MedicalResearch.com Interview with:
Professor John McDonald PhD
Director of its Integrated Cancer Research Center
School of Biology at the Georgia Institute of Technology
Medical Research: What is the background for this study? What are the main findings?
Response: Ovarian cancer is a deadly disease because it cannot be diagnosed at early stages when it can be most effectively effectively treated.
It has long been recognized that there is a great need for an accurate diagnostic test for early stage ovarian cancer.
Until now, efforts to develop a highly accurate way to detect early stage ovarian cancer have been unsuccessful.
We have used a novel approach that integrates advanced methods in analytical chemistry with advanced machine learning algorithms to identify 16 metabolites that collectively can detect ovarian cancer with extremely high accuracy (100% in the samples tested in our study)
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MedicalResearch.com Interview with:
Dustin T. Duncan, ScD
Assistant Professor
Department of Population Health and
Dr. Paul Krebs PhD
Assistant Professor in the Department of Population Health
New York University School of MedicineMedical Research: What is the background for this study? What are the main findings?
Dr. Krebs: Everyone seems to be talking about health apps, but there was no quality research on what was actually happening in the US with regard to these apps. Knowing why people use and don’t use health-related apps is critical for advancing this area of healthcare. In terms of main findings, we found that a little over half of Americans are using a health-related app, primarily in the domains of fitness and nutrition. We also found greater use among minority populations, younger persons, among people who were obese, and those with higher incomes. Surprisingly we found that about 40% of people would not pay anything for a health app. Hidden costs and difficulty of data entry were main reasons people stopped using them.
Dr. Duncan: Little is know about health app use, which was surprising to us—especially because many people have smartphones so downloading a health app can easy. We wanted to understand the landscape of health app use and patterns in the US to ultimately improve the population’s health.
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MedicalResearch.com Interview with:
Anuradha Godavarty PhD
and
Dr. Sarah J Erickson-Bhatt PhD
Dept of Biomedical Engineering,
Florida International University
Miami, FL
Medical Research: What is the background for this study? What are the main findings?
Response: It is well known that early detection and staging of breast cancer is crucial in order to save lives. While the current gold standard for breast cancer screening is x-ray mammography, this method still misses many cancers especially in younger women with denser tissue. Our group and others have explored diffuse optical tomography using near-infrared light to image breast tumors. We have developed a unique optical imager with a hand-held probe that can contour to breast curvature in order to image the tissue without painful compression and without ionizing radiation (like x-rays). This study demonstrated the ability of the device to detect lesions in breast cancer patients due to elevated levels of total hemoglobin concentration in tumor vasculature. The hand-held has a potential to not only image the breast contours, but the probe was flexible to image the surrounding chest wall regions, thus expanding its application to image lymphatic spread as well.
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MedicalResearch.com Interview with:
Dr. Carmine SimoneMD, FRCSC
Chief, Department of Surgery, Toronto East General Hospital
Co-Program Medical Director, Surgery HealthService, Toronto East General Hospital
Lecturer, University of Toronto, Division of Thoracic Surgery
Courtesy Staff, Sunnybrook Health Sciences Centre & Royal Victoria Hospital, Barrie
Medical Research: What is the background for this study? What are the main findings?
Dr. Simone: Patients preparing for surgery are often overwhelmed with information. Most of the time patients are given written instructions regarding preoperative preparation as well as written information at discharge. Our own institutional experience is that only 2/3 of patients read the information we provide and less than half of these patients can understand or retain the information they read.
We have found that providing patients SMS alerts or reminders leading up to their surgery increases the likelihood that they will follow instructions and keep their appointments. Furthermore having patients log their progress after discharged from hospital allows patients to track their progress and report complications earlier and avoid coming to the ER. Educational modules enable patients to better gauge their symptoms and make more informed decisions about calling the surgeon’s office or proceeding to the emergency department. We found a significant reduction in the number of ER visits and cancelled procedures after implementing the mobile device reminders and post-discharge daily log.
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[wysija_form id="5"]MedicalResearch.com Interview with:
Professor Philip Breedon
Professor of smart technologies
Nottingham Trent University
Design for Health and Wellbeing Research GroupMedical Research: What is the background for this study?
Prof. Breedon: This report presented an innovative approach of enhancing the efficiency of spinal surgery by utilizing the technological capabilities and design functionalities of wearable headsets, in this case Google Glass. The overall aim was to improve the efficiency of the Selective Dorsal Rhizotomy ( SDR) neurosurgical procedure through the use of Google Glass via an innovative approach to information design for the intraoperative monitoring display.
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[caption id="attachment_18704" align="alignleft" width="149"] Dr. Charuhas Thakar[/caption]
MedicalResearch.com Interview with:
Charuhas V. Thakar, MD, FASN
Professor of Medicine
Director, Division of Nephrology and Hypertension
University...
MedicalResearch.com Interview with:
Ashley K. Day, Ph.D., M. Psych (Hlth)
Post-Doctoral Associate
Rutgers Cancer Institute of New Jersey
Medical Research: What is the background for this study? What are the main findings?
Dr. Day: Skin cancer is one of the most common cancers in the US, and it is estimated that more than 9,000 Americans will die of melanoma this year. Melanoma patients have a 9-times greater risk for a diagnosis of another melanoma compared to the general population. Because of this, it is important that melanoma patients practice regular sun protection and skin self-examination behaviors. There is potential opportunity to use the Internet to deliver information and interventions to help melanoma patients engage in these behaviors. However, it is important to understand patients’ preferences. Our research explored factors associated with the receptivity of patients with melanoma to such Internet-delivered behavioral interventions.
We found that, in a sample of 176 melanoma patients, the vast majority (84.1%) had Internet access and had previously sought melanoma information online (77.7%). More than two-thirds of patients (68.4%) reported being at least moderately interested in participating in an Internet-based intervention to promote engagement in sun protection and skin self-examination behaviors. Receptivity to such an intervention was higher among patients who were younger, had greater knowledge of the ABCDE signs of melanoma (looking at the asymmetry, border irregularity, color, diameter, and evolution of the mole or affected area), and were more comfortable using the Internet.
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MedicalResearch.com Interview with:
Ichiro Morioka, M.D.
Professor of Pediatrics, Kobe University Graduate School of Medicine
Chuo-ku, Kobe, JapanMedical Research: What is the background for this study? What are the main findings?
Dr. Morioka: Japan has the highest survival rate for preterm infants due to recent advanced medical treatment and the availability of Neonatal Intensive Care Units (NICU). Despite this, cases of cerebral palsy and hearing loss caused by neonatal jaundice continue (kernicterus) to occur, with cases reported for at least 2 in every 1000 infants born before the 30th week of gestation. It has also been established that cases of jaundice can worsen even two weeks after birth and thereafter, meaning that there is a need for continuous long-term jaundice monitoring of infants in the NICU. However, jaundice in preterm infants is difficult to detect through physical observations, and monitoring through a daily blood test is not a realistic option.
We focused on transcutaneous jaundice monitoring used in daily health tests for full term infants. The bilirubin levels of 85 infants with a birth weight of under 1500 grams were monitored in NICUs at Kobe University, Kakogawa City Hospital, Hyogo Prefectural Kobe Children’s Hospital, Japanese Red Cross Society Himeji Hospital, and Takatsuki General Hospital, and were taken a total of 383 transcutaneous and blood bilirubin measurements at the same time. Through our results we were able to ascertain that the chest and back areas of preterm infants have the highest levels of sensitivity, and transcutaneous bilirubin levels in those areas were close to bilirubin levels in the blood. In addition to expanding the possibilities for transcutaneous monitoring of jaundice in preterm infants, we discovered the optimum area of skin to monitor it.
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MedicalResearch.com Interview with: An Do, MD
Assistant Professor
Department of Neurology
University of California, Irvine
Medical Research: What is the background for this study? What are the main findings?
Dr. An Do: In this study, we demonstrated that it is possible for a person with paraplegia due to spinal cord injury to regain brain-controlled walking through the use of a brain-computer interface. This system records EEG signals as a person is thinking about walking. While the person is thinking about walking, EEG signals change in a manner which can be detected by a computer algorithm. Upon detecting that a person is thinking about walking from the EEG signals, the computer sends a command signal to an electrical stimulation system to stimulate the nerves in the legs to continuously generate alternating right and left stepping movements. This stepping stimulation stops when he stops thinking about walking.
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MedicalResearch.com Interview with:
Wencui Han PhD
Assistant Professor
Business Administration
University of Illinois at Urbana Champaign
Medical Research: What is the background for this study? What are the main findings?
Dr. Han: Well-designed disease registries integrate a variety of information, including patient demographics, laboratory results, pharmacy data, and comorbidity data, to serve a variety of functions outside the clinical encounter. However, the adoption of disease registries by healthcare organizations is associated with significant direct and indirect costs. The impacts of using disease registries that meet meaningful use (MU) requirements in improving health outcomes and creating cost savings are understudied. This study examines the impact of using a registry for patient reminders and for improvement of the quality of care, hospital utilization, and cost saving. The results suggest that the use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes.
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MedicalResearch.com Interview with:
Dr. Xiaohu Xia Ph.D.
Assistant Professor
Department of Chemistry
Michigan Technological University
Houghton, MI 49931
Medical Research: What is the background for this study? What are the main findings?
Dr. Xia: Peroxidases, a family of enzymes that catalyze the oxidation of certain compounds with peroxides, have found widespread use in areas such as biomedicine and environmental protection. Over the past several years, researchers have found that certain inorganic nanomaterials (such as nanoparticles made of metal, metal oxides, and carbon) possess intrinsic peroxidase-like activities. As the major advantage over their natural counterparts, these peroxidase mimics are much more stable because they are less vulnerable to denaturation and protease digestion. In spite of the superior stability of the mimics, improvement in their catalytic efficiency has been met with limited success. The catalytic efficiencies for most of the previously reported peroxidase mimics with sizes 1-100 nm are limited to the range of 101-104 s-1 in terms of catalytic constant (Kcat, which measures the maximum number of chemical conversions of substrate molecules per second per enzyme/mimic).
Our research team have recently developed a new type of peroxidase mimic with a record high efficiency that was engineered by coating ~18 nm palladium (Pd) nanocubes with ultrathin iridium (Ir) skins of a few atomic layers (i.e., Pd-Ir core-shell cubes, see Figure). The catalytic efficiency of our Pd-Ir cubes could reach a level of Kcat = 106 s-1.
In view of the substantially enhanced efficiency, we applied our Pd-Ir cubes to the colorimetric enzyme-linked immunosorbent assay (ELISA) of human prostate surface antigen (PSA) by functionalizing their surface with antibodies. The detection limit of the Pd-Ir cubes-based ELISA of PSA was determined to be 0.67 pg/mL, which is over 100-fold lower than that of the conventional horseradish peroxidase(HRP)-based ELISA using the same set of antibodies and the same procedure (see Figure).
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MedicalResearch.com Interview with:
Stephanie J. Crowley, Ph.D.
Assistant Professor
Biological Rhythms Research Laboratory
Department of Behavioral Sciences
Rush University Medical Center
Chicago, IL 60612
Medical Research: What is the background for this study? Dr. Crowley: Your readers may have seen recent reports by the American Academy of Pediatrics and the CDC about problems with early morning school bells for teens and the need to push school start times later. These recent calls for later school start times come from data showing that biological processes make it challenging for a teen to get enough sleep and be rested for school when they have to wake up very early for school. One of these biological processes is the circadian timing system, which is the approximate 24-hour brain clock that regulates the timing of sleep and wake. During the teen years, the brain clock is shifted later making it more difficult for many teens to fall asleep early enough to get sufficient sleep on school nights.
Medical Research: What are the main findings?
Dr. Crowley: Melatonin suppression, as tested in this new study, is a good indication of how light affects the circadian system. Our findings show that even a very small amount of light (similar to “romantic mood lighting”) in the evening suppressed melatonin levels in the middle-school-aged adolescents. Because evening light “seen” by the brain clock shifts the clock later in time, the message is that biologically-driven later sleep times starts at this early age and needs to be considered when managing school and sleep schedules.
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MedicalResearch.com Interview with:
Dr. Jeff Karp Ph.D
Associate Professor of Medicine
Brigham and Women's Hospital
Harvard Medical School
Cambridge, MA 02139 and
Giovanni TraversoM.B., B.Ch., Ph.D
The David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology, Cambridge, MA
Medical Research: What is the background for this study? What are the main findings
Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment. Enema therapy has 3 major issues.
It is difficult to retain
There is high systemic absorption of the drug (that can lead to toxic side effects), and
Compliance is low as patients must take enemas every day.
Our approach can potentially address all three. The engineered gel that we designed has dual targeting capability. It rapidly attaches to ulcers within seconds to minutes (we have 5-10x less systemic absorption as the gel only attaches to ulcers) and selectively releases drug in the presence of ulcers, and we showed that we could reduce the dosing frequency.
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MedicalResearch.com Interview with:
Conrad Earnest, PhD, FACSM
Texas A&M University
College Station, TX
Medical Research: What is the background for this study? Dr. Earnest: The study presented here is a thesis project performed by Robbyne Smith and Sammy Licence, under the direction of Professor Conrad Earnest. We were curious to about the effects of walking, texting and doing both while simultaneously being cognitively distracted by common tasks - in our case a maths test.
Much of our curiosity was born from watching a YouTube video and reading an article on inattentional blindness where people did not notice a unicycling clown while using their mobile phones.
https://www.youtube.com/watch?v=Ysbk_28F068
Several reports suggest that this type of pedestrian behavior leads to more pedestrian accidents, possibly increases the risk of tripping and increases riskier road crossing behavior due to a lack of attention.
While much of the literature has examined this question using a “straight line” model to look at walking characteristics and deviations within ones walking path, we elected to build an obstacle course that imitated common barriers that we measured in the city of Bath, England, that pedestrians might encounter during their walking day.
Medical Research: What are the main findings?Dr. Earnest: Our main findings were that people slowed their walking speed, took more steps in their approach to common obstacles, and increased the height of their step to go up steps and over curbs.
Interestingly, we did not see an increase in what we called barrier contacts, which were used as a surrogate measure for tripping.
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MedicalResearch.com Interview with:
Adam Friedman, MD, FAAD
Associate Professor of Dermatology
Residency Program Director
Director of Translational Research
Department of Dermatology
George Washington School of Medicine and Health Sciences
Medical Research: What is the background for this study? What are the main findings?
Dr. Friedman: Acne vulgaris is one of the most common skin disease that affects approximately 40-50 million people in the United States. Acne’s multifactorial etiology, resulting from a mix of androgen-induced elevations in sebum production, abnormal follicular epithelial desquamation and proliferation, hypercolonization of Propionibacterium acnes and host inflammatory reactions, make treatment often times challenging. In looking at the topical therapeutic armament for Acne Vulgaris, which includes benzoyl peroxide, salicyclic acid, topical antibiotics such as clindamycin, and retinoids, all suffer from various related side effects including irritation, erythema, dryness, peeling and scaling, bacterial resistance, and resulting dyschromia from the associated irritation in patients of darker skin types. These adverse events often serve as major limiting factors influencing patient compliance and ultimately impacting efficacy. Therefore new treatments which target all of the complexities of acne are needed, especially given we have not had anything really new brought to market in years. Here, we looked to biology for the answer. Our bodies generate Nitric Oxide, a diatomic lipid loving gaseous molecule, to perform a broad range of biological activities, including but not limited to killing bacteria/fungi/viruses and inhibiting inflammation - key elements in Acne. Its action however is very short lived and therefore using Nitric Oxide as a treatment is difficult as one would need a delivery system that would allow for continued and controlled release. Enter nanotechnology. We designed exceedingly small particles (of note, 1 nanometer = 1 billionth of a meter) which allow for the generation of nitric oxide gas from nitrite salt, and will only release the gas when exposed to moisture over time. The size of the particles also enables them to better interact with their environment, i.e. cells, pathogens, improving their activity as compared to large sized treatments
In this study, we showed that the nitric oxide generating/releasing nano particles effectively killed the organism, P. acnes but was not toxic to both human skin cells and a live vertebrae model (embryonic zebra fish). More importantly, we found that the nano particles inhibits the activation of a newly recognized but exceedingly important inflammatory pathway that is directly tied to the formation of an acne lesion, called the NLRP3 inflammasome. Research has shown that our bodies already regulate this pathway with nitric oxide, and therefore once again, we are looking to biology for answers. As opposed to a drug that may only have one target, the nanoparticles inhibited multiple components/elements of the inflammasome pathway, giving some insight into its potential as a treatment for acne as well as other inflammatory diseases.(more…)
MedicalResearch.com Interview with:
Dr. Carsten Lennerz
Deutsches Herzzentrum
München
Medical Research: What is the background for this study? What are the main findings?Response: The number of cardiovascular implantