Author Interviews, Cost of Health Care, JAMA, Ophthalmology, Surgical Research, UCSF / 23.01.2018

MedicalResearch.com Interview with: Catherine L. Chen, MD, MPH Assistant Professor UCSF Department of Anesthesia & Perioperative Care MedicalResearch.com: What is the background for this study? What are the main findings? Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient's blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported. In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing. In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery. We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 17.01.2018

MedicalResearch.com Interview with: Oma Reges, PhD Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel Department of Health Systems Management, Ariel University, Ariel, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: Israel, based on the most recently published data (2015), performs more per-capita bariatric surgery than the U.S.A (about 9,000 to 9,500 procedures annually, which is 1.8 times higher rate per capita than the U.S.A, where there are about 200,000 procedures a year). It is important to evaluate the impact of these procedures on health status, as there is a lack of data of the effectiveness of these procedures over time. We were able to document lower mortality rates, of up to 50%, in the obese patient undergoing surgery as opposed to matched obese patients who continue with usual care.  (more…)
Author Interviews, Diabetes, JAMA, OBGYNE, Surgical Research / 16.01.2018

MedicalResearch.com Interview with: Charles Billington MD Chief, Section of Endocrinology and Metabolism Minneapolis VA Health Care System Professor of Medicine, University of Minnesota  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We wanted to know if adding gastric bypass to intense lifestyle and medical therapy would improve overall diabetes treatment as represented by the triple endpoint of blood sugar, blood pressure and cholesterol control. We found that adding gastric bypass did provide significant benefit at five years after surgery, but that the size of the benefit declined substantially from the first to the fifth year. We also found that gastric bypass did provide significantly better blood sugar control throughout the five years, but the rate of diabetes remission at five years was low. There were many more adverse events in the gastric bypass group.  (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 15.01.2018

MedicalResearch.com Interview with: Jøran Hjelmesæth MD, PhD Professor, Head Morbid Obesity Centre and Section of Endocrinology Department of Medicine Vestfold Hospital Trust Tønsberg, Norway Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo, Norway MedicalResearch.com: What is the background for this study? What is known?  Some previous studies have shown beneficial long-term effects of bariatric surgery on the remission and incidence of diabetes, hypertension and dyslipidemia, whilst high quality data on the long-term incidence of adverse effects, mental health conditions and complications after bariatric surgery are sparse or lacking. In addition, the control groups in previous studies of the effect of bariatric surgery seldom or never received any specific specialist based non-surgical treatment alternative. The present pragmatic real world study was performed at a publicly funded single tertiary care obesity center in Norway where patients could choose between bariatric surgery and specialized medical treatment (voluntarily and free of charge). Nearly complete short- and long-term (≤ 10 years) data on beneficial and detrimental outcomes were retrieved from national registries (Norwegian Prescription Database and Norwegian Patient Registry).  The results confirm the beneficial long-term effects of bariatric surgery (gastric bypass) on the remission and incidence of diabetes, hypertension and dyslipidemia, as demonstrated in some previous studies. (more…)
Author Interviews, Pain Research, Surgical Research / 05.01.2018

MedicalResearch.com Interview with: “Migraine” by makelessnoise is licensed under CC BY 2.0Lisa Gfrerer, MD PhD Clinical Fellow in Surgery Brigham and Women's Hospital William Gerald Austen MD Chief, Plastic and Reconstructive Surgery Chief, Division of Burn Surgery Massachusetts General Hospital  MedicalResearch.com: What are the main findings? Response: Migraine surgery patients at our institution are chronic pain patients who have failed conservative therapy and are severely disabled by their disease. We initiated this study to understand two important points. First, it was previously unclear how to categorize these patients in terms of pain intensity and disability on the spectrum of better known pain conditions such as chronic back pain/ nerve pain/ carpal tunnel.  This is very important to appreciate the extent of this disease. Second, instead of collecting migraine characteristic such as decrease in migraine days/ duration/ pain, we wanted to understand how functionally disabled these patients are in their daily lives and how much better they get after surgery. This is ultimately what matters to patients. We therefore decided to evaluate our outcomes by using the Pain Self Efficacy Questionnaires (PSEQ). This validated pain questionnaire has been used to describe pain intensity/disability in patients with different acute and chronic pain conditions. (more…)
Author Interviews, Heart Disease, JACC, Pediatrics, Surgical Research, UCSD / 04.01.2018

MedicalResearch.com Interview with: Rakesh K. Singh MD, MS Department of Pediatrics, University of California–San Diego and Rady Children’s Hospital San Diego, California Steven E. Lipshultz MD Department of Pediatrics Wayne State University School of Medicine and Children’s Hospital of Michigan Detroit, Michigan  MedicalResearch.com: What is the background for this study? Response: Dilated cardiomyopathy (DCM) is a disease characterized by dilation and dysfunction of the left ventricle of the heart. While DCM is a relatively rare disease in children, nearly 40% of children with DCM require a heart transplant or die within 2 years of diagnosis. Heart transplantation has improved the outcomes of children with DCM over the last 3 decades, but is limited by donor heart availability. Newer therapies, including advanced ICU care and artificial heart machines, are now being used to treat children with DCM. This study published in the November 28, 2017 issue of the Journal of American College of Cardiology (JACC) sought to determine whether more children with DCM were surviving longer in the more recent era. Specifically, it investigated whether children with DCM were surviving longer without the need for heart transplantation. Rakesh Singh, MD is the first author and an Associate Professor of Pediatrics at UC San Diego/Rady Children’s Hospital, while the senior author is Steven Lipshultz, MD, Professor at Wayne State University School of Medicine/Detroit Medical Center’s Children’s Hospital of Michigan and Director of Children’s Research Center of Michigan. The Pediatric Cardiomyopathy Registry (PCMR) is a National Heart, Lung, and Blood Institute (NHLBI) sponsored registry from 98 pediatric centers in United States and Canada created to study the outcomes of children with various heart muscle disorders known as cardiomyopathies. For this study, outcomes of 1,199 children diagnosed with DCM from 1990-1999 were compared with 754 children diagnosed with DCM from 2000-2009. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 04.01.2018

MedicalResearch.com Interview with: Edward L. Hannan, PhD, MS, MS, FACC Distinguished Professor and Associate Dean Emeritus University at Albany School of Public Health Rensselaer, NY 12144     MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have done a lot of work on complete revascularization (CR) vs. incomplete revascularization (IR) already, and as a follow-up it seemed as if there may be different types of IR that are associated with even worse outcomes relative to CR and other IR. Incomplete revascularization is associated with worse outcomes if it involves multiple vessels, vessels with severe stenosis, or significant proximal left anterior descending artery vessel (PLAD) stenosis. (more…)
Author Interviews, Mayo Clinic, OBGYNE, Surgical Research / 03.01.2018

MedicalResearch.com Interview with: Dr. Shannon Laughlin-Tommaso MD Associate Professor of Obstetrics and Gynecology Consultant, Division of Gynecology, Department of Obstetrics & Gynecology Mayo Clinic, Rochester New York  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are increasing data from a number of studies about the long term risks of hysterectomy both with and without removing the ovaries. We studied women who underwent hysterectomy with conservation of both ovaries to determine the long-term risk of cardiovascular disease using the Rochester Epidemiology Project (REP). The advantage of using the REP is that we were able to follow women for an average of 22 years, where previous studies had only been able to follow for 7-10 years and we were able to determine which women already had cardiovascular disease risk factors at the time of hysterectomy. We found that women who undergo hysterectomy have a 33% increased risk of new onset coronary artery disease, a 13% increased risk of hypertension, a 14% increased risk in lipid abnormalities, and an 18% increased risk of obesity. For women who had a hysterectomy before age 35 years, these risks were even higher: 2.5-fold risk of coronary artery disease and 4.6-fold risk of congestive heart failure. (more…)
Author Interviews, Infections, Ophthalmology, Surgical Research / 14.12.2017

