Author Interviews, Heart Disease, NEJM, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Dr. Kaare Harald Bønaa Principal investigator University of Tromsø, Norway MedicalResearch.com: What is the background for this study? Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known. Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Jason H. Wasfy, MD, MPhil Assistant Medical Director, Massachusetts General Physicians Organization Director of Quality and Analytics Massachusetts General Hospital Heart Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Surgical Research / 30.08.2016

MedicalResearch.com Interview with: Gennaro Giustino MD Resident Physician - Department of Medicine The Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: A period of dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The pathophysiological rationale for DAPT after DES-PCI is predicated on the need to prevent stent-related thrombotic complications while vascular healing and platform endothelialization are ongoing, a process that seems to last between 1 and 6 months with new-generation DES. Whether to extend DAPT after this mandatory period in order to provide a broader atherothrombotic risk protection (for stent-related and non-stent-related atherothrombotic events) is currently a matter of debate. Current guidelines recommend at least 6 months of DAPT after PCI in patients with stable coronary artery disease (CAD) and at least 12 months of DAPT in patients presenting with acute coronary syndrome (ACS). While, several risk scores have been developed to guide clinical decision making for DAPT intensity and duration (namely the DAPT score and the PARIS risk scores) little attention has been payed so far to PCI complexity and the extent of CAD to guide duration of DAPT. In fact irrespective of clinical presentation, patients undergoing more complex PCI procedure (likely due to greater coronary atherosclerotic burden) may remain at greater risk for ischemic events and therefore may benefit of prolonged, or more intense, DAPT. (more…)
Author Interviews, Breast Cancer, Cancer Research, Cost of Health Care, Sloan Kettering, Surgical Research / 18.08.2016

MedicalResearch.com Interview with: Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan-Kettering Cancer Center MedicalResearch.com: What is the background for this study? Response: DCIS, ductal carcinoma in situ, intraductal cancer or Stage 0 cancer refers to what some people call the earliest form of cancer we can find and others term “precancerous”. This difference in terms is due to the fact that DCIS lacks the ability to spread to other parts of the body, a fundamental characteristic of cancer. The goal of treatment in DCIS is to prevent progression to invasive cancer which has the ability to spread. DCIS accounted for only 2-3 % of breast cancers seen in the pre-screening mammography era, but it comprises 25-30% of the malignancies detected in screening mammography programs. For this reason it is uncommon in women under age 40, and more commonly seen in women over 50 years of age. Approximately 70% of the women in the US diagnosed with DCIS are treated with lumpectomy (removal of the DCIS and a margin of surrounding normal breast tissue), and additional surgeries to obtain clear, or more widely clear, margins are done in approximately 30% of women. For this reason, the Society of Surgical Oncology, the American Society for Therapeutic Radiation Oncology, and the American Society of Clinical Oncology undertook the development of an evidence based guideline to determine the optimal clear margin for women with DCIS treated with lumpectomy and whole breast radiotherapy. (more…)
Author Interviews, PAD, Surgical Research / 18.08.2016

