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…)
Author Interviews, Colon Cancer, Menopause, Surgical Research / 05.05.2016

MedicalResearch.com Interview with: Josefin Segelman MD, PhD Senior consultant colorectal surgeon Department of Molecular Medicine and Surgery Karolinska Institutet Ersta Hospital Stockholm Sweden MedicalResearch.com: What is the background for this study? Dr. Segelman: Hormonal factors influence the development of colorectal cancer. Observational studies and clinical trials have reported a protective effect of hormone replacement therapy and oral contraceptives. Oophorectomy alters endogenous levels of sex hormones, but the effect on colorectal cancer risk is unclear. Removal of the ovaries alters levels of sex hormones in both pre- and postmenopausal women. In premenopausal women, bilateral oophorectomy is followed by surgical menopause as the endogenous estrogen levels drop. Both before and after natural menopause, bilateral oophorectomy promptly decreases endogenous androgen levels by half as the ovaries and adrenals are equally important for androgen production. MedicalResearch.com:  What are the main findings? Dr. Segelman: The present nationwide cohort study explored the association between removal of the ovaries for benign indications and subsequent risk of colorectal cancer. Among 195 973 women who underwent the procedure from 1965 – 2011, there was a 30% increased risk of colorectal cancer compared with the general population. After adjustment for various factors, women who underwent bilateral oophorectomy had a higher risk of rectal cancer than those who had unilateral oophorectomy (HR 2.28, 95% CI 1.33-3.91). (more…)
Author Interviews, Education, Gender Differences, Surgical Research / 04.05.2016

MedicalResearch.com Interview with: Alison M. Fecher, MD Assistant Professor of Surgery Indiana University Health MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Fecher: It has long been known that female faculty are underrepresented in departments of surgery at U.S. medical schools. Our study wanted to identify obstacles women face in entering certain surgical subspecialties and in career advancement. We found that women are poorly represented in some of the most competitive subspecialties, including cardiothoracic and transplant surgery. We also found that women tend to advance more slowly up the career ladder, with many of them spending more years at the assistant professor level than their male counterparts. One reason for this may be that they tend to publish less peer-reviewed articles than male faculty; however, our results show that the publications of female faculty often has a greater impact on the field, as measured by citations and recentness of articles. (more…)
AHA Journals, Author Interviews, Duke, Geriatrics, Heart Disease, Surgical Research / 03.05.2016

MedicalResearch.com Interview with: Jessica J. Jalbert PhD From the Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA LASER Analytica New York, NY MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Jalbert: Landmark clinical trials have demonstrated that carotid artery stenting (CAS) is a safe and efficacious alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. Clinical trials, however, tend to enroll patients that are younger and healthier than the average Medicare patient. We therefore sought to compare outcomes following CAS and CEA among Medicare patients. MedicalResearch.com: What are the main findings? Dr. Jalbert: We found that outcomes among real-world Medicare patients undergoing CAS and CEA were similar. While our results were inconclusive due to small sample size, we also found some evidence suggesting that patients over the age of 80 and those with symptomatic carotid stenosis may have better outcomes following carotid endarterectomy than CAS. (more…)
Author Interviews, Cancer Research, Surgical Research / 03.05.2016

MedicalResearch.com Interview with: Desiree Ratner, MD Director, Comprehensive Skin Cancer Program, Mount Sinai Beth Israel and Professor of Dermatology Icahn School of Medicine at Mount Sinai MedicalResearch.com: How big is the problem of skin cancer in the US?  Dr. Ratner: Skin cancer is an enormous problem in the United States and the numbers are increasing every year.  There are over 2 million cases of basal cell carcinoma per year, over 700,000 cases of squamous cell carcinoma per year, and over 140,000 cases of melanoma per year in the U.S. alone. MedicalResearch.com: What type of patients do you evaluate and treat? Dr. Ratner: My practice is limited to skin cancer, so most of my patients are referred to me by general dermatologists for surgery.  I see patients who require Mohs surgery for non-melanoma skin cancers, excisions for non-melanoma skin cancers, and other surgical procedures for a variety of other benign and malignant lesions. (more…)
AACR, Author Interviews, Cancer Research, Lung Cancer, Race/Ethnic Diversity, Surgical Research / 02.05.2016