MedicalResearch.com Interview with: Penny Asbell, MD Icahn School of Medicine Mt. Sinai, New York City. MedicalResearch.com: What is the background for this study? ─     Bacterial endophthalmitis is a serious, although infrequent, complication of ocular surgery, typically caused by perioperative introduction of bacterial flora from the patient’s own conjunctiva and skin. ─     Prophylactic measures such as perioperative antibiotic treatment may minimize the risk for endophthalmitis, but can be complicated by antibiotic resistant bacteria. ─     The ongoing Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is the only nationwide antibiotic resistance surveillance program specific to ocular pathogens. ─     The purpose of this presentation is to report on the antibiotic susceptibility profiles of bacterial isolates from the vitreous and aqueous humor collected in the ARMOR study expanding upon earlier findings. (more…)
Author Interviews, Environmental Risks, Health Care Systems, Surgical Research / 11.12.2017

MedicalResearch.com Interview with: <a href="https://www.flickr.com/photos/armymedicine/6127836005">“surgery”</a> by <i> <a href="https://www.flickr.com/people/armymedicine/">Army Medicine</a> </i> is licensed under <a href="https://creativecommons.org/licenses/by/2.0"> CC BY 2.0</a>Andrea MacNeill MD MSc FRCSC Surgical Oncologist & General Surgeon University of British Columbia Vancouver General Hospital BC Cancer Agency MedicalResearch.com: What is the background for this study? Response: Climate change is one of the most pressing public health issues of the present era, responsible for 140,000 deaths annually.  Somewhat paradoxically, the health sector itself has a considerable carbon footprint, as well as other detrimental environmental impacts.  Within the health sector, operating rooms are known to be one of the most resource-intensive areas and have thus been identified as a strategic target for emissions reductions. (more…)
Author Interviews, NEJM, Surgical Research, Technology / 06.12.2017

MedicalResearch.com Interview with: Suresh Vedantham, M.D. Principal Investigator, ATTRACT Trial Professor of Radiology & Surgery Mallinckrodt Institute of Radiology Washington University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response:   About 300,000 Americans each year are diagnosed with a blood clot (deep vein thrombosis, DVT) for the first time.  In total, about 600,000 Americans have a DVT each year, as noted in the 2008 Surgeon General’s Call to Action. Despite the use of standard treatment (blood thinning drugs and compression stockings), about 40% of DVT patients develop a long-term complication called post-thrombotic syndrome (PTS).  PTS impairs patients’ quality of life and typically causes chronic pain and swelling of the leg that occur on a daily basis. In many patients, this leads to major disability the prevents them from walking, working, or conducting normal daily activities. Some patients develop painful open sores on the leg called “venous ulcers”, that are difficult to heal. Pharmacomechanical catheter-directed thrombolysis (“PCDT”) is a minimally-invasive treatment that removes blood clots through a tiny (2-3 mm) incision using the clot-busting drug tissue plasminogen activator (TPA) along with catheter-based devices that can chew up the clots. The benefits and risks of PCDT have not before been evaluated for DVT treatment in a rigorous study.      The final results of the ATTRACT Trial, which was primarily sponsored by the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH), are being published in The New England Journal of Medicine.  ATTRACT, the most rigorous study to date of clot-busting treatment for DVT, was a multicenter randomized controlled trial comparing PCDT and standard therapy versus standard therapy alone in 692 patients with above-knee DVT. This landmark study, conducted in 56 U.S. hospitals, was led by Principal Investigator Dr. Suresh Vedantham, Professor of Radiology & Surgery at the Mallinckrodt Institute of Radiology at Washington University in St. Louis, along with outstanding DVT researchers at McMaster University (Hamilton, Ontario [Canada]), the Massachusetts General Hospital (Boston, MA), and the Mid America Heart Institute (Kansas City, MO).   The primary study result is that for most patients with DVT, the addition of PCDT to standard therapy does not prevent the development of PTS.  Because the use of PCDT involves a small but significant increase in major bleeding complications, it should not be routinely used as first-line DVT treatment.  However, PCDT did reduce the severity of PTS and appeared likely to provide better relief of DVT-related leg pain and swelling.  Further analyses will determine which DVT patients are most likely to experience these benefits. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 06.12.2017

