Surgical Research
02 Nov Laser-Assisted Technology Allows Easier Removal of IVC Filters
MedicalResearch.com Interview with: [caption id="attachment_29338" align="alignleft" width="200"]
Dr. William T. Kuo[/caption]
William T. Kuo, MD, FSIR, FCCP, FSVM
Director, Stanford IVC Filter Clinic
Director, IR Fellowship Program
Founding Director, IR-DR Residency Program
Associate Professor, Interventional Radiology
Stanford University Medical Center
Stanford, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In the USA, over 250,000 IVC filters are now implanted each year, and rising filter use has led to an increase in filter-related morbidity and recognition of the potential complications from indwelling IVC filters. Consequently, the FDA has issued two safety communications alerting all physicians caring for patients with IVC filters to consider removing the filter as soon as protection from pulmonary embolism is no longer needed:
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm?so urce=govdelivery&utm_medium=email&utm_source=govdelivery
Despite heightened awareness, up to 40-60% of IVC filters cannot be easily removed using standard methods alone, after the filter becomes firmly embedded. Additionally, many patients have undergone prior placement of a permanent-type filter not even designed for retrieval, leaving them with few options for safe device removal. Although all of these patients can develop filter-related morbidity especially after chronic implantation, there is currently no routine option for removing embedded IVC filters refractory to standard retrieval methods. Our 5-year first-in-human study of a novel procedure—laser-assisted filter removal— demonstrates the safety and efficacy of this technique to treat such patients. In a cohort refractory to standard retrieval methods and high force, endovascular laser-assisted retrieval was overall safe and successful in removing a variety of filter types including permanent filters, regardless of dwell time and without the need for open surgery.
31 Oct Smoking Reduces Surgical Improvement for Cervical Myelopathy
MedicalResearch.com Interview with: [caption id="attachment_29280" align="alignleft" width="140"]
Dr. David Kusin[/caption]
Dr. David Kusin MD
University of Nebraska Medical Center
Omaha
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further.
We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms.
30 Oct 15-Year Study Shows Benefit of Early Surgical Treatment in Non-STEMI Coronary Syndrome
MedicalResearch.com Interview with: [caption id="attachment_29286" align="alignleft" width="200"]
Prof.Lars Wallentin[/caption]
Prof. Lars Wallentin MD
Department of Medical Sciences, Cardiology
Uppsala Clinical Research Center
Uppsala University, Uppsala, Sweden
MedicalResearch.com: What is the background for this study?
Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. Still there are remaining controversies concerning the long-term effects, the appropriate selection of patients for this approach and the opportunities for a more personalised approach to early invasive procedures.
28 Oct Study Supports Feasibility of TAVI for High-Risk Aortic Regurgitation
MedicalResearch.com Interview with: Anna Franzone, MD and Prof.Thomas Pilgrim, MD Department of Cardiology Bern University Hospital INSELSPITAL Bern, Switzerland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgical aortic valve replacement is the therapeutic standard for patients with pure native aortic regurgitation (AR). However, transcatheter aortic valve implantation (TAVI) is emerging as a novel treatment option for patients deemed inoperable or at high-risk for surgery because of advanced age and multiple comorbidities. We performed a systematic review and meta-analysis including 237 patients with pure native AR undergoing TAVI across 13 studies. The primary study endpoint, all-cause mortality at 30-day, ranged from 0% up to 30% with a summary estimate rate of 7% . The occurrence of complications such as the need for a second valve implantation was relatively low as well as the rates of other endpoints (cerebrovascular events, major bleeding and vascular complications).27 Oct Physical Activity Doesn’t Increase After Hip Replacement
MedicalResearch.com Interview with: Tom Withers Research Student, School of Health Sciences University East Anglia Norwich, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a lot of subjective evidence to suggest that physical activity does not improve following hip replacement we wanted to therefore synthesise the current evidence to come to a more objective conclusion. The main finding from this study is that physical activity does not significantly change pre-operatively compared to up to one year post-operatively.21 Oct Hernias Repaired With Mesh Have Lower Risk of Re-Operation
MedicalResearch.com Interview with: Thue Bisgaard, M.D., D.M.Sc Professor of Surgery, Hvidovre Hospital Hvidovre Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: The complete spectrum for the benefits and risks of mesh used to reinforce hernia repair is not known because there are very few clinical trial data reporting hernia outcomes as they pertain to mesh utilization. Generally, there is evidence that mesh is beneficial in terms of less risk of reoperation for recurrence after incisional hernia repair compared with sutured repair. The present study confirmed this for the first time in nationwide analysis with a long-term follow-up of 5 years up. From earlier studies from our group (Ann Surg 2012) it is known that reoperation rate for recurrence severely underestimates overall (clinical) risk of recurrence making differences between mesh vs. sutured repair even much bigger. Although rare (5%) the incidence of mesh-related complications was progressively increasing throughout the study period suggesting that mesh-related complications rate may continue to accrue with even longer follow-up.18 Oct Liposomal Bupivacaine Infiltration Reduced Costs and Opioid Use in TKA Surgery
MedicalResearch.com Interview with: Bryan Sakamoto MD, PhD Department of Anesthesia Richard L. Roudebush, Veterans Affairs Medical Center Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana MedicalResearch.com: What is the background for this study? Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population.18 Oct LEAN Principles Improved Surgical Safety, Outcomes and Efficiency
MedicalResearch.com Interview with: Vishal Sarwahi, MD, senior author Associate Surgeon-in-Chief Chief, Spinal Deformity and Pediatric Orthopaedics Billie and George Ross center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery Cohen's Children Medical Center Northwell Hofstra School of Medicine and [caption id="attachment_28960" align="alignleft" width="125"]
Stephen F. Wendolowski[/caption]
Stephen F. Wendolowski
Research Assistant
Pediatric Orthopaedics
Cohen Children’s Medical Center
New Hyde Park, NY, 11040
MedicalResearch.com: What is LEAN?
Response: LEAN is a management principle that supports the concept of continuous improvement through small incremental changes to not only improve efficiency, but also quality. Particularly, we took interest in the 5S’s – Sort, Simplify, Sweep, Standardize, and Self-Discipline. We felt that Sort, Simplify, and Standardize were the most relevant to surgery.
12 Oct DuraGraft® Vascular Graft Evaluated to Prevent Vein Graft Failure After CABG
MedicalResearch.com Interview with: [caption id="attachment_28827" align="alignleft" width="169"]
Dr. Miguel Haime[/caption]
Miguel Haime, MD
VA Boston Healthcare System and Boston Medical Center
Boston, MA
Dr. Haime discusses an abstract about Somahlution DuraGraft during a rapid response session at the 2016 annual meeting of the European Association for Cardio-Thoracic Surgery (EACTS; 1–5 October, Barcelona, Spain)
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Coronary artery bypass grafting (CABG) surgery is the standard of care for multi-vessel coronary heart disease. During CABG, we use saphenous vein grafts as bypass conduits for surgical revascularization. Pathophysiological changes that occur in vein grafts during the surgical procedure can compromise the durability and patency of the graft and increase the risk of vein graft failure.
At the European Association for Cardio-Thoracic Surgery (EACTS) annual meeting, we presented results from a retrospective, non-randomized study conducted at VA Boston Healthcare System to evaluate the Real World Evidence of DuraGraft®, a vascular graft treatment designed to prevent vein graft failure after CABG.
06 Oct Higher Income Inequality Associated With Higher Medicare Expenditures
Posted at 23:42h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Surgical Research
MedicalResearch.com Interview with:
Diego Lopez
Harvard medical student and
Dr. Andrew Loehrer MD
former surgical resident at MGH
senior author:
David C. Chang, PhD, MPH, MBA
Associate Professor of Surgery
Director of Healthcare Research and Policy Development
Department of Surgery
Massachusetts General Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Income inequality in the United States has been increasing in recent decades, and has become an important in this election cycle. Although income inequality is often framed in terms of its effects on politics and the economy, little attention has been paid to its effect on the healthcare system. In our study, we set out to evaluate the way in which counties with differing levels of income inequality made use of the healthcare system while controlling for the overall income (as well as other demographic variables).
We found that areas with higher income inequality were associated with higher Medicare expenditures. And these effects are independent of – meaning they are in addition to – the known effect of poverty on healthcare utilization.
03 Oct Mechanism of Injury Makes A Difference In Risk of Venous Thromboembolism
Posted at 17:51h
in Accidents & Violence, Author Interviews, Clots - Coagulation, JAMA, Surgical Research, Thromboembolism
MedicalResearch.com Interview with:
Charles A. Karcutskie IV, MD, MA
Postdoctoral Research Fellow
University of Miami Miller School of Medicine
Department of Surgery
Divisions of Trauma, Surgical Critical Care, and Burns
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our research group at the Ryder Trauma Center have recently done several studies showing various differences in outcomes and risk based on mechanism of injury. Additionally, venous thromboembolism (VTE) is another topic that our group has focused on in the past several years. Because trauma patients are inherently at a higher risk for VTE due to the nature of their injury, we questioned whether the most important risk factors for VTE were different after blunt or penetrating trauma. At our institution, we assess VTE risk with the Greenfield Risk Assessment Profile, which is a list of several risk factors that each have weight toward an overall risk score. We took these risk factors and analyzed them individually based on mechanism of injury. We found that the factors that contribute to the VTE risk are different based on injury mechanism: After blunt trauma, transfusion status, neurologic status, and pelvic fracture contributed most. After penetrating trauma, vascular injury, severe abdominal injury, and age 40-59 years contributed most. This tells us that mechanism of injury may need to be incorporated into the risk assessment in order to discover the highest risk patients.
30 Sep No Link Found Between Vasectomy and Developing or Dying From Prostate Cancer
Posted at 23:01h
in Author Interviews, Journal Clinical Oncology, Prostate Cancer, Surgical Research, Urology
MedicalResearch.com Interview with:
[caption id="attachment_28482" align="alignleft" width="134"]
Dr. Eric Jacobs[/caption]
Eric Jacobs, PHD
Strategic Director, Pharmacoepidemiology
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Vasectomy is a common, inexpensive, and very effective method of long-term birth control. However, in 2014, an analysis from a large epidemiologic cohort study, the Health Professionals Follow-Up Study, found that vasectomy was associated with about 10% higher overall risk of prostate cancer and about 20% higher risk of fatal prostate cancer. Together with other researchers at the American Cancer Society, I analyzed the association between vasectomy and fatal prostate cancer among more than 363,000 men in the Cancer Prevention Study II (CPS-II) cohort, age 40 and older, who were followed for up to 30 years. This is the largest prospective analysis of vasectomy and fatal prostate cancer to date. We also examined vasectomy and prostate cancer in a subset of about 66,000 CPS-II study participants who were followed for new diagnoses of prostate cancer.
We found no link between having had a vasectomy and risk of either developing or dying from prostate cancer.
30 Sep Triclosan-Containing Sutures Reduced Surgical Infections in Children
MedicalResearch.com Interview with: Dr Marjo Renko MD PEDEGO Research Unit University of Oulu Oulu, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: For over a decade there has been suture materials containing antiseptic agent in the market. Trials in adults have shown some possible benefits from these sutures as in some studies they have reduced occurrence of surgical site infections. Only one small study had so far been published in children and thus we decided to carry out a large trial comparing sutures containing triclosan with ordinary ones. Our trial included over 1500 children who came to Oulu University Hospital for surgery. Surgical site infections were carefully monitored. Surgical site infections occurred in 2.6 % of the children who received absorbing sutures containing triclosan while that occurred in 5,4 % of the children who received ordinary sutures.27 Sep C-section carries a 4-fold increased risk of blood clots, compared with vaginal deliveries
Posted at 11:23h
in Author Interviews, Blood Clots, CHEST, OBGYNE, Surgical Research, Thromboembolism
MedicalResearch.com Interview with:
Marc Blondon, MD
Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Venous thromboembolism, a condition including deep vein thrombosis (blood clots) and pulmonary embolism, is more common in older than younger patients. However, pregnancy and particularly the postpartum period are times at greater risk of blood clots in women. It is important to understand the risk and the risk factors for thrombosis in the postpartum period to guide the use of preventive measures such as heparin, an anticoagulant treatment, or leg compression devices.
Our study summarizes the evidence on the link between C-sections and blood clots from the past 35 years.
Our meta-analysis demonstrates that:
- C-section carries a 4-fold increased risk of blood clots in the postpartum period, compared with vaginal deliveries ;
- that this risk is most prominent but not restricted to emergency C-section ;
- and that women who undergo elective C-section are also at higher risk than women who have a vaginal delivery.
- Importantly, we estimated an absolute risk of blood clots after a C-section of 2-4 per 1000 pregnancies: on average, 3 out of 1000 women after C-section will develop a blood clot.
