Medical Research Journals
02 May Blood Pressure Medications In Elderly Require Personalized Approach
MedicalResearch.com Interview with: [caption id="attachment_34312" align="alignleft" width="149"]
Dr. Ravindrarajah[/caption]
Dr. Rathi Ravindrarajah PhD
Division of Health and Social Care Research
Faculty of Life Sciences & Medicine
Guy’s Campus
King’s College London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Clinical trials show that it is beneficial to lower systolic blood pressure (SBP) in adults aged 80 and over, but non-randomized epidemiological studies suggest that lower systolic blood pressure may be associated with a higher risk of mortality.
Our main findings were that there was a terminal decline in systolic blood pressure in the final 2 years of life suggesting that the higher mortality in those with a low SBP shown in non-randomized epidemiological studies might be due to reverse causation.
02 May Myocardial Injury Not Uncommon After Non-Cardiac Surgery
MedicalResearch.com Interview with: [caption id="attachment_34286" align="alignleft" width="150"]
Dr. Devereaux[/caption]
Dr. PJ Devereaux MD, PhD, FRCP(C)
Director of the Division of Cardiolog
Scientific Leader of the Anesthesiology, Perioperative Medicine and
Surgical Research Group at the Population Health Research Institute
Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine
McMaster University
MedicalResearch.com: What is the background for this study?
Response: Although the majority of patients undergoing noncardiac surgery benefit from surgery and do well, even when a small proportion of these patients have a serious complication it represents a major population issue. A recent publication in JAMA Cardiology established that >5 million Americans age ≥45 years undergo major in-patient noncardiac surgery annually, and 1.3% of these patients die in the hospital. This means 65,000 of these patients die, and cardiovascular causes are a dominant cause.
01 May Statins Users May Have Higher Likelihood of Back Disorders
MedicalResearch.com Interview with: [caption id="attachment_34240" align="alignleft" width="70"]
Dr. Makris[/caption]
Una Makris MD, MSc
Clinical Investigator at the VA North Texas Health System
VA North Texas Health Care System
Assistant Professor at UT Southwestern Medical Center
Departments on Internal Medicine and Clinical Sciences
Dr. Makris is a Rheumatologist, clinically, and spends the majority of time focused on clinical research investigating how to improve outcomes for adults with back pain.
MedicalResearch.com: What is the background for this study?
Response: Back pain is the most common type of musculoskeletal (MSK) pain. We know that expenditures for back pain exceed $100 billion each year (and this was in 2005). Back pain results in tremendous disability (including reduced mobility) and impaired quality of life (not exclusive to physical consequences, but also including important psychosocial repercussions). We also know that statins are prescribed very often, and frequently in younger populations who are active. Some reports suggest that statins may have a protective effect on musculoskeletal conditions such as back pain.
01 May Pregnant Women Should Have Blood Pressure Screening for Preeclampsia Throughout Pregnancy
MedicalResearch.com Interview with: [caption id="attachment_34274" align="alignleft" width="175"]
Dr. Phipps[/caption]
Dr. Maureen Phipps, USPTS Task Force member
Department chair and Chace-Joukowsky professor of obstetrics and gynecology
Assistant dean for teaching and research on women's health
Warren Alpert Medical School of Brown University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Preeclampsia, which includes high blood pressure after 20 weeks of pregnancy, is one of the most serious health problems affecting pregnant women. After reviewing the evidence, the Task Force found the benefits of screening for preeclampsia outweighed the harms and recommended screening pregnant women for preeclampsia with blood pressure measurements throughout pregnancy. The evidence showed mothers and their babies are likely to benefit from screening, as screening leads to treatment that reduces their risk of severe complications, including death.
01 May ADHD Less Common in Girls, But Has More Serious Consequences
MedicalResearch.com Interview with: [caption id="attachment_34264" align="alignleft" width="120"]
Prof. Pell[/caption]
Professor Jill Pell MD
Director of Institute (Institute of Health and Wellbeing)
Associate (School of Medicine, Dentistry and Nursing)
University of Glasgow
MedicalResearch.com: What is the background for this study?
Response: The novelty of our study lies in its scale and scope. In terms of scope, it reported on six educational outcomes and three health outcomes in the same group of children.
In terms of scale, it is the first study of a whole country to compare educational outcomes of children with treated ADHD with their unaffected peers and is more than 20 times larger than previous studies on similar educational outcomes. The only previous countrywide study on health outcomes, included only children with very severe ADHD who were in psychiatric hospitals.
01 May Age-related Macular Degeneration Underdiagnosed in Primary Care
MedicalResearch.com Interview with: [caption id="attachment_34283" align="alignleft" width="114"]
Dr. Neely[/caption]
David C Neely, MD
The University of Alabama at Birmingham
MedicalResearch.com: What is the background for this study? What are the main
findings?
Response: This study examined the prevalence of eyes with age-related macular degeneration (AMD) in patients seen in primary eye care clinics who purportedly have normal macular health.
Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care providers had macular characteristics that indicated age-related macular degeneration.
30 Apr Rate of Law Enforcement Associated Injuries Has Remained Stable Over Time
Posted at 23:37h
in Accidents & Violence, Author Interviews, JAMA, Mental Health Research, Surgical Research
MedicalResearch.com Interview with:
Elinore J. Kaufman, MD, MSHP
Department of Surgery, New York
Presbyterian Hospital Weill Cornell Medicine
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Deaths of civilians in contact with police have recently gained national public and policy attention. However, we know very little about nonfatal injuries, which far outnumber deaths.
MedicalResearch.com: What should readers take away from your report?
Response: Nonfatal injuries are much more pervasive than law enforcement-associated deaths, and rates have remained stable over several years, at approximately 51,000 emergency department visits and hospitalizations each year.
These injuries primarily affect young men, and mental illness is a common theme. As a physician, my goal is always to get to zero preventable injuries.
27 Apr Noninvasive Patch Test Can Improve Clinical Diagnosis of Melanoma
MedicalResearch.com Interview with: [caption id="attachment_34201" align="alignleft" width="200"]
Dr. Laura K. Ferris[/caption]
Laura Korb Ferris, MD, PhD
Associate Professor, University of Pittsburgh Clinical and Translational Science Institute
Director of Clinical Trials
Department of Dermatology
University of Pittsburgh Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We found that a non-invasive adhesive patch applied to the skin over a pigmented skin lesion allowed us to capture enough genetic material from the lesion to analyze and predict if that lesion is likely to be melanoma, meaning a biopsy is warranted, or if it is likely benign, meaning the patient would not need a skin biopsy.
In this study, we asked dermatologists to use their clinical judgement to decide if they would recommend biopsying a skin lesion based on photos and information about the lesion and the patients, such as the patient's age, personal and family history of skin cancer, and if the lesion was new or changing. We then provided them the read out of the gene test and asked them how this influence their decision. We found that with this test result, dermatologists were more accurate in their decision making, meaning they were more likely to recommend biopsy of melanomas and less likely to biopsy harmless moles than they were without the test. This is important as it means this test has the potential to reduce the number of unnecessary skin biopsies performed, saving patients from undergoing a procedure and having a scar as a result, without increasing the risk of missing a melanoma.
27 Apr New Marijuana Laws Associated With Increase in Cannabis-Related Health Problems
MedicalResearch.com Interview with: [caption id="attachment_34181" align="alignleft" width="165"]
Dr. Hasin[/caption]
Deborah S. Hasin, Ph.D.
Professor of Epidemiology
Columbia University
New York, New York 10032
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Among adults, the prevalence of cannabis use and cannabis use disorders has increased in recent years. Concerns have been raised that for various reasons, medical marijuana laws would promote use of cannabis and consequently, cannabis-related consequences.
Many studies show that this didn't happen among adolescents, but very little was known about the relationship between medical marijuana laws and adults. Using data from three surveys spanning the years 1991-2013, the study findings suggested that medical marijuana laws did play a role in increasing rates of cannabis use and cannabis use disorders.
26 Apr Over 50? Exercise Linked To Improved Cognitive Function
MedicalResearch.com Interview with: Dr. Joseph Michael Northey UC Research Institute for Sport and Exercise (UCRISE), Discipline of Sport and Exercise Science, Faculty of Health University of Canberra, Canberra, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Physical exercise has an important role to play in maintaining cognitive function across the lifecycle. However, the benefits of implementing a physical exercise intervention were not clear. To address these issues which prevented evidence-based prescription of exercise for cognitive function, a systematic review of all the available literature up to November of 2016 in adults older than 50 was conducted.25 Apr Community Targeting of High Risk Minority Males Improves HIV Detection and Treatment
MedicalResearch.com Interview with: [caption id="attachment_34177" align="alignleft" width="200"]
Dr. Miller[/caption]
Robin Lin Miller, Ph.D.
Professor, Ecological-Community Psychology
Co-Director, MA in Program Evaluation
Chair, Graduate Program in Ecological-Community Psychology
Michigan State University
East Lansing, MI 48824
MedicalResearch.com: What is the background for this study?
Response: We wanted to identify promising strategies for providing access to HIV-testing for gay and bisexual male youth. We were especially interested in testing strategies to reach gay and bisexual male youth of color, as they bear a disproportionate burden of the HIV epidemic and are the least likely to be aware of their HIV status. We also wanted to explore approaches to successfully link these youth with HIV-negative test results to diverse HIV prevention services, including pre-exposure prophylaxis, when warranted.
Although some argue that the ideal place to test adolescents and young adults is via emergency rooms and in routine medical care visits, we found that we were able test many more youth with previously undiagnosed HIV-infection through intensive, targeted community outreach efforts. We also tested a much higher proportion of young men of color through targeted outreach.
25 Apr Use of HEART Score in ER Can Help Evaluate Low Risk Chest Pain
MedicalResearch.com Interview with: [caption id="attachment_34167" align="alignleft" width="180"]
Dr.Poldervaart[/caption]
Judith Poldervaart MD, PhD
Assistant professor
Julius Center for Health Sciences and Primary Care
University Medical Center
Utrecht
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Since its development in 2008, interest in the HEART score is increasing and several research groups around the world have been publishing on the HEART score. After validation of any risk score for cardiac events, there is a concern about the safety when used in daily practice.
We were able to show the HEART score is just as safe as the usual care currently used at EDs, which has not been shown yet in previous research. That we did not find a decrease in costs, is probably due to the hesitance of physicians to discharge low-risk patients from the ED without further testing. But extrapolation of the findings of a cost-effectiveness analysis (including nonadherence) suggests that HEART care could lead to annual savings of €40 million in the Netherlands. Hopefully, in time (and more publications of the HEART score now appearing almost weekly from all over the world) this effect on use of health care resources will become more apparent.
25 Apr Submission and Publication Bias Against Studies With Negative Results Declining
MedicalResearch.com Interview with: Gary Evoniuk, PhD Director of Publication Practices, Medical Communications Quality & Practices GlaxoSmithKline Research and Development, Research Triangle Park, NC 27709 MedicalResearch.com: What is the background for this study? Response: In recent years, industry, and to a lesser extent academia, have been criticised for failing to submit clinical trial data for publication, especially when the data are perceived to be “negative”, (i.e. unfavourable to the drug under study) leading to publication bias. We felt it was important to determine whether this criticism is based on perception or reality and so we conducted what is, to our knowledge the only study to systematically address the issue of submission and publication bias based on study outcome.25 Apr Heart Rate Variability on Holter Monitor Linked To CHF
MedicalResearch.com Interview with Phyllis K. Stein, PhD Division of Hospital Medicine Washington University School of Medicine St. Louis, Missouri MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was based on results from the Cardiovascular Health Study (CHS) which was designed to be a prospective study of risk factors for cardiovascular disease and stroke in community-dwelling older adults. Of this cohort, about ¼ volunteered to have Holter recordings. They form the basis of our study. All participants were carefully followed and all outcomes fully adjudicated. Thus, we were able to add the Holter findings to the existing Health ABC study and determine whether they added to a validated risk score.25 Apr Xpert HCV Viral Load Test Can Detect Active Hepatitis C Infection From Fingerstick
MedicalResearch.com Interview with: [caption id="attachment_34147" align="alignleft" width="200"]
Dr. Grebely[/caption]
Jason Grebely PhD
Associate Professor
Senior Research Fellow (UNSW)
Viral Hepatitis Clinical Research Program
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Globally, testing and diagnosis of hepatitis C virus infection remain low. Although point of care tests for HCV infection exist, but many of these tests only measure HCV antibodies (previous exposure), not HCV RNA (active infection). Given that 25% of individuals spontaneously clear HCV infection, efforts to enhance diagnosis of chronic HCV infection and improve the HCV care cascade requires enhanced uptake of HCV RNA testing.
We conducted the first evaluation of the Xpert HCV Viral Load test (manufactured by Cepheid) - a point-of-care hepatitis C virus test that can detect active infection - from a finger-stick sample of blood. We established that there is good sensitivity and specificity of the Xpert HCV Viral Load point-of-care test using blood samples collected by finger-stick in participants attending drug health and homelessness services in Australia.
25 Apr Loss of a Sibling In Childhood Increases Short and Long Term Mortality
MedicalResearch.com Interview with: [caption id="attachment_34053" align="alignleft" width="200"]
Dr. Yong Yu[/caption]
Dr. Yongfu Yu, PhD
Department of Clinical Epidemiology
Aarhus University Hospital
Aarhus, Denmark
MedicalResearch.com: What is the background for this study?
Response: Bereavement by the death of a close relative is ranked as one of the most severe life events and it is likely to cause psychological stress regardless of coping mechanisms. An increased risk of mortality and adverse health outcomes has been observed among the bereaved spouses, parents, and children. It is estimated that nearly 8% of individuals in the US experienced a sibling death in childhood but much less is known about its health consequences. Sibling relationship tends to be the longest and the most intimate in family thus the death of a sibling can be a devastating life event, especially when this event happens at early ages. However, to our knowledge, no study has investigated the effects of sibling death in childhood on subsequent mortality in bereaved siblings with a long follow-up time.
24 Apr USPSTF Recommends Men 70 or Older Not Be Screened for Prostate Cancer
MedicalResearch.com Interview with: [caption id="attachment_34129" align="alignleft" width="154"]
Dr. Bibbins-Domingo[/caption]
Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S.
Lee Goldman, MD, endowed chair in medicine and professor of medicine and of epidemiology and biostatistics
University of California, San Francisco
Chair of the U.S. Preventive Services Task Force
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prostate cancer is one of the most common cancers to affect men, and the Task Force believes all men should be aware of the benefits and harms of screening for prostate cancer. Prostate cancer screening with PSA testing can help men reduce their chance of dying of prostate cancer or of having metastatic cancer. These are important benefits but occur in a small number of men. There are risks associated with screening, specifically overdiagnosis and overtreatment with surgery and radiation that can have important side effects like impotence and incontinence.
Since the release of our 2012 recommendation, new evidence has emerged that increased the Task Force’s confidence in the benefits of screening, which include reducing the risk of metastatic cancer (a cancer that spreads) and reducing the chance of dying from prostate cancer. This draft recommendation also reflects new evidence on the use of active surveillance in men with low-risk prostate cancers that may help mitigate some of the harms in these men by allowing some men with low risk cancer to delay or avoid surgery or radiation. Therefore, in our new 2017 draft recommendation, the Task Force encourages men ages 55 to 69 to make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms. For men age 70 years and older, the potential benefits do not outweigh the harms, and these men should not be screened for prostate cancer.
24 Apr Study Compares Appendectomy Outcomes Between General Surgeons and Surgical Residents
MedicalResearch.com Interview with: Haggi Mazeh, MD, FACS Endocrine and General Surgery Department of Surgery Hadassah-Hebrew University Medical Center, Mount Scopus Jerusalem, Israel 91240 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The level of operating room autonomy given to surgical residents varies greatly between different institutions and different countries. On one hand, providing residents the opportunity to operate alone augments their confidence and their sense of responsibility, possibly accelerating their learning process. On the other hand, it may be argued that the presence of a senior general surgeon in every operation is a safer approach. Before 2012, a large proportion of appendectomies at our institution were performed by surgical residents alone. After 2012, our institutional policy changed to require the presence of a senior general surgeon in every appendectomy case. This unique situation provided us the opportunity to compare the outcomes of appendectomies performed by residents alone to those performed in the presence of a senior general surgeon. Our study demonstrated no difference in the complication rates between the two groups of patients. However, surgeries performed in the presence of senior general surgeons were significantly shorter than those performed by residents.22 Apr Outbreak of Severe Fungal Eye Infections Linked To IV Opioid Epidemic
MedicalResearch.com Interview with: Aubrey Tirpack, PGY3 New England Eye Center Tufts Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Intravenous drug abuse is a known risk factor for the development of endogenous fungal endophthalmitis (EFE), a severe intraocular infection cause by the seeding of mycotic organisms to the eye. Our institution noted a marked increase in cases of EFE beginning in May 2014, which correlates to increasing rates of opioid abuse throughout the New England region. Ten patients were found to have intravenous drug abuse related EFE over the two year time period studied. The most common presenting symptoms were floaters, decreased vision, and pain. All patients were treated with systemic antifungals and nine patients underwent intravitreal antifungal injection. All patients were ambulatory at presentation and the majority were without systemic signs of infection.22 Apr Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults
Posted at 15:21h
in Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Pediatrics
MedicalResearch.com Interview with:
Charlotte Björkenstam PhD
Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.
We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.
21 Apr No Magic Age To Stop Performing Screening Mammograms
MedicalResearch.com Interview with: Cindy S. Lee, MD Department of Radiology and Biomedical Imaging University of California, San Francisco, San Francisco Now with Department of Radiology NYU Langone Medical Center, Garden City, New York MedicalResearch.com: What led you and colleagues to conduct this study? Response: I am a breast imager. I see patients who come in for their screening mammograms and I get asked, a lot, if patients aged 75 years and older should continue screening, because of their age. There is not enough evidence out there to determine how breast cancer screening benefits women older than 75. In fact, all previously randomized trials of screening mammography excluded people older than 75 years. Unfortunately, age is the biggest risk factor for breast cancer, so as patients get older, they have higher risks of developing breast cancer. It is therefore important to know how well screening mammography works in these patients.20 Apr Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Uveitis
MedicalResearch.com Interview with: Andrew Dick FRSB FMedSci Professor of Ophthalmology Bristol Eye Hospital, University of Bristol, Bristol, England National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, Institute of Ophthalmology, University College London, London, England and John Sheppard, MD President, Virginia Eye Consultants Professor of Ophthalmology, Eastern Virginia Medical School MedicalResearch.com: What should readers take away from your report? Dr. Andrew Dick: These findings demonstrate that adalimumab is associated with clinically meaningful improvements in visual functioning for patients with non-infectious intermediate uveitis, posterior uveitis, and panuveitis. The emphasis of this work is that for the first time in uveitis we have seen patient reported outcome benefit of a biologic treatment. This analysis supports the use of adalimumab as a promising new treatment option, having demonstrated improvements in both clinical and visual functioning outcomes in patients with active and inactive uveitis. Dr. John Sheppard: Uveitis has a substantial effect on individuals’ physical, professional, psychological, avocational and social functioning in day-to-day life. Adalimumab, an anti-inflammatory drug that binds to tumor necrosis factor, was recently approved for the treatment of non-infectious intermediate uveitis, posterior uveitis, and panuveitis. It is the first systemic therapy specifically approved for uveitis. The analyses in this study provide evidence that patients with noninfectious uveitis treated with adalimumab experience significant and clinically meaningful improvements in vision-related quality of life, compared with those who received placebo.20 Apr Men and African Americans More Likely To Transition to Hypertension At Younger Age
Posted at 15:56h
in Author Interviews, Blood Pressure - Hypertension, Gender Differences, JAMA, Race/Ethnic Diversity
MedicalResearch.com Interview with:
[caption id="attachment_33996" align="alignleft" width="150"]
Dr. Hardy[/caption]
Shakia Hardy, MPH, CPH. PhD
Department of Epidemiology
The University of North Carolina at Chapel Hill
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous studies characterizing blood pressure levels across the life course have relied on prevalence estimates at a given age.
Our study was interested in identifying critical ages at which net transitions between levels of blood pressure occurred. We used data from the National Health and Nutrition Examination Survey (2007-2012) to estimate age-, race-, and sex-specific annual net transition probabilities between ideal blood pressure, prehypertension and hypertension.
We found that African Americans and men were more likely to transition from ideal levels of blood pressure in childhood or early adulthood compared to white Americans and women, which puts them at increased risk of developing prehypertension and hypertension earlier in life.
20 Apr Frequency of Retinal Screening in Diabetes May Be Tailored to Individual
MedicalResearch.com Interview with: John M. Lachin, Sc.D. Research Professor of Biostatistics and of Epidemiology, and of Statistics The George Washington University Biostatistics Center and David Matthew Nathan, M.D. Professor of Medicine, Diabetes Unit Massachusetts General Hospital MedicalResearch.com: What is the background for this study? Response: Traditional guidelines for screening for retinopathy, based on indirect evidence, call for annual examinations. The automatic annual screening for retinopathy, without considering potential risk factors for progression, appears excessive based on the slow rate of progression through sub-clinical states of retinopathy.20 Apr More Work Needed To Ensure Compliance With High Intensity Statins After Heart Attack
MedicalResearch.com Interview with: [caption id="attachment_33991" align="alignleft" width="130"]
Dr. Rosenson[/caption]
Robert Rosenson, MD
Professor of Medicine and Cardiology
Icahn School of Medicine at Mount Sinai
New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: High intensity statin therapy is underutilized in patients with acute coronary syndromes. In 2011, 27% of patients were discharged on a high intensity statin (Rosenson RS, et al. J Am Coll Cardiol).
In this report, we investigate the factors associated with high adherence to high intensity statin. High adherence to high intensity statins was more common among patients who took high intensity statin prior to their hospitalization, had fewer comorbidities, received a low-income subsidy, attended cardiac rehabilitation and more visits with a cardiologist.
20 Apr Some Breast Cancer Patients With Complete Response To Neoadjuvant Therapy Can Avoid Further Surgery
Posted at 00:20h
in Author Interviews, Breast Cancer, Chemotherapy, JAMA, MD Anderson, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_33987" align="alignleft" width="136"]
Dr. Tadros[/caption]
Audree Tadros, MD, MPH
Chief Administrative Fellow, Breast Surgical Oncology Training Program
Department of Breast Surgical Oncology
MD Anderson Cancer Center and
[caption id="attachment_33988" align="alignleft" width="120"]
Dr. Kuerer[/caption]
Henry M. Kuerer, MD, PhD, FACS
Executive Director, Breast Programs
MD Anderson Cancer Network
PH and Fay Etta Robinson Distinguished Professor in Cancer Research
Dept of Breast Surgical Oncology
Director, Breast Surgical Oncology Training Program
MedicalResearch.com: What is the background for this study?
Response: Neoadjuvant chemotherapy (NCT) has the ability to confer a pCR (pathologic complete response-when no residual cancer is found) in both the breast and axillary lymph nodes. We know that this is most likely to occur in women with HER2 positive and triple negative disease. The high rate of pCR among these patients raises the question of whether surgery is still required, particularly among those who will receive adjuvant radiation therapy.
Until recently, we lacked the ability to pre-operatively predict patients who achieved a breast pCR. Recently, we completed a clinical feasibility trial examining the ability of image-guided biopsy to predict a pCR after neoadjuvant chemotherapy. Our biopsy technique was able to accurately predict a pCR in 98% of patients with only a 5% false negative rate. Based upon these findings, we believe we can accurately determine which patients achieve a breast pCR. This led us to develop a clinical trial to see if breast surgery is redundant in patients who achieve a pCR. An important question that remained was if we are going to omit breast surgery in these exceptional responders, can we also omit axillary surgery?
19 Apr Rapid Rule-Out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement
MedicalResearch.com Interview with: Martin P. Than, MBBS Emergency Department, Christchurch Hospital and Dr John W Pickering, PhD Associate Professor Senior Research Fellow in Acute Care Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board | Christchurch Hospital Research Associate Professor | Department of Medicine | University of Otago Christchurch New Zealand MedicalResearch.com: What is the background for this study? Response: Patients being investigated for possible acute coronary syndrome comprise one of the largest groups of patients presenting to emergency rooms. Troponin assays have developed such that they can now measure with greater accuracy much lower concentrations of troponin. A large retrospective registry based study and a couple of smaller prospective studies suggested that patients with a very low concentrations of troponin T (below the current limit of detection of 5 ng/L) measured with Roche Diagnostic’s high-sensitivity troponin T (hsTnT) assay on presentation to the emergency department (ie single blood draw) are very unlikely to be having a myocardial infarction (MI). Our study gathers the current best evidence for using concentrations below the limit of detection in conjunction with no evidence of new ischaemia on ECG to safely risk stratify patients to a very low-risk group for MI and, therefore, potentially identify patients safe for early discharge.19 Apr Cardiac Magnetic Resonance Can Exclude Clinically Relevant Coronary Artery Disease
MedicalResearch.com Interview with: [caption id="attachment_34037" align="alignleft" width="132"]
Pr. Schwitter[/caption]
Pr. Juerg Schwitter MD
Médecin Chef Cardiologie
Directeur du Centre de la RM Cardiaque du CHUV
Centre Hospitalier Universitaire Vaudois - CHUV
Suisse
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Coronary artery disease (CAD) is still one of the leading causes of death in the industrialized world and as such, it is also an important cost driver in the health care systems of most countries. For the European Union, the estimated costs for CAD management were 60 billion Euros in 2009, of which approximately 20 billion Euros were attributed to direct health care costs (1). In 2015, the total costs of CAD management in the United States were estimated to be 47 billion dollars (2).
Substantial progress has been achieved regarding the treatment of CAD including drug treatment but also revascularizations procedures. There exists a large body of evidence demonstrating myocardial ischemia as one of the most important factors determining the patient’s prognosis and reduction of ischemia has been shown to improve outcome.
On the other hand, techniques to detect CAD, i.e. relevant myocardial ischemia, were insufficient in the past. Evaluation of myocardial perfusion by first-pass perfusion cardiac magnetic resonance (CMR) is now closing this gap (3) and CMR is recommended by most international guidelines for the work-up of known or suspected CAD (4,5).
Still, a major issue was not clarified until now, i.e. “how much ischemia is required to trigger revascularization procedures”. Thus, this large study was undertaken to assess at which level of ischemia burden, patients can be safely deferred from revascularization and can be managed by risk factor treatment only. Of note, this crucial question was addressed in both, patients with suspected CAD but also in patients with known (and sometimes already advanced) CAD, thereby answering this question in the setting of daily clinical practice.