MedicalResearch.com Interview with: Anita P. Courcoulas MD, MPH Professor of Surgery, Chief MIS Bariatric & General Surgery University of Pittsburgh Medical Center MedicalResearch.com: What is the background for this study? Response: This study is the main long term outcomes report from The Longitudinal Assessment of Bariatric Surgery (LABS) Study, an NIH-NIDDK ( National Institute of Diabetes and Digestive and Kidney Diseases) funded study at 10 hospitals in 6 clinical centers and a data coordinating center.  It was a multicenter, prospective three phase longitudinal cohort study that began recruitment of participants in 2006 when gastric bypass and laparoscopic adjustable banding were the two most common bariatric procedures performed in the U.S. The goal of this particular study from LABS was to address the longer-term durability and variability of weight loss and the assess the longer-term impact of bariatric surgery on major health conditions including diabetes, dyslipidemia, and hypertension. (more…)
Author Interviews, Boehringer Ingelheim, Surgical Research / 27.11.2017

MedicalResearch.com Interview with: Thomas Seck, M.D., vice president Clinical Development and Medical Affairs Primary Care Boehringer Ingelheim Pharmaceuticals, Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Response: This is a new subanalysis of the phase III RE-VERSE AD™ study, which evaluated the safety and efficacy of idarucizumab, marketed in the U.S. as Praxbind®, in reversing the anticoagulant effect of Pradaxa® (dabigatran etexilate mesylate). This data assessed idarucizumab in a subset of patients requiring an urgent procedure or emergency surgery. The analysis found that idarucizumab rapidly and completely reversed the anticoagulant effect of dabigatran in approximately 98 percent of patients based on dTT. The median time between administration of idarucizumab and start of surgery was 1.7 hours for patients requiring abdominal procedures, 1.9 hours for orthopedic procedures, 1.4 hours for vascular procedures, 1.3 hours for drainage procedures and 1.2 hours for catheter procedures. Among these patients, periprocedural homeostasis was assessed as normal in more than 92 percent of patients, across all surgery types. (more…)
Author Interviews, JAMA, Surgical Research / 26.11.2017

MedicalResearch.com Interview with: Brian C. Stagg, MD Department of Ophthalmology and Visual Sciences University of Michigan Medical School National Clinician Scholars Program University of Michigan Institute for Healthcare Policy and Innovation Joshua D. Stein, MD, MS Associate Professor University of Michigan Department of Ophthalmology and Visual Sciences Director, Center for Eye Policy and Innovation Ann Arbor  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cataract surgery is one of the most common surgeries in the US. It is typically performed at either hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs). ASCs are cheaper and more efficient, but some people believe that HOPDs may be safer for people with co-morbid medical conditions. We conducted this study to evaluate how the use of ambulatory surgery centers for cataract and other ocular surgeries has changed since 2001. We also wanted to see what factors influenced whether or not a patient had cataract surgery at an ASC (versus a HOPD), and to compare ASC use for cataract surgery with ASC use for other common eye surgeries (glaucoma, cornea, retina, strabismus). (more…)
Alcohol, Author Interviews, Surgical Research, Weight Research / 20.11.2017

MedicalResearch.com Interview with: “Alcohol” by Takahiro Yamagiwa is licensed under CC BY 2.0 Marta Yanina Pepino PhD Department of Food Science and Human Nutrition College of Agricultural, Consumer and Environmental Sciences University of Illinois Urbana, IL  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study is not the first to look at whether sleeve gastrectomy affects alcohol absorption and metabolism. Before our study, there were three published studies in the literature on this issue. However, findings from these studies were discrepant. Two of the studies found that sleeve gastrectomy did not affect blood alcohol levels and one of the studies did found that peak blood alcohol levels were higher when people drink after having a sleeve gastrectomy. All these three studies used a breathalyzer to estimate blood alcohol levels. Our study tested the following two related hypothesis. First, that similar to Roux-en-Y- gastric bypass (RYGB), sleeve gastrectomy accelerates alcohol absorption, which cause peak blood alcohol levels to be higher and much faster than before surgery. Because the breathalyzer requires a 15 min of waiting time between drinking the last sip of alcohol and the time that you can read a good estimate of blood alcohol levels from the breath, we hypothesized that the breathalyzer was not a good technique to estimate peak blood alcohol levels in people who may reach a peak blood alcohol level before those 15 min have passed, such as people who underwent sleeve gastrectomy or RYGB. We found these two hypothesis to be truth: 1) Sleeve gastrectomy, similar to RYGB, can double blood alcohol levels; and 2) The breathalyzer technique is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol (it underestimate blood alcohol levels by ~27% and it may miss peak blood alcohol levels). (more…)
Author Interviews, Heart Disease, Surgical Research, Weight Research / 16.11.2017

MedicalResearch.com Interview with: “Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr. Carlos Aurelio Schiavon Research Institute, Heart Hospital São Paulo, Brazil  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity. To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses. After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension. (more…)
Author Interviews, JAMA, Opiods, Surgical Research / 16.11.2017

MedicalResearch.com Interview with: “Surgery” by mrpbps is licensed under CC BY 2.0Sagar Patel MD Facial Plastic Surgeon Board Certified Otolaryngology, Head and Neck Surgeon Facial Plastic Surgery Associates, Houston, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Response: While the majority of diverted opioids that are abused originate from pills prescribed for chronic conditions, with 214,000 rhinoplasties performed in the US in 2015, assessing opioid usage after rhinoplasty is an important view into prescription practices for acute pain after surgical procedures. Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed. We them mathematically analyzed. (more…)
Author Interviews, BMJ, Imperial College, Surgical Research / 15.11.2017

MedicalResearch.com Interview with:     Professor JT Powell PhD, MD, FRCPath Faculty of Medicine, Department of Surgery & CancerImperial College London       MedicalResearch.com: What is the background for this study? Response: The mortality from ruptured abdominal aortic aneurysm (AAA) remains very high causing about 6000 deaths each year in the UK.  The only hope for survival is an emergency operation to repair the burst aorta.  Even so the mortality may be as high as 45% within a month of repair using open surgery. It has been suggested that minimally invasive repair using keyhole or endovascular techniques would lower the mortality to about 25% within a month of repair.  However not all shapes of aorta are suitable for endovascular repair (also called EVAR). (more…)
Author Interviews, JAMA, Lung Cancer, Medical Imaging, Surgical Research, Vanderbilt / 10.11.2017

MedicalResearch.com Interview with: Amelia W. Maiga, MD MPH Vanderbilt General Surgery Resident VA Quality Scholar, TVHS MedicalResearch.com: What is the background for this study? What are the main findings? Response: Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. Our investigation adds to growing evidence that FDG-PET scans should be interpreted with caution in the diagnosis of lung cancer. Misdiagnosis of lung lesions driven by FDG-PET avidity can lead to unnecessary tests and surgeries for patients, along with potentially additional complications and mortality. To estimate FDG-PET diagnostic accuracy, we conducted a multi-center retrospective cohort study. The seven cohorts originating from Tennessee, Arizona, Massachusetts and Virginia together comprised 1188 nodules, 81 percent of which were malignant. Smaller nodules were missed by FDG-PET imaging. Surprisingly, negative PET scans were also not reliable indicators of the absence of disease, especially in patients with smaller nodules or who are known to have a high probability of lung cancer prior to the FDG-PET test. Our study supports a previous meta-analyses that found FDG-PET to be less reliable in regions of the country where fungal lung diseases are endemic. The most common fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and coccidioidomycosis is prevalent in the southwestern U.S. These infections generate inflamed nodules in the lungs (granulomas), which can be mistaken for cancerous lesions by imaging. (more…)
Abuse and Neglect, Circadian Rhythm, Heart Disease, Lancet, Surgical Research / 03.11.2017

