor of Medicine Director, Vanderbilt University Hospital Medical Intensive Care Unit Division of Allergy, Pulmonary, and Critical Care Medicine Nashville, TN   MedicalResearch.com: What is the background for this study? Response: Our study (called the SMART study) evaluates the effects of different types of intravenous fluids used in practice in critically ill patients.  It is very similar to the companion study (called the SALT-ED study and published in the same issue) which compares the effects of different types of intravenous fluids on non-critically ill patients admitted to the hospital.  Saline is the most commonly used intravenous fluid in critically ill patients.  It contains higher levels of sodium and chloride than are present in the human blood.  Balanced fluids contain levels of sodium and chloride closer to those seen in human blood. Large observational studies and studies in animals have suggested that the higher sodium and chloride content in saline may cause or worsen damage to the kidney or cause death.  Only a few large studies have been done in humans and the results are a bit inconclusive.

01 Mar

Posted at 12:29h in Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease, NEJM, Vanderbilt
MedicalResearch.com Interview with: [caption id="attachment_40216" align="alignleft" width="142"]Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN  Dr. Self[/caption] Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Doctors have been giving IV fluids to patients for more than 100 years. The most common IV fluid during this time has been saline; it has high levels of sodium and chloride in it (similar to table salt).  Balanced fluids are an alternative type of IV fluid that has lower levels of sodium and chloride that are more similar to human blood. Our studies were designed to see if treating patients with these balanced fluids resulted in better outcomes than saline.  We found that patients treated with balanced fluids had lower rates of death and kidney damage than patients treated with saline.

28 Feb

Posted at 19:49h in Author Interviews, Cost of Health Care, JAMA, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_40286" align="alignleft" width="201"]Dr. Chris Childers, M.D.  Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 Dr. Childers[/caption] Dr. Chris Childers, M.D. Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 20 million Americans undergo a surgical procedure each year with a price tag over $1 trillion.  The operating room (OR) is a particularly resource dense environment, yet little is known about the actual costs of running an OR.  Most previous efforts focusing on OR costs have come from single-site studies with little detail about the drivers of OR costs. Using financial statements from all California hospitals we estimated that the average cost to the hospital for one minute of OR time was between $36 and $37. Perhaps more notable was the composition of these costs.  Almost two-thirds ($20-21) was attributable to “direct costs” - those generated by the OR itself - including $14 for the wages and benefits of staff, $2.50-3.50 for surgical supplies, and $3 for “other” costs such as equipment repair and depreciation. Interestingly, the remainder ($14-16) was dedicated to “indirect costs” such as the costs associated with hospital security and parking.  While these indirect costs are necessary for a hospital to run, they are not under the purview of the operating room. Finally, we also learned that OR costs have increased quickly over the past 10 years – faster than other sectors of healthcare as well as the rest of the economy.

27 Feb

Posted at 21:08h in Author Interviews, Depression, Heart Disease, JAMA
MedicalResearch.com Interview with: [caption id="attachment_40300" align="alignleft" width="142"]David Bekelman, MD, MPH  Associate Professor of Medicine and Nursing Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, CO University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO Dr. Bekelman[/caption] David Bekelman, MD, MPH  Associate Professor of Medicine and Nursing Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, CO University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many of the 5.8 million Americans with heart failure live with bothersome symptoms, reduced function and poor quality of life.  Improving their care is important because many people with heart failure live with these challenges for years.

This study evaluated the effect of a team intervention, Collaborative Care to Alleviate Symptoms and Adjust to Illness, also called CASA, on several aspects of quality of life in 314 patients with heart failure.  The patients, who received care at diverse health systems in Colorado, were randomized to receive usual care or usual care supplemented with the CASA intervention, which included a nurse and a social worker who collaborated with a primary care provider, cardiologist, and palliative care physician to address the patients’ needs.

The study found that the CASA intervention did not influence the primary outcome of heart failure health status, yet did improve patients’ depression and fatigue.  CASA did not influence number of patient hospitalizations or mortality.