25 Sep Impact of Renal Dysfunction on Results of TAVR Outcomes
MedicalResearch.com Interview with: Pablo Codner, MD; Amos Levi, MD (firsts authors) and Prof. Ran Kornowski, MD, FACC, FESC (senior author) Rabin Medical Center Derech Ze`ev Israel. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) is a well-established treatment for patients with severe aortic stenosis (AS) who are deemed inoperable by the “heart team”, for those at high risk for surgery and also for patients at intermediate surgical risk. Currently this therapeutic alternative is being compared with surgical aortic valve replacement in patients at low risk for surgery. Patients with chronic kidney disease were excluded from most randomized trials. We evaluated outcomes within a large multicenter cohort of patients undergoing TAVR distinguished by renal function, from 11 high volume centers in 8 different countries across Europe and Asia. In our experience patients with renal dysfunction were associated with poor clinical outcomes. All-cause and cardiovascular mortality rates during the follow-up period increased with declining renal function. A glomerular filtration rate ≤30 mL/min was identified on multivariate analysis as an independent predictor for all-cause and cardiovascular mortality. We also found higher rates of severe bleeding and vascular complications among patient with advanced or end stage renal failure.22 Sep Decision-Making in Laryngology: Both Sides of the Story
MedicalResearch.com Interview with: [caption id="attachment_28269" align="alignleft" width="133"]
Dr. Mark Courey[/caption]
Dr. Mark Courey, MD
Senior Faculty,Otolaryngology
The Mount Sinai Hospital
New York Eye and Ear Infirmary of Mount Sinai
MedicalResearch.com: Would you tell us a little about yourself? How did you become interested in voice disorders?
Response: I became interested in voice disorders because during my residency in the late 1980’s there was little known about how to help patients with disorders of voice. The main instrument we use to evaluate vocal folds (the stroboscope) was just becoming clinically available. Only a handful of physicians had one available. We could not see vocal fold function and could only see the lesions on the vocal folds. We did not know how the lesions affected function. So many surgeons only treated patients with laryngeal cancer and told the others to be happy that they did not have cancer.
22 Sep ENT Surgeon Manages Middle Ear Cholesteatoma Removal In One Surgical Procedure
MedicalResearch.com Interview with: [caption id="attachment_28267" align="alignleft" width="160"]
Dr. Eric E Smouha[/caption]
Eric E Smouha, MD
Professor, Otolaryngology
The Mount Sinai Hospital
New York Eye and Ear Infirmary of Mount Sinai
MedicalResearch.com: Would you tell us a little about yourself? How did you become interested in ENT and specifically middle ear problems?
Response: I am a neurotologist, i.e. , ENT physician specialized in disorders of the ear and skull base. Neurotologists treat problems of the middle ear and inner ear. Middle ear problems are interesting because they are prevalent, and surgery frequently results in restoration of function.
22 Sep 3D Models and Immersive Virtual Reality Simulation for Complex Skull Base Surgery
MedicalResearch.com Interview with: [caption id="attachment_28265" align="alignleft" width="160"]
Dr. Alfred Marc Calo Iloreta[/caption]
Alfred Marc Calo Iloreta, MD
Assistant Professor
Skull Base Surgery and Rhinology
Department of Otolaryngology -
Head and Neck Surgery
Icahn School of Medicine at Mount Sinai
New York, New York
MedicalResearch.com: Would you tell us a little about yourself? How did you become interested in ENT and your subspecialty in particular?
Response: I am a ENT/Head and Neck Surgeon practicing in Manhattan at the Mount Sinai Hospital. I trained here in New York City for residency and also completed a fellowship in Rhinology and Skull Base Surgery.
I chose this field and sub-specialty because of the intricate and complex anatomy of the head and neck. In addition rhinology and skull base surgery utilizes multiple advanced technologies from high definition optics, to neuronavigation to allow us to work with this complex anatomy.
21 Sep The Capillary Index Score as a Marker of Viable Cerebral Tissue in Stroke
MedicalResearch.com Interview with: [caption id="attachment_28204" align="alignleft" width="132"] Dr. Firas Al-Ali[/caption] Firas Al-Ali, MD Departments of Neuro-Interventional Surgery Cleveland Clinic Akron General, Akron, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Capillary Index Score (CIS) is based on the simple following assumption: “ the presence of capillary blush on...
21 Sep An answer for eschar buildup: anti-stick solution for electrosurgery
MedicalResearch.com Interview with
Tim Reese, president of Eagle Surgical Products, LLC,
Sales and distribution company for Electro Lube®
MedicalResearch.com: What is the background of Electro Lube®?
Response: Developed in 2004, Electro Lube® is an anti-stick solution for electrosurgery designed to keep instruments clean. The product is a mixture of natural, non-synthetic, non-flammable, non-allergenic biocompatible phospholipids without any known side effects associated with patient use.
19 Sep JAMA Study Finds More Interventions and Increasing Survival After Out-of-Hospital Cardiac Arrests
MedicalResearch.com Interview with: Nish Patel, MD and Nileshkumar J. Patel, MD University of Miami Miller School of Medicine MedicalResearch.com: What is the background for this study? Response: Out of hospital cardiac arrest (OHCA) is estimated to affect approximately 300,000 people in the United States annually. Pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) contributes 23-54% of OHCA patients, with the median values at the lower end of this range. Coronary artery disease is thought to be responsible for up to 70% of these OHCA cases. It has been suggested that urgent coronary intervention in unconscious patients after cardiac arrest may improve survival. In the 2015 American Heart Association (AHA) guidelines, coronary angiography is recommended in patients with OHCA patients with a suspected cardiac etiology and ST elevations (STE) on ECG (Class of recommendation I, Level of evidence B), and it should be considered in patients after cardiac arrest presenting without STE but with suspected cardiac etiology of cardiac arrest (Class of recommendation II a, Level of evidence B). However, there is paucity of information about the use of coronary angiography and percutaneous coronary intervention (PCI) and its potential benefit for the VT/VF OHCA patient population. Therefore, we reviewed the Nationwide Inpatient Sample (NIS), to examine temporal trends of coronary angiography and PCI in VT/VF OHCA in the United States, for patients with and without STE. We also studied the temporal trends of survival to discharge in these patient populations.14 Sep Study Outlines Risk Factors for Infectious Endocarditis After TAVR
MedicalResearch.com Interview with: [caption id="attachment_21314" align="alignleft" width="120"]
Dr. Rodés-Cabau[/caption]
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? What are the main findings?
Response: Infectious endocarditis (IE) is one of the most serious complications after surgical prosthetic valve replacement. There are however scarce data regarding the incidence, predictive factors, treatment, and outcomes of IE post-TAVR. To date, the present study represents the largest series of IE post-TAVR, and the main findings can be summarized as follows: (1) the incidence of infective endocarditis (IE) post-TAVR is similar to that reported for IE after surgical prosthetic valve replacement; (2) among patients undergoing TAVR, younger age, male sex, a history of diabetes mellitus, and moderate-to-severe residual aortic regurgitation were associated with a higher risk of IE, (3) Enterococci species was the most frequently isolated pathogen, (4) IE post-TAVR was associated with a very high rate of in-hospital complications and mortality during index hospitalization and at follow-up.
11 Sep TAVR: Women Have More Short Term Complications But Better One-Year Survival
MedicalResearch.com Interview with: [caption id="attachment_27680" align="alignleft" width="152"]
Dr. Michael Gaglia[/caption]
Michael A. Gaglia Jr., MD, MSc, FACC, FSCAI
Scientific Lead, Population Research
Medstar Cardiovascular Research Network
Interventional Cardiology
Medstar Heart and Vascular Institute
Washington, DC 20010
MedicalResearch.com: What is the background for this study?
Response: Cardiovascular outcomes vary according to gender in a variety of disease states. For example, short-term mortality is higher among women presenting with an acute coronary syndrome in comparison to men. There is a similar trend for higher short-term mortality of women undergoing coronary artery bypass grafting, although this is in part due to a relatively higher burden of comorbidities. Female gender is also a well-established risk factor for bleeding complications after percutaneous coronary intervention.
In regards to women undergoing surgical aortic valve replacement for severe aortic stenosis (AS), however, the data is equivocal; some studies suggest higher mortality for women, whereas others suggest improved survival for women.
The emergence of transcatheter aortic valve replacement (TAVR) as the preferred therapeutic option for patients with severe AS at high or extreme risk for surgery offered another opportunity to examine gender disparities in outcomes. The evidence base for the impact of gender upon TAVR, however, is still evolving. A recent meta-analysis suggested improved long-term survival among women after TAVR. And in general, previous studies also suggest more vascular and bleeding complications in women when compared to men. The goal of this study was relatively simple: to compare outcomes between women and men undergoing TAVR at a single center.
04 Sep Significant Decline in Readmissions After PCI in Medicare Patients
MedicalResearch.com Interview with: [caption id="attachment_27659" align="alignleft" width="125"]
Dr. Christian McNeely[/caption]
Christian A. McNeely, M.D.
Resident Physician - Internal Medicine
Barnes-Jewish Hospital
Washington University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Prior research has demonstrated that readmission in the first 30 days after percutaneous coronary intervention (PCI) is common, reported around one in six or seven Medicare beneficiaries, and that many are potentially preventable. Since 2000, there have been significant changes in the management of coronary artery disease and the use of PCI. Additionally, in the last decade, readmission rates have become a major focus of research, quality improvement and a public health issue, with multiple resulting national initiatives/programs which may be affecting care. Therefore, in this study, we sought to examine contemporary trends in readmission characteristics and associated outcomes of patients who underwent PCI using the Medicare database from 2000-2012.
04 Sep No Evidence of Worse STEMI Outcomes During Off-Hours
Posted at 00:37h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School, Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes.
In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well.
03 Sep Poor Work/Life Balance Cited As Main Reason For Few Female Surgeons
MedicalResearch.com Interview with: Miss Hui-Ling Kerr SpR Trauma and Orthopaedics Department of Trauma and Orthopaedic Bristol Royal Infirmary, Bristol, UK MedicalResearch.com: What is the background for this study? Response: Gender inequality at consultant level in surgery has not improved despite greater opportunities for women and only a small proportion of women apply to become surgical trainees. We wanted to find out if the lack of female surgical role models acted as a deterrent to first year female junior doctors and final year medical students towards a career in surgery.02 Sep Most Gastric Bypass Patients Keep Weight Off After Surgery
MedicalResearch.com Interview with: [caption id="attachment_27481" align="alignleft" width="156"]
Dr. Matt Maciejewski[/caption]
Matthew Leonard Maciejewski, PhD
Professor in the Division of General Internal Medicine
Department of Medicine
Duke University School of Medicine
Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care
Durham VA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: No study based on a US cohort undergoing current procedures has examined weight change comparing surgical patients and nonsurgical patients for as long as we have. This is the first study to report 10-year outcomes on gastric bypass patients and compare them to matched patients who did not get surgery. At 1 year, gastric bypass patients lost 31% of their baseline weight compared controls who only lost 1.1% of their baseline weight. At 10 years, gastric bypass had lost 28% of their baseline weight.
We also compared weight loss at 4 years for Veterans who received the 3 most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric banding). At 4 years, patients undergoing gastric bypass lost more weight than patients undergoing sleeve gastrectomy or gastric banding. Given that few high quality studies have examined sleeve gastrectomy to 4 years, the 4-year sleeve outcomes contribute to filling this important evidence gap as the sleeve gastrectomy is now the most commonly performed bariatric procedure worldwide.
02 Sep Invasive Cardiac Therapies Linked To Better Survival Following Heart Attack
MedicalResearch.com Interview with: [caption id="attachment_27459" align="alignleft" width="163"]
Dr. Marlous Hall[/caption]
Dr Marlous Hall PhD
Senior Epidemiologist
Leeds Institute of Cardiovascular and Metabolic Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that death rates following heart attacks have fallen considerably over recent decades. Many studies have looked at the effect of medications and invasive strategies, and their association with better clinical outcomes is clear.
However, a big question remains: why have heart attack deaths fallen? Is it due to increased use of medications and treatment, is the risk of patients simply lower over time due to things like earlier diagnosis or are patients generally healthier with fewer comorbidities such as diabetes? Answering this is not straightforward - as gold standard studies like clinical trials on historic data cannot be done.
An alternative approach is to look for patterns in data observed from routine care to look at all these factors together. This study used a large and rich dataset covering heart attack care in the UK (Myocardial Ischaemia National Audit Project (MINAP)). This dataset was linked to outcome data from the Office for National Statistics to allow us to look at all the different factors that could influence the change in mortality over time.