MedicalResearch.com Interview with: Asal Mohamadi Johnson, PhD, MPH Assistant Professor of Epidemiology, Integrative Health Science Stetson University DeLand, FL 32723 MedicalResearch.com: What is the background for this study? Dr. Johnson: Public health research is primarily focused on neighborhood poverty and racial disparities by illustrating differences between white and black individuals or communities. For example, it has been established that African Americans have higher cancer mortality rates and are less likely to receive appropriate treatment that whites. What we wanted to know in this study was the impact of living in segregated areas apart from other area level characteristics such as poverty or education. Instead of solely looking at health disparities between whites and black patients, our study focused on differences in survival among black patients with early stage Non-Small Cell Lung Cancer (NSCLC) living in different levels of neighborhood segregation. (more…)
Author Interviews, Diabetes, JAMA, Surgical Research, Weight Research / 20.04.2016

MedicalResearch.com Interview with: Annemarie G. Hirsch, PhD, MPH Center for Health Research Geisinger Health System Danville, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bariatric surgery is currently the most effective treatment in reversing insulin resistance in patients with type 2 diabetes. However, the likelihood of remission or cure after surgery varies tremendously based on certain patient characteristics. The DiaRem score provides patients with a personalized prediction of whether or not they can expect long-term remission of their disease if they choose to have surgery. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 20.04.2016

MedicalResearch.com Interview with: James E. Mitchell, MD President and Scientific Director Neuropsychiatric Research Institute, Fargo Professor and Chairman Department of Neuroscience University of North Dakota School of Medicine and Health Sciences MedicalResearch.com: What is the background for this study? What are the main findings Dr. Mitchell: The amount of weight loss following bariatric surgery is widely variable. Eating behaviors and weight control practices after surgery are important in determining weight loss outcomes. (more…)
Author Interviews, JAMA, Pediatrics, Surgical Research / 18.04.2016

MedicalResearch.com Interview with: Thomas J. Sandora, M.D., M.P.H. Senior Associate Physician in Medicine; Hospital Epidemiologist; Medical Director, Infection Control Boston Children’s Hospital Associate Professor of Pediatrics, Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sandora: Giving antibiotics before certain types of operations results in lower rates of surgical site infections. However, there are limited data about which pediatric operations require antibiotic prophylaxis. We examined national variability in antibiotic prophylaxis for the 45 most commonly performed pediatric operations at children's hospitals in the U.S. We found that antibiotic use was considered appropriate for only 64.6% of cases, with a high degree of variability within procedures and between hospitals. (more…)
Author Interviews, NEJM, Pain Research, Surgical Research / 14.04.2016

MedicalResearch.com Interview with: Zoher Ghogawala MD FACS Department of Neurosurgery Lahey Hospital and Medical Center Burlington, MA 01805 MedicalResearch.com: What is the background for this study? Dr. Ghogawala: There is enormous practice variation around the utilization of lumbar spinal fusion in the United States and across the world.  In the United States, lumbar spinal fusion utilization has increased to 465,000 hospital-based procedures in 2011 according to a report from the AHRQ (published in 2014).  Spinal fusion accounts now for the highest aggregate hospital cost (12.8 billion dollars in 2011) of any surgical procedure performed in US hospitals.  What is problematic is that there are no top tier studies that address the question of whether or not adding a lumbar spinal fusion when performing a simple decompression is necessary or helpful.  The question is whether we perform too many fusions in the United States. The SLIP study is the first class I study that demonstrates that the addition of a lumbar fusion when performing a lumbar laminectomy to decompress spinal nerves improves health-related quality of life for patients suffering from low back pain and sciatica from lumbar stenosis with spondylolisthesis - a very common cause of low back pain caused by nerve compression associated with one spinal bone being slightly out of alignment.  MedicalResearch.com: What are the main findings? Dr. Ghogawala: 1)  Adding a lumbar fusion when performing a lumbar laminectomy results in superior health-related quality of life at 2,3, and 4 years after surgery. 2)  Patients with fusion obtained durable results but 14% required re-operation for problems adjacent to their fusion over the 4 year study period. 3)  Lumbar laminectomy alone provided good results for 70% of patients.  There was less blood loss and faster recovery for these patients.  On the other hand, the outcomes were less durable.  One in three patients who underwent a lumbar laminectomy alone required re-operation within 4 years because their back became unstable.  These patients underwent fusion and their health-related quality of life improved. (more…)
Author Interviews, Hospital Acquired, JAMA, Outcomes & Safety, Surgical Research / 12.04.2016