27 Feb

Posted at 17:58h in Author Interviews, Circulation Issues, Clots - Coagulation, JAMA
MedicalResearch.com Interview with: [caption id="attachment_40213" align="alignleft" width="149"]Shyueluen Chang Shyueluen Chang[/caption] Shyueluen Chang MD Phlebologist with Dermatologist background Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital Taoyuan, Taiwan MedicalResearch.com: What is the background for this study?   Response: Varicose veins are common, with about 23 percent of U.S. adults having the condition, but they are rarely thought to be associated with serious health risks. In contrast, venous thrombosis (DVT), pulmonary embolism (PE), and peripheral artery disease (PAD) are also vascular diseases that are associated with serious systemic effects. Not much is known about varicose veins and the risk of other vascular diseases. Elucidating potential associations between varicose veins and health-threatening diseases is important. Partner's note: Understanding the broader impact of vascular diseases can provide valuable insights into the risks associated with varicose veins.

27 Feb

Posted at 15:38h in Author Interviews, End of Life Care, Heart Disease, JAMA, Technology
MedicalResearch.com Interview with: [caption id="attachment_40246" align="alignleft" width="159"]A left ventricular assist device (LVAD) pumping blood from the left ventricle to the aorta, connected to an externally worn control unit and battery pack. Wikipedia image A left ventricular assist device (LVAD) pumping blood from the left ventricle to the aorta, connected to an externally worn control unit and battery pack.
Wikipedia image[/caption] Larry A. Allen, MD, MHS Associate Professor, Medicine Associate Head for Clinical Affairs, Cardiology Medical Director, Advanced Heart Failure Aurora, CO 80045 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Deciding whether or not to get a left ventricular assist device (LVAD) is one of the most challenging medical decisions created by modern medicine. LVADs improve overall survival but also come with serious risks and lifestyle changes. Particularly for older patients with multiple medical problems, this is a complex choice. Our research group at the University of Colorado spent years systematically developing unbiased pamphlet and video decision aids for patients and caregivers. We also developed a clinician-directed decision support training for LVAD program staff. The DECIDE-LVAD trial studied the implementation and effectiveness of this decision support intervention with patients and their caregivers in 6 hospitals in the U.S. When compared to previously used education materials, the decision aids appeared to improve patients’ decision quality and lowered the total number of patients getting LVADs.

26 Feb

Posted at 21:12h in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease
MedicalResearch.com Interview with: [caption id="attachment_40274" align="alignleft" width="143"]Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center Dr. Alban[/caption] Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization. Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care.

26 Feb

Posted at 20:43h in AHA Journals, Author Interviews, Heart Disease, Mediterranean Diet, Nutrition, Vegetarians, Weight Research
MedicalResearch.com Interview with: “Vegetarian dan dan noodles” by Andrea Nguyen is licensed under CC BY 2.0Francesco Sofi, MD PhD Department of Experimental and Clinical Medicine University of Florence, Florence, Italy; Clinical Nutrition Unit, Careggi University Hospital Don Carlo Gnocchi Foundation Italy, Onlus IRCCS Florence, Italy  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mediterranean and Vegetarian diets are two of the most beneficial dietary patterns for prevention of chronic degenerative diseases. No studies have been conducted in the same group of subjects, by comparing these two dietary profiles. Main results are that both diets have been found to be beneficial for cardiovascular prevention, in the same group of subjects at low risk of cardiovascular disease. In particular, vegetarian diet determined a reduction of total and LDL-cholesterol, whereas Mediterranean diet resulted in lower levels of triglycerides and some inflammatory parameters

26 Feb

Posted at 20:13h in Author Interviews, Emergency Care, Heart Disease, JAMA
MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaDaniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California  MedicalResearch.com: What is the background for this study? What are the main findings? Response: When people talk about medical error, they are usually referring to treatment error—giving the wrong medication, operating on the wrong side of the body, etc.  But many believe that diagnostic error—the failure to diagnose a condition when a patient seeks care—is at least as widespread and consequential a problem.  However, diagnostic errors are intrinsically difficult to measure, since one can rarely prove that a condition was present at the time it was not diagnosed. In this study, we introduce a novel method for measuring how often patients who come to the emergency room with symptoms of an imminent cardiovascular emergency such as acute myocardial infarction (heart attack) are discharged home without a diagnosis. We find that among Medicare patients whose ER visits were attributable to symptoms of an imminent infarction, only about 2.3% were discharged home, and that the figure was under 5% for each of the other four conditions we studied.    However, we also found that these relatively low rates did not improve between 2007 and 2014.