MedicalResearch.com Interview with: Prof David Montaigne MD Faculté de Médecine de Lille H Warembourg Lille, France MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known for many decades that cardiovascular diseases exhibit a diurnal variation with for instance higher incidence of myocardial infarction in the early morning as opposed to the evening. Although studies on circadian gene knock-out and mutant mice argue for a biorhythm in myocardial ischemia-reperfusion tolerance, whether a biorhythm in the myocardial tolerance to ischemia, exists in humans was unclear because of conflicting reports in the context of myocardial infarction. We demonstrated for the first time in humans that the myocardial tolerance to ischemia-reperfusion is different along the day, in line with rodent experiments performed in the early 2010s. We demonstrated that this biorhythm is clinically meaningful and that it can be targeted as a cardioprotective strategy. In this topic, Rever-alpha is of specific interest. It belongs at the same time to circadian genes and nuclear receptor families: being a nuclear receptor, it is a feasible pharmacological target, conversely to other circadian genes. (more…)
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 31.10.2017

MedicalResearch.com Interview with: Philipp Gerner MD Candidate - Class of 2018 University of Massachusetts Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids. As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients. Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain. (more…)
Author Interviews, Epilepsy, NEJM, Neurological Disorders, Pediatrics, Surgical Research / 25.10.2017

MedicalResearch.com Interview with: Dr. Manjari Tripathi Professor, Epileptology, Neurology Dr. P Sarat Chandra, Chief epilepsy Neurosurgeon AIIMS, New Delhi MedicalResearch.com: What is the background for this study?:
  1. Surgery for drug resistant epilepsy (DRE) is an accepted procedure for children and there have been multiple surgical series and surgical techniques published in literature. However, till date there are no randomized controlled trials (RCT) available to objectively demonstrate the safety and efficacy of surgical therapy in children with DRE. There are till date only 2 randomized trials for adult patients with drug resistant epilepsy (both for mesial temporal sclerosis only, Wiebe S et al, New Eng J Med, 2001 & Engel J et al, JAMA, 2012).
  2. Children constitute a significant proportion of patients undergoing surgical therapy for DRE (close to 50% in tertiary centers). They have unique problems associated due to uncontrolled epilepsy and some of these include epileptic encephalopathy and status epilepticus. In addition, surgery is also associated with problems like hypothermia, issues related to blood loss etc. Thus the senior author (Manjari Tripathi) and her team felt that a RCT would be very important to objectively assess the role of surgery and hence designed this study.
(more…)
Author Interviews, JAMA, Kidney Disease, Surgical Research / 25.10.2017

MedicalResearch.com Interview with: In Gab Jeong, MD Associate Professor Department of Urology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea MedicalResearch.com: What is the background for this study? What are the main findings? Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown. We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519). (more…)
Anesthesiology, Author Interviews, Pediatrics, Surgical Research, Technology / 18.10.2017

MedicalResearch.com Interview with: Dr. Sunghee Han Professor Seoul National Unversity College of Medicine Seoul National University Hospital Department of Anesthesia and Pain Medicin What is the background for this new technology and study? What are the main findings? Response: The time from patient arrival in the operating theatre to induction of general anesthesia is one of the most stressful moments for children undergoing surgery. Various strategies such as 'pre-operative guided operating room tour' or 'therapeutic play intervention' have been developed in order to reduce children's pre-operative anxiety. Although these existing simulation-based approaches may be effective, they have not been widely used in real clinical settings with limited budget and resources such as manpower and space. Virtual Reality(VR), a relatively new technology in the field of healthcare, can allow the user to experience an immersive environment. In this study, using VR technology, we provided the children with a realistic trip to the operating theatre accompanied by ‘My best friend’ Pororo. “Pororo, The Little Penguin” is a very famous cartoon character in Korea and Asia. Most children in Korea watch Pororo in TV, play with Pororo toys since early yeas and perceive Pororo as a ‘close friend’. In the VR content used in this study, Pororo acts as a patient and is subjected to anesthesia and surgery himself. Pororo kindly brings his friend(the viewer; paediatric patient) to the theatre and shows all that is going on in there. Intervention with the VR content was able to reduce the level of anxiety in paediatric patients and promote collaborative behavior and acceptance of the invasive procedures, especially general anesthesia. Parental satisfaction level was also relatively higher in the VR group. (more…)
Author Interviews, ENT, JAMA, Stanford, Surgical Research / 12.10.2017