MedicalResearch.com Interview with: Christina A. Minami, MD Surgical Outcomes and Quality Improvement Center Department of Surgery, Feinberg School of Medicine, Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Illinois MedicalResearch.com: What is the background for this study? Dr. Minami: An earlier study by our group demonstrated a seemingly paradoxical relationship between hospital quality and hospital penalization in the Hospital-Acquired Condition, or HAC, Reduction Program. Basically, of those hospitals that were penalized more frequently were those that were major teaching hospitals, had more quality accreditations, and had better performance on process and outcome measures. When CMS released that surgical-site infections were going to be added to the HAC scoring, we decided to see if these additional measures might exhibit the same paradoxical association between quality and penalization. MedicalResearch.com: What are the main findings? Dr. Minami: The SSI measures follow the same trend as was previously illustrated. Basically, the hospitals who were in the bottom 25% (that is, those who were the worst performers) were more often those that were major teaching hospitals, with more quality accreditations, and offered more advanced services. It’s possible that this is due in part to surveillance bias, or “the more you look, the more you find” phenomenon. Also, what do we really call an infection? The National Healthcare Safety Network has specific definitions and guidelines, but there are still different data collections used by different hospitals. (more…)
Author Interviews, NYU, Radiology, Surgical Research / 09.04.2016

MedicalResearch.com Interview with: Eric T. Aaltonen MD, MPH Interventional Radiologist Assistant Professor, Department of Radiology Radiology  NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Aaltonen: A few years ago we started placing Denali  inferior vena cava (IVC) filters and noticed that these filters tended to not tilt and were subsequently more straight forward to remove when patients returned for filter retrieval.  Subsequently, a retrospective study was performed comparing these Denali filters with ALN and Option filters that have also been placed and removed at our hospitals.  The results demonstrate that Option filters have an increased rate of tilt at retrieval and increased retrieval time compared to Denali filters.  No significant difference in tilt or retrieval time was found with ALN filters.  Additionally, the presence of tilt correlates with more equipment use and increased fluoroscopy time during retrieval. (more…)
Author Interviews, JAMA, Pain Research, Surgical Research, University of Pittsburgh, Weight Research / 06.04.2016

MedicalResearch.com Interview with: Wendy King, PhD Associate Professor of Epidemiology Epidemiology Data Center, Room 105 University of Pittsburgh Pittsburgh, PA 15213 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. King: Severe obesity is associated with significant joint pain and impaired physical function, such as difficulty bending, lifting carrying and walking. Excess weight can lead to joint damage and accompanying pain, resulting in activity restriction and walking limitations. Obesity can also contribute to pain and physical limitations through factors such as impaired cardiorespiratory function, systematic inflammation, reduced flexibility, low strength per body mass, and depression.  Previous studies have reported significant improvements in mean values of bodily and joint specific pain, physical function, and walking capacity in the first 3-12 months following RYGB or LAGB. However, very few studies have examined the variability in response to surgery or reported on longer-term follow-up of these procedures. My colleagues and I followed 2,221 patients participating in the Longitudinal Assessment of Bariatric Surgery-2, a large NIH-funded prospective study of adults with severe obesity undergoing weight-loss surgery at one of 10 hospitals across the U.S. Through three years of follow-up, approximately 50 to 70 % of patients who underwent bariatric surgery reported clinically important improvements in bodily pain, physical function and usual walking speed. About three-quarters of the participants with symptoms indicative of osteoarthritis before surgery experienced improvements in knee and hip pain and function. In addition, over half of participants who had a mobility deficit prior to surgery did not post-surgery. Several baseline characteristics such as younger age, male sex, higher household income, lower body mass index, fewer depressive symptoms and no history of diabetes or venous edema with ulcerations, were associated with a higher chance of improvement in pain and physical function following surgery. In addition, pre- to post-surgery reductions in weight and depressive symptoms, and remission of diabetes and venous edema with ulcerations were associated with pre- to post-surgery improvements. Thus, our findings reinforce results from shorter-term studies by addressing the durability or response and expand our understanding of the variability in response, and what factors are related to chance of improvement. (more…)
Author Interviews, Diabetes, Endocrinology, Surgical Research, Weight Research / 04.04.2016

MedicalResearch.com Interview with: Ana Priscila Soggia Sirio Libanes Hospital, São Paulo, Brazil MedicalResearch.com: What is the background for this study? What are the main findings? Response: For many years, bariatric surgery is performed to treat class II and III obesity with diabetes remission in 80-90% of cases, related to weight loss and change in the secretion of intestinal factors that control blood glucose, like GLP-1 and GIP. In 2010, the International Diabetes Federation (IDF), proposed that diabetic patients with BMI between 30-35kg/m2 could be eligible, for bariatric surgery, in the case of no glycemic control with drug treatment. In this context, once glycemic control after bariatric surgery, was not related only to weight loss and also due to intestinal factors with physiological actions, the protocol was proposed. The objectives were to compare the clinical and surgical treatment in diabetics patients with class I obesity; and to compare the efficacy and security between two different surgical techniques. This study was developed and conducted by a research team from Sirio-Libanês Hospital in partnership with Ministry of Health through its philanthropic program PROADI. It is a clinical trial, with 42 class I obese diabetic type 2 patients with inadequate glycemic control that were randomized to tree arms: clinical treatment, gastric bypass surgery or sleeve with ileal transposition (sleeve-IT) surgery. The results showed that the sleeve-IT procedure is more effective for the treatment of diabetes in these patients compared with treatment with medication and with bypass surgery, currently considered the first choice of treatment. Among patients who underwent sleeve-IT, 100% achieved glycemic control after 1 year (HbA1c<6,5%) compared to 46% for bypass and 8% in the case of medication therapy. In addition, diabetes remission, that was defined as adequate glycemic control without any anti-diabetic medication, occured in 75% of sleeve-IT patients had versus 30% in bypass group. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Pulmonary Disease, Surgical Research, Technology / 18.03.2016

MedicalResearch.com Interview with: Dr. Ariel Drori MD Hadassah Medical Center  MedicalResearch.com: What is the background for the ThoraXS device? Dr. Drori: The initial recognition of the need for a device like ThoraXS first came to me on an operational deployment during my reserve service where I serve as a military doctor. While serving on the Gazan border, I was called to a battle scene to treat a soldier who was suffering from pneumothorax after being shot in the chest.  A quick evacuation by helicopter meant that I didn't have the time to perform the entire procedure and I was forced to hand over a partially-treated patient whose condition was unstable. The reality of constant combat injuries mixed with a rising number of daily civilian terror attack casualties led us to understand that we need to provide a cheap, easy to use, robust and reliable solution that on the one hand can withstand the most extreme combat conditions and on the other, be used by any paramedic and in any pre-hospital and hospital setting. This line of thought eventually led to the adoption of ThoraXS's simple yet sophisticated mechanical mechanism that ticks all the boxes. (more…)