26 Feb

Posted at 14:29h in Author Interviews, Cognitive Issues, JAMA, Pediatrics
MedicalResearch.com Interview with: [caption id="attachment_40257" align="alignleft" width="149"]Sabrina Twilhaar, MS, PhD candidate Child Study Group, sectie Klinische Neuropsychologie Vrije Universiteit Amsterdam Sabrina Twilhaar[/caption] Sabrina Twilhaar, MS, PhD candidate Child Study Group, sectie Klinische Neuropsychologie Vrije Universiteit Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings?  Response: It is well-known that preterm birth has negative consequences for cognitive development. During the early 1990s important progress in neonatal health care resulted in a considerable increase in the survival of preterm infants. Earlier meta-analyses showed large differences in intelligence between very preterm and full-term born children. However, these meta-analyses included mostly studies on children born before 1990. Because of the advances in neonatal health care since that time, it was important to update our knowledge on the outcomes of more recently born preterm infants. We combined the results of 71 studies, together including 7752 very preterm and 5155 full-term born children, and found a difference in intelligence between very preterm and full-term children that was still large. Interestingly, despite advancing neonatal health care, we also found no indication of improvement in the cognitive outcomes of very preterm born children during the period from 1990 to 2008. In addition, we searched for factors that increase the risk for poor cognitive outcomes in these children and we found that children with a chronic lung disease that is amongst others caused by mechanical ventilation of the immature lungs are even more at risk for poor cognitive outcomes.

23 Feb

Posted at 20:34h in Author Interviews, HIV, NYU/NYMC, PLoS, Zika
MedicalResearch.com Interview with: [caption id="attachment_40227" align="alignleft" width="300"]Researchers at NYU College of Dentistry are developing a test for Zika virus that uses saliva to identify diagnostic markers of the virus in a fraction of the time of current tests. NYU/Sapna Parikh Researchers at NYU College of Dentistry are developing a test for Zika virus that uses saliva to identify diagnostic markers of the virus in a fraction of the time of current tests.
NYU/Sapna Parikh[/caption] Maite Sabalza Ph.D Post Doctoral Associate Department of Basic Science and Craniofacial Biology College of Dentistry, New York University New York, NY 10010 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: With previous NIH funding we were able to develop an automated “dual assay” (able to detect both host antibodies and viral RNA) for HIV. In relatively short time, we were able to migrate those findings into the new assay for ZIKA Virus.

22 Feb

Posted at 20:54h in Author Interviews, Brigham & Women's - Harvard, JAMA, Ovarian Cancer
MedicalResearch.com Interview with: [caption id="attachment_40206" align="alignleft" width="143"]Michael J. Barry, M.D., Task Force member Director of the Informed Medical Decisions Program Health Decision Sciences Center Massachusetts General Hospital. Professor of Medicine Harvard Medical School and Physician at Massachusetts General Hospital Dr. Barry[/caption] Michael J. Barry, M.D., Task Force member Director of the Informed Medical Decisions Program Health Decision Sciences Center Massachusetts General Hospital. Professor of Medicine Harvard Medical School and Physician at Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Ovarian cancer is the fifth leading cause of cancer death among women in the United States. It is hard to detect, and many women diagnosed with ovarian cancer do not show signs or symptoms early on. As a result, ovarian cancer is often diagnosed at a late stage, when it is hard to treat successfully. The U.S. Preventive Services Task Force looked at the latest evidence to see if screening women who do not have signs or symptoms of ovarian cancer can prevent them from dying of the disease. Unfortunately, we found that screening for ovarian cancer does not decrease the number of women who die, but it does lead to some women having unnecessary surgery to remove their ovaries. As a result, we are recommending against ovarian cancer screening in women who are not at high risk.