MedicalResearch.com Interview with: George Adams, M.D., M.H.S., F.A.C.C., F.S.C.A.I. Director of Cardiovascular and Peripheral Vascular Research Rex Hospital Raleigh, North Carolina Summary: The early findings of a novel all-comers PAD study (LIBERTY 360°) suggest that ‘watchful waiting’ in Rutherford class 2-3 and ‘primary amputation’ in Rutherford class 6 may not be necessary. Peripheral vascular intervention can be successful in these patient populations as well. MedicalResearch.com: What is the background for this study? Response: Approximately 18 million Americans have peripheral artery disease (PAD), and 2 million of these patients suffer from critical limb ischemia (CLI)1,2, the end stage of PAD3. CLI is highly prevalent in older patients with diabetes and/or end-stage renal disease4, and is associated with high risk of amputation and mortality5. Briefly, the LIBERTY 360° study6 is a prospective, observational, multi-center study with liberal inclusion criteria and few exclusions, meant to evaluate procedural and long-term clinical and economic outcomes of endovascular device interventions in patients with symptomatic lower extremity PAD, including CLI. The study included any FDA-approved technology to treat claudication and CLI. Four core laboratories were utilized for independent analysis. (more…)
Author Interviews, NEJM, Neurological Disorders, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: Gil I. Wolfe, MD, FAAN Irvin and Rosemary Smith Professor and Chair Dept. of Neurology/Jacobs Neurological Institute Univ. at Buffalo Jacobs School of Medicine and Biomedical Sciences/SUNY Buffalo General Medical Center Buffalo, NY 14203-1126 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thymectomy has been used in myasthenia gravis (MG), in particular those patients who do not have a tumor of the thymus gland, known as a thymoma, for over 75 years without randomized data to support its use. A practice parameter in 2000 on behalf of the American Academy of Neurology stated that the benefits of thymectomy in this population of non-thymomatou smyasthenia gravis patients remained uncertain, classified thymectomy as a treatment option in this group, and called for rigorous, randomized studies. What we found is that compared to an identical prednisone protocol alone, that extended transsternal thymectomy confers significant benefits to non-thymomatous MG patients over a period of three years after the procedure. The benefits include better disease status, reduced prednisone requirements, fewer hospitalizations to manage myasthenia gravis worsenings, and a lower symptom profile related to side effects from medications used to control the disease state. (more…)
Author Interviews, Heart Disease, Surgical Research, Weight Research / 12.08.2016

MedicalResearch.com Interview with: Dr. Michelle R. Lent, PhD Geisinger Obesity Institute Geisinger Clinic Danville, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than one-third of adults in the United States live with obesity. Currently, the most effective treatment for obesity is bariatric surgery. Bariatric surgery patients are expected to lose 30 to 40 percent of their body weight, but not all patients are able to lose this amount of weight and others experience weight regain. Why some patients succeed in weight loss over time, while others are less successful, remains unclear. In this study, we evaluated over 200 patient characteristics in relation to long-term weight loss after bariatric surgery (7 years or longer), including gender, age and weight at the time of surgery, lab tests, medical conditions and medications, among others. We found that patients who used insulin, had a history of smoking, or used 12 or more medications before surgery lost the most weight, while patients with high cholesterol, older patients and patients with higher body mass indexes at the time of surgery lost the least amount of weight after surgery. (more…)
Author Interviews, Heart Disease, JACC, Stroke, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future. While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR. (more…)
Anemia, Author Interviews, Hematology, Lancet, Surgical Research / 06.08.2016

MedicalResearch.com Interview with: Clinical Professor Alhossain A.Khalafallah Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Senior Staff Specialist Launceston General Hospital, Australia MedicalResearch.com: What is the background for this study? Response: 1. Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting up to one third of the population worldwide. 2. Prevalence of anaemia in orthopaedic surgery ranges between 10-20% with the main cause of anaemia identified as nutritional deficiency. 3. New intravenous iron preparations have been developed at a higher purchase price than oral iron. Iron carboxymaltose, as one example, remains underutilised in the treatment of perioperative anaemia. 4. To our knowledge, this study is the first to compare the efficacy, safety and long term effect on iron stores and length of hospital stay in the postoperative anaemia setting. (more…)
Author Interviews, OBGYNE, Science, Surgical Research / 05.08.2016

MedicalResearch.com Interview with: Dr David A MacIntyre MRC Career Development Fellow Lecturer in Reproductive Systems Medicine Institute of Reproductive and Developmental Biology Department of Surgery and Cancer Imperial College London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread - around 5mm thick - that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread - called multifilament - is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner 'fishing line' thread, while the other half had the thicker 'shoe lace' thread. The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape - 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research / 28.07.2016

MedicalResearch.com Interview with: Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance. In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either 1) reducing their mortality, 2) reducing their patients’ comorbidities and complications, or 3) sending their patients to non-safety-net hospitals for their surgery. While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy. (more…)
Author Interviews, Outcomes & Safety, Prostate Cancer, Surgical Research / 27.07.2016

MedicalResearch.com Interview with: Prof Robert A Gardiner AM The University of Queensland Centre for Clinical Research Royal Brisbane & Women’s Hospital, Herston Brisbane,Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to determine whether one approach gave better results than the other at 12 weeks and 24 months after surgery with respect to the quality of life outcomes of urinary, sexual and bowel function and return to usual activities as well as oncological outcomes. There was no significant statistical difference between the robotic and open surgical approach for these parameters at the early time-point of 12 weeks follow-up. (more…)
Author Interviews, Gastrointestinal Disease, Lancet, Surgical Research / 27.07.2016

MedicalResearch.com Interview with: Mr Steven Brown MBChB, BMedSci, FRCS, MD Reader in Surgery Honorary Secretary to the ACPGBI Consultant colorectal surgeon University of Sheffield, UK MedicalResearch.com: What is the background for this study? Response: Haemorrhoids are common. One in 4 of us will at some time have symptoms that can be directly attributed to piles. Whilst most symptoms will settle spontaneously or with improvement to our lifestyle, there remains a large group of patients who require intervention to reduce symptomatology. Numerous interventions exist ranging from relatively minor office therapy to procedures that may take several weeks to recover from. Haemorrhoidal artery ligation (HAL) is one of the more recent surgical operations for haemorrhoidal therapy. It has been introduced certainly into the UK associated with a significant element of media hype purporting ‘painless surgery for piles’. Substantial subsequent medical literature has also suggested an efficacy rivaling other more invasive procedures. Too good to be true? Perhaps. Several systematic reviews have highlighted the lack of good quality data as evidence for the advantages of the technique. A well designed randomized controlled trial was required. The existing literature on haemorrhoidal artery ligation at the time of the trial suggested the procedure was most effective for less symptomatic haemorrhoids (those that are associated with bleeding and/or minor prolapse; grade II or mild III piles). These type of haemorrhoids also tend to be the most common requiring intervention. The most frequently used alternative procedure for these grade of haemorrhoids in the UK is rubber band ligation (RBL), a simple office therapy not requiring anaesthetic. Hence participants with this grade of haemorrhoids were chosen as the participants with RBL as the comparator. Multiple outcomes were investigated but a patient reported outcome measure of recurrence was chosen as the primary outcome. (more…)
Author Interviews, Genetic Research, JAMA, Pediatrics, Surgical Research / 26.07.2016

MedicalResearch.com Interview with: Dr. Katherine Nelson MD Staff Paediatrician with the Paediatric Advanced Care Team at SickKids and PhD student University of Toronto MedicalResearch.com: What is the background for this study? Response: Trisomy 13 and 18 are rare genetic conditions that cause problems in multiple organ systems, including heart defects and severe neurologic impairment. A majority of children with trisomy 13 and 18 die in the first days to weeks after birth, though a small number survive beyond one year. For years, health care providers have debated the effectiveness and ethics of surgical interventions in these populations. (more…)
Accidents & Violence, Author Interviews, Surgical Research / 25.07.2016

MedicalResearch.com Interview with: Joshua Brown, M.D., M.S., research fellow Division of Trauma and General Surgery University of Pittsburgh School of Medicine MedicalResearch.com: What is the background for this study? Response: A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the U.S., the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest). We examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. We compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate. (more…)
Author Interviews, JAMA, Surgical Research / 21.07.2016

MedicalResearch.com Interview with: Dr. David A. Hyman, MD Division of Otolaryngology–Head and Neck Surgery Department of Surgery University of Wisconsin School of Medicine and Public Health Madison MedicalResearch.com: What is the background for this study? What are the main findings? Response: Motor vehicle collisions represent a significant source of facial fractures seen at US trauma centers. In the last few decades there have been significant advances in airbag technology as well as a national legislative push regarding seat belt use which has led to increased safety device use. With these trends, we sought to assess the incidence of facial fractures in patients who present to US trauma centers as well as to analyze what effect restraint devices have on the likelihood of facial fractures after motor vehicle collisions. This analysis was performed using National Trauma Data Bank data from 2007-2012. We found the incidence of at least one facial fracture after a motor vehicle collision was 10.9% with nasal fracture being the most common facial fracture. Based on our analysis of more than 56 thousand patients with a facial fracture, we found that use of an airbag alone reduced the likelihood of a facial fracture by 18% while use of a seat belt alone reduced likelihood by 43%. Use of both reduced the likelihood of facial fractures in a crash by 53%. Younger age, male sex, and use of alcohol increased the likelihood of facial fracture. (more…)
Author Interviews, Geriatrics, JAMA, Surgical Research / 15.07.2016

MedicalResearch.com Interview with: Julia Berian, MD, MS ACS Clinical Research Scholar American College of Surgeons Chicago, IL 60611 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The US population is rapidly aging and older adults consume a disproportionate share of operations. Older adults experience a high rate of postoperative complications, which can affect quality of life. In this study, function, mobility and living situation are considered together as independent living. The study examined a large surgical database for the occurrence of loss of independence (defined as a decline in function or mobility, or increased care needs in one's living situation) and its relationship to traditional outcomes such as readmission and death after the time of discharge. Patients included in the study were age 65 or older and underwent an inpatient surgical operation. Loss of independence was assessed at the time of discharge. Readmission and death-after-discharge were assessed up to 30 days postoperatively. (more…)
Author Interviews, Surgical Research / 05.07.2016

MedicalResearch.com Interview with: Stephen Ferzoco, MD, FACS Chief of General Surgery Atrius Health in Boston MedicalResearch.com Editor's Note: Dr. Stephen Ferzoco, a prominent active, academic surgeon, discusses the complexities of surgery for hernia repair. MedicalResearch.com: What is the background for this surgery? How many patients are affected by clinically significant hernias? Response: A hernia is a common condition where soft tissue breaches a weak spot in the abdominal wall. Hernias can affect the abdomen (ventral) or the groin (inguinal). In the U.S. there are about 350,000 ventral hernia procedures each year; these hernia patients present a range of complexity to the surgeon, with some of these procedures being among the most difficult cases for surgeons to manage. Inguinal hernias are even more common, with about 750,000 total procedures performed in the U.S. each year. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, MRI, Surgical Research / 24.06.2016

MedicalResearch.com Interview with: Eva C. Gombos, MD Assistant Professor, Radiology Harvard Medical School Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? Response: Treatment of early stage breast cancer, breast-conserving therapy (BCT), which consists of lumpectomy followed by whole-breast irradiation, requires re-excision 20 %–40% of patients due to positive margins. Breast MR is the imaging modality with the highest sensitivity to detect breast cancer. However, patients who undergo breast MR imaging have not experienced reduced re-excision or improved survival rates. Our hypothesis is that supine (performed with patient lying on her back) MR imaging within the operating room can be used to plan the extent of resection, to detect residual tumor immediately after the first attempt at definitive surgery, and to provide feedback to the surgeon within the surgical suite. The aim of this study was to use intraoperative supine MR imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone performed the patient lying on her stomach) to surgery (supine) and to evaluate the residual tumor immediately after BCT. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 23.06.2016

MedicalResearch.com Interview with: Dr. Stefan Toggweiler, MD Heart Center, Luzerner Kantonsspital Lucerne, Switzerland MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of aortic stenosis in inoperable and high-risk patients. It is well known that TAVR is associated with acute and delayed occurrence of conduction disorders. Namely, delayed high-degree atrioventrcular block is a feared complication. Thus, patients are usually monitored by telemetry for a few days, but there is currently no consensus on the duration of telemetry. In this study, we evaluated how the postprocedural ECG determines the need for permanent pacemaker implantation in patients undergoing TAVR. (more…)
Author Interviews, Education, PNAS, Surgical Research / 23.06.2016

MedicalResearch.com Interview with: Sunita Sah MD PhD Management & Organizations Johnson Graduate School of Management Cornell University MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sah: Physicians often recommend the treatment they specialize in, e.g., surgeons are more likely to recommend surgery than non-surgeons. Results from an observational study and a randomized controlled laboratory experiment found that when physicians revealed their bias toward their own specialty, patients were more likely to report increased trust in the physician’s expertise and take the treatment in accordance with the physician’s specialty. (more…)
Author Interviews, Brigham & Women's - Harvard, Genetic Research, Kidney Disease, Surgical Research / 07.06.2016

MedicalResearch.com Interview with: David E. Leaf, MD, MMSc, FASN Instructor in Medicine, Harvard Medical School Associate Physician, Renal Division, Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Leaf: Heme oxygenase-1 (HO-1), the rate-limiting enzyme in the degradation of heme, has a central role in the pathophysiology of acute kidney injury (AKI) in animal models, but data on HO-1 in human AKI are sparse. Genetic polymorphisms in the number of guanosine thymidine dinucleotide [(GT)n] repeats in the promoter of the HO-1 gene are inversely associated with HO-1 expression, and longer (GT)n repeats are associated with increased cardiovascular events and mortality in a variety of clinical settings. However, no study has evaluated the association between number of (GT)n repeats and risk of AKI in a large cohort of patients. We analyzed the allelic frequencies of (GT)n repeats in the HO-1 gene promoter in 2377 Caucasian patients who underwent cardiopulmonary bypass surgery to evaluate their association with AKI. We categorized patients as having the short (S) or long (L) allele if they had. (more…)
Annals Thoracic Surgery, Author Interviews, Heart Disease, Surgical Research / 07.06.2016

MedicalResearch.com Interview with: Giovanni Esposito MD, PhD Associate Professor of Cardiology Department of Advanced Biomedical Sciences Federico II University, Naples Napoli - Italy and Giuseppe Gargiulo, MD PhD Student Federico II University of Naples, Italy
MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Esposito: Aortic stenosis (AS) is the most frequent type of valvular heart disease in Europe and North America. As soon as symptoms occur, the prognosis of severe AS is poor, with majority of patients dying within 2 to 5 years. Unfortunately medical therapy of AS has no significant effects on patient survival, therefore the only treatment able to improve patient prognosis is valve replacement. Until 2002, the only treatment strategy was the surgical aortic valve replacement (SAVR). SAVR requires an open-heart procedure and cannot be offered to all patients with AS due to their advanced age and presence of comorbidities that make them inoperable or at high-risk for surgery. In the last decade, the less invasive percutaneous approach called transcatheter aortic valve implantation (TAVI) has demonstrated to be a valid alternative to SAVR for those patients deemed inoperable or at high risk for SAVR. After the first percutaneous intervention performed by Alain Cribier in 2002, TAVI has rapidly accumulated growing interest and enthusiasm that led to the first PARTNER trial guiding current guideline recommendations. Both American and European guidelines recommend to perform TAVI in all patients judged inoperable, and to consider TAVI as an alternative in high-risk patients, but with a Class IIb and a preference to SAVR. However, scientific evidence on TAVI exploded in the last few years, the guidelines cited are outdated (2014 and 2012 respectively), we have today 5 randomized trials and many other observational studies including patients with different pre-procedural risk (i.e lo-to-intermediate and high-risk), as well as long-term results of prior studies (i.e. 5-year follow-up of the PARTNER trial and 3-year of the US CoreValve trial), therefore we conducted a systematic review and meta-analysis comparing clinical outcomes, including short- and mid-term mortality, of adult patients with severe aortic stenosis undergoing either TAVI or SAVR with the aim to update this comparison and offer new perspectives. (more…)
Author Interviews, Baylor University Medical Center Dallas, Heart Disease, Surgical Research / 07.06.2016

MedicalResearch.com Interview with: Jeffrey M. Schussler, MD, FACC, FSCAI, FSCCT, FACP Baylor Scott & White Health Care System Cardiology: Baylor University Medical Center, Dallas, Tx Medical Director: CVICU Hamilton Heart and Vascular Hospital Professor of Medicine: Texas A&M School of Medicine MedicalResearch.com: What is the background for this study? Dr. Schussler: For the past few years, there has been an increased interest in performing coronary catheterization through the wrist. This is a technique that has been done (with great success and low complication rate) in other countries for years, with adoption rates >90% in some places. The US has been slower to adopt performing catheterization from the wrist, but the rate of using this approach has grown tremendously in the last 5 years. While less than 5% of all interventions were done using radial access previously, it now appraches 30% nationally. This increased rate of adoption been spurred on by studies which have shown lower incidences of complications, as well as some mortality benefit, and in particular in those patients who are highest risk for complications. (more…)
ASCO, Author Interviews, Cost of Health Care, Prostate Cancer, Surgical Research / 06.06.2016

MedicalResearch.com Interview with: Sarmad Sadeghi MD, MS, PhD Assistant Professor of Medicine Norris Comprehensive Cancer Center University of Southern California MedicalResearch.com: What is the background for this study? Dr. Sadeghi: Several years ago analyses of outcomes for radical prostatectomy highlighted the significant impact of surgical experience on the oncological outcome for the patients. In this case experience was measured by the number of radical prostatectomies performed by the surgeon, and oncological outcome was measured by treatment failure rates (rising PSA). Despite this data, the move for redirecting patients to “high volume centers” where more experienced surgeons perform the operation has been sluggish. There was insufficient data on what is involved in referring patients to high volume centers and whether or not such action is cost effective. In a previous study we demonstrated that for every referral to a high volume center, there would be an average of $1,800 over a follow-up period of 20 years in societal cost savings. The main source of these savings is fewer treatment failures. The next question was who is a good candidate for referral and whether these savings can offset the referral costs. (more…)
Anesthesiology, Author Interviews, Ophthalmology, Surgical Research / 04.06.2016

MedicalResearch.com Interview with: Dr Gilles Guerrier Cochin University Hospital Paris, France MedicalResearch.com: What is the background for this study? Dr. Guerrier: Awake eye surgery is particularly stressful for patients. Music has long been known to reduce anxiety, minimise the need for sedatives, and make patients feel more at ease. The purpose of this pilot study was to evaluate the effect of music on anxiety in outpatients undergoing elective eye surgery under topical (local) anaesthesia. The music played was specifically composed to ease anxiety following strict criteria, including instrumental pieces only using a decreasing tempo and a progressive decrease in the number of instruments playing. Each patient was able to choose from a panel of 16 recorded music styles according to their own preferences, and listened through high quality headphones. There were various styles available, including jazz, flamenco, Cuban, classical and piano. The music was provided by MUSIC CARE, a Paris-based company that produces music aimed at preventing and managing pain, anxiety and depression. (more…)
Author Interviews, Diabetes, Infections, Surgical Research / 04.06.2016

MedicalResearch.com Interview with: Dr. Mary Forhan OT Reg (Alberta), PhD, Assistant Professor ad Dr. Tasuku Terada, post-doctoral research fellow Faculty of Rehabilitation Medicine University of Alberta MedicalResearch.com: What is the background for this study? Response: The prevalence of obesity has increased. Notably, a proportion of severe obesity (body mass index: body weight [kg] divided by height squared [m2]: >40kg/m2) has shown the most significant increase. Greater body mass increases the risk of cardiovascular disease and referrals for coronary artery graft surgery (CABG) have increased in patients with severe obesity. Interestingly, while obesity is often considered to increase the risk of complications and associated health care costs, many studies have reported better prognosis in patients with obesity compared to patients with normal weight, a phenomenon referred to as the obesity paradox. Therefore, it was not clear if patients with severe obesity were at higher risk of complications and contributed to greater resource use. A better understanding of the relationship between obesity and post-surgical adverse outcomes was needed to provide quality and efficient care. (more…)
Author Interviews, Heart Disease, Hospital Acquired, Infections, Surgical Research / 22.05.2016