MedicalResearch.com Interview with: David Schoppy, MD PhD Resident, Division of Head and Neck Surgery Department of Otolaryngology Stanford University School of Medicine Stanford, Palo Alto, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type). This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery - achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached. This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs. (more…)
Annals Thoracic Surgery, Author Interviews, Gender Differences, Heart Disease, Surgical Research, Women's Heart Health / 06.10.2017

MedicalResearch.com Interview with: Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa MedicalResearch.com: What is the background for this study? What are the main findings Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes. The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG). (more…)
Author Interviews, Dermatology, JAMA, Melanoma, Surgical Research / 05.10.2017

MedicalResearch.com Interview with: Adewole Adamson, MD, MPP Department of Dermatology UNC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgery is the primary intervention for the treatment of melanoma. Little is known about how delays for surgery, defined as the time between diagnosis and surgical treatment, among melanoma patient differ by insurance type. After adjustment of patient-level, provider-level, and tumor-level factors we found that Medicaid patients experience a 36% increased risk of delays in surgery for melanoma. These delays were 19% less likely in patients diagnosed and 18% less likely in patients surgically treated by dermatologists. Non-white patients also had a 38% increased risk of delays. (more…)
Author Interviews, Clots - Coagulation, Genetic Research, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Anne R. Bass, MD Associate Professor of Clinical Medicine Weill Cornell Medical College Rheumatology Fellowship Program Director Hospital for Special Surgery New York, NY 10021 MedicalResearch.com: What is the background for this study? Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient. In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Marc D. Basson, MD, PhD, MBA Professor of Surgery, Pathology, and Biomedical Science Senior Associate Dean for Medicine and Research University of North Dakota School of Medicine & Health Sciences Grand Forks, ND 58202  MedicalResearch.com: What is the background for this study? What are the main findings? Response: I and other surgeons have previously had the experience of caring for patients with appendicitis who had recently undergone colonoscopy, and wondered if there might be a connection.  However, colonoscopy and appendicitis are both common events, and so it would be difficult to tell whether they are linked or just coincidences from scattered occurrences. After obtaining appropriate regulatory approvals, we identified almost 400,000 veterans from the US Department of Veterans Affairs database who had undergone screening colonoscopy and compared their rates of appendectomy and acute appendicitis in the week following colonoscopy to rates of appendectomy and appendicitis over each of the following 51 weeks.  We asked the question in several different ways and verified our results by examining surgical and pathology reports.  Depending on how the question was asked and appendicitis or appendectomy defined, rates of appendectomy and appendicitis were clearly 4-9 times higher in the first week after diagnostic colonoscopy.  This wasn’t true when we asked whether appendectomy was more common after several other procedures that also required sedation and contact with the medical system. (more…)
Author Interviews, Dermatology, JAMA, Surgical Research / 28.09.2017

MedicalResearch.com Interview with: P. Daniel Ward, MD, MS, FACS Facial Plastic Surgeon WardMD Form Medical SpaAdjunct Associate Professor, University of Utah School of Medicine Salt Lake City, Utah 84121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: As a facial plastic surgeon with an interest in finding treatments for patients with facial paralysis, we are always looking for ways to improve the care that our patients receive. One of those treatments is to treat the effects of abnormal and asymmetric facial motion with botulinum, which decreases the deformity that results from facial nerve disorders by decreasing muscular hyperactivity. This study was based on the fact that there are three commercially available types of botulinum available for treatment of the face. There have been studies that have compared the different types of botulinum for cosmetic purposes, but there have not been any studies that specifically looked to see if there were any differences between the different types of botulinum when used for treatment of facial nerve disorders. The main finding of the study is that the three different types of botulinum are essentially equivalent with the exception being that one type of botulinum, incobotulinum toxin, was slightly less effective than the other two types of botulinum at the 4-week follow up point. Of note, all three types were equivalent at all other time points. (more…)