22 Feb

Posted at 12:14h in Author Interviews, Hematology, NEJM, Orthopedics, Thromboembolism
MedicalResearch.com Interview with: [caption id="attachment_40142" align="alignleft" width="200"]Dr. David R. Anderson, MD, FRCPC, FACP Faculty of Medicine Dean, Professor Dean, Faculty of Medicine Division of Hematology, Department of Medicine  & Nova Scotia Health Authority Dr. Anderson[/caption] Dr. David R. Anderson, MD, FRCPC, FACP Faculty of Medicine Dean, Professor Dean, Faculty of Medicine Division of Hematology, Department of Medicine & Nova Scotia Health Authority MedicalResearch.com: What is the background for this study? What are the main findings? Response: Blood clots in the lungs (pulmonary embolism) and veins of the legs (deep vein thrombosis) are well recognized complications following total hip and knee arthroplasty surgeries.  Prior to the routine use of antithrombotic prophylaxis, pulmonary embolism was the most common cause of death following these procedures.  Oral anticoagulants such as rivaroxaban are commonly prescribed for the indication of preventing blood clots following total hip or knee arthroplasty.  For maximal benefit these agents are continued following surgery for up to five weeks following total hip arthroplasty and for two weeks following total knee arthroplasty. There is evidence that aspirin has some benefit for the prevention of deep vein thrombosis and pulmonary embolism following total hip or knee arthroplasty.  However there is less evidence for its benefit than for oral anticoagulants.  We reasoned that aspirin would potentially be an attractive alternative for extended out of hospital prophylaxis following total hip or knee arthroplasty for patients who received a short course (5 days )of rivaroxaban following surgery.  Aspirin would be attractive for this indication because of its low cost, ease of use, and low rates of side effects. Our study demonstrated that in a randomized controlled trial involving a large group (over 3400) of patients undergoing total hip or knee arthroplasty that extended therapy with aspirin was comparable to rivaroxaban for the prevention of deep vein thrombosis and pulmonary embolism following surgery.  Low rates of complications (< 1%) were observed with both treatment arms.  We also found that rates of clinically important bleeding complications (the most common side effect with antithrombotic drugs) were uncommon and similar with the two agents.

22 Feb

Posted at 12:08h in Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Mental Health Research
MedicalResearch.com Interview with: “hospital.” by Bethany Satterfield is licensed under CC BY 2.0Mark van den Boogaard, PhD, RN, CCRN Assistant Professor Department of Intensive Care Medicine Radboud University Medical Center Nijmegen Netherlands  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Delirium is affecting many of our intensive care unit (ICU) patients which is impacting their recovery on the short-term as well as on the long-term. Therefore we were very interested to investigate if the use prophylactic haloperidol would be beneficial for the ICU patients. Especially because there were indications that it would be effective in ICU delirium prevention and also because this drug is being used in daily practice to prevent ICU delirium although there is no clear evidence. The overall finding of our large-scale well designed study is that we didn’t find any beneficial effect of prophylactic haloperidol in ICU patients. Moreover, this finding is very consistent over all groups of patients. 

21 Feb

Posted at 21:56h in Author Interviews, Cost of Health Care, Duke, Electronic Records, JAMA
[caption id="attachment_40182" align="alignleft" width="200"]Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University Prof. Barak Richman[/caption] MedicalResearch.com Interview with: Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US not only has the highest health care costs in the world, we have the highest administrative costs in the world. If we can reduce non-value added costs like the ones we document, we can make substantial changes in the affordability of health care without having to resort to more draconian policy solutions. Our paper finds that administrative costs remain high, even after the adoption of electronic health records.  Billing costs, for example, constituted 25.2% of professional revenue for ED departments and 14.5% of revenue for primary care visits.  The other numbers are captured below. [caption id="attachment_40183" align="alignleft" width="680"]Administrative Costs Still High With EHRs Administrative Costs Still High With EHRs[/caption]

21 Feb

Posted at 15:38h in Annals Internal Medicine, Author Interviews, Pain Research, Rheumatology
MedicalResearch.com Interview with: Dr Sarah Kingsbury PhD Osteoarthritis Strategic Lead Deputy Section Head, Musculoskeletal Medicine and Imaging Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds MedicalResearch.com: What is the background for this study? What are the main findings? Response: Osteoarthritis of the hand is a painful and disabling condition, estimated to effect up to 31 per cent of people aged over 70. It can stop people from carrying out everyday activities and can limit their quality of life. The first-line pharmacological treatments for hand osteoarthritis, including paracetamol and non-steroidal anti-inflammatory drugs, are often not effective and are associated with side effects. Doctors have used hydroxychloroquine, an established treatment for rheumatoid arthritis, as an off-label alternative, supported by increasing evidence that inflammation is a factor in osteoarthritis. Until now, there has not been a large-scale study into whether using hydroxychloroquine works. HERO was a 12 month randomised, double-blind, placebo controlled, pragmatic trial, designed with a view to replicate anecdotal reports of hydroxychloroquine use in clinical practice, and  powered to detect a moderate effect equivalent to that for NSAIDs in this population. The study involved 248 patients at 13 NHS hospitals in England: all had the condition for at least 5 years, had changes to the joints in their hands consistent with osteoarthritis and reported moderate to severe pain on at least half of the days in the previous three months to the study commencing. Participants were randomised 1:1 to either hydroxychloroquine or placebo and followed up at 3 monthly intervals for 12 months. The study found that patients initially reported a small reduction in the severity of pain before the improvement plateaued. However, a similar amount of change was seen in both the group receiving hydroxychloroquine medication and the group taking the placebo.

21 Feb

Posted at 14:48h in Alcohol, Author Interviews, Cognitive Issues, Lancet
MedicalResearch.com Interview with: “undefined” by Iñaki Queralt is licensed under CC BY 2.0Michaël Schwarzinger, MD, PhD Translational Health Economics Network (THEN) Paris MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association of heavy drinking with dementia has been known for decades. For instance, there is about no Wernicke–Korsakoff syndrome without heavy drinking and the syndrome was described in 1890. But this type of dementia is very rare. Also, heavy drinking is knowingly associated with multiple risk factors for dementia onset such as hypertension or diabetes. But heavy drinkers generally refuse to participate to cohort studies and declaration of alcohol use among participants is generally biased downward... So the study rationale is very strong, but supporting empirical evidence is quite scarce. This nationwide study included all 31+ million adults discharged from hospitals over 6 years, i.e., 50% of the French population before 65 years old and 80% above that age. Of 1.1+ million adults diagnosed with dementia, one in twenty had an early-onset (before 65 years old). Heavy drinking was recorded in most (56%) early-onset dementia cases: two-third in men; one-third in women. In addition, the association of heavy drinking with dementia goes far beyond 65 years old, both directly (>3 times higher risk for dementia onset after controlling for more than 30 known risk factors for dementia) and indirectly as heavy drinking was associated with all other independent risk factors for dementia onset. Accordingly, heavy drinking had the largest effect on dementia risk of all independent modifiable risk factors such as hypertension or diabetes. The effects were found whatever dementia case definition or population studies.

21 Feb

Posted at 12:35h in Author Interviews, Diabetes, Heart Disease, JACC, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_40110" align="alignleft" width="136"]Dr. Jayan Nagendran MD, PhD, FRCSC Director of Research, Division of Cardiac Surgery Associate Professor, Department of Surgery Division of Cardiac Surgery University of Alberta Dr. Nagendran[/caption] Dr. Jayan Nagendran MD, PhD, FRCSC Director of Research, Division of Cardiac Surgery Associate Professor, Department of Surgery Division of Cardiac Surgery University of Alberta MedicalResearch.com: What is the background for this study? Response: The primary modalities of treatment of symptomatic coronary artery disease (coronary heart disease) are either percutaneous coronary intervention (coronary stunting) or coronary artery bypass grafting surgery. There are well designed clinical trials that guide clinical practice for the treatment of patients with diabetes requiring coronary revascularization and there are trials that examine the best modality of coronary revascularization in patients with left ventricular dysfunction. However, there is a lack of evidence for patients with both diabetes and left ventricular dysfunction. As such, we performed a propensity matched study of patients with diabetes and left ventricular dysfunction undergoing either percutaneous coronary intervention compared to coronary artery bypass grafting surgery. We used our provincial database that captures >100,000 patients undergoing coronary angiography to attain our two cohorts for comparison.

20 Feb

Posted at 12:31h in Accidents & Violence, Author Interviews, JAMA, Pediatrics
MedicalResearch.com Interview with: Guoqing Hu, PhD Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha, Hunan, China    On behalf of the authors MedicalResearch.com: What is the background for this study? What are the main findings? Response: We've known for some time that suffocation is a leading cause of death for American infants - in fact, it is the cause of over 3/4 of the injury deaths to babies under 12 months of age. We've also known that there are strategies, such as "safe sleeping", that can greatly reduce the risk of a baby suffocating to death. The surprise in our study is that the suffocation rate for infants under 12 months of age appears to be increasing in the United States over the past 15 years. More babies are dying from suffocation today than in the 1990s, and that is a significant public health concern. Think about the implications of each one of those deaths to the infant's parents and loved ones. There are few things more devastating than losing a baby to an unintentional, or "accidental" death. There are ways we can prevent unintentional suffocations, and we need to work together to inform parents and ensure babies are kept safe to reduce those deaths, especially as rates in the US appear to be increasing.

19 Feb

Posted at 19:58h in Author Interviews, Diabetes, JAMA, Surgical Research, Weight Research

MedicalResearch.com Interview with: Dr Jérémie Thereauz Praticien Hospitalier Chirurgie viscérale et digestive  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bariatric surgery has been proved to reduce type 2 diabetes in morbid obese patients. However, results of bariatric surgery at a nationwide level are lacking. The aim of our study...