MedicalResearch.com Interview with: Luis Nombela-Franco, MD, PhD Structural cardiology program. Interventional Cardiology department. Hospital Clínico San Carlos, Cardiovascular Institute Madrid, Spain (Dr. Nombela-Franco, has a special interest in interest on percutaneous treatment of structural heart disease and coronary interventions with special focus on chronic total occlusion) MedicalResearch.com: What is the background for this study? Dr. Nombela-Franco: In-hospital infections are one of the most common complications that may occur following medical and surgical admissions, significantly impacted length of hospital stay, costs and clinical outcomes. In addition, approximately one third of hospital-acquired infections are preventable. Transcatheter aortic valve replacement (TAVR) is currently the standard of care for symptomatic patients with severe aortic stenosis deemed at high surgical risk or inoperable. Patients undergoing TAVR have several comorbidities and the invasive (although less invasive the surgical treatment) nature of the procedure and peri-operative care confers a high likelihood in-hospital infections in such patients. This study analyzed the incidence, predictive factors and impact of in-hospital infections in patients undergoing transcatheter aortic valve implantation. (more…)
Author Interviews, Surgical Research / 21.05.2016

MedicalResearch.com Interview with: Mark E. Cohen, PhD Statistical Manager Continuous Quality Improvement Division of Research and Optimal Patient Care American College of Surgeons Chicago, IL MedicalResearch.com: What is the background for this study? Dr. Cohen: The ACS NSQIP Surgical Risk Calculator (built from 2.7 million patient records from nearly 600 hospitals) has been widely adopted as a decision aid and informed consent tool by surgeons and patients. Predictive accuracy can be assessed in terms of discrimination, calibration, and combined discrimination and calibration. In this study, we focused primarily on calibration. Calibration refers to the consistency of agreement between observed and predicted risk across the range of predicted risk. One would not want, for example, a model that dramatically overestimates risk for low-risk patients and underestimates risk for high-risk patients – this sort of systematic error, if of sufficient magnitude, would make a risk calculator unacceptable for clinical use. We also assessed the potential benefits of statistical recalibration using restricted cubic splines. MedicalResearch.com: What are the main findings? Dr. Cohen: Without recalibration, the Risk Calculator was shown to have excellent calibration, though there was, at times, a slight tendency for predicted risk to be overestimated for lowest- and highest-risk patients and underestimated for moderate-risk patients. After recalibration this distortion was eliminated. (more…)
Author Interviews, CMAJ, Pediatrics, Surgical Research, Weight Research / 10.05.2016

MedicalResearch.com Interview with: Atul Sharma MD, MSc(Statistics), FRCPC Researcher, Children’s Hospital Research Institute of Manitoba; Assistant Professor, Department of Pediatrics and Child Health, University of Manitoba; Senior Consultant, Biostatistics Group, George and Fay Yee Center for Healthcare Innovation MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sharma: Between 1978 and 2004, a previous comparison of directly measured heights and weights demonstrated an alarming increase in the prevalence of overweight or obesity in Canadian children aged 2-17y, from 23.3% (95% CI = 20.5-26.0) to 34.7% (33.0-36.4) based on the new 2007 WHO criteria. In Canada, the definitions of overweight and obesity changed with the introduction of the new '2010 WHO Growth Charts for Canada’, Previous definitions were based on Body Mass Index (BMI) percentiles from the 2000 Centers for Disease Control and Prevention (CDC) growth chart’s. In addition to revising the percentile thresholds for diagnosing overweight or obesity, the WHO charts were based on a very different reference population. As a result, the proportion of Canadian children being classified as overweight or obese increased with the introduction of the new WHO charts. Our current study applied current Canadian definitions of overweight and obesity to a contemporary sample of Canadian children age 3-19y to assess recent trends in the rates of overweight and obesity. By pooling data from the Canadian Community Health Survey (CCHS, cycle 2.2) and the Canadian Health Measures Survey (CHMS, cycles 2 and 3), we were able to study a representative sample of more than 14000 Canadian children from the period 2004-2013. The sample was evenly split between boys and girls and approximately 80% white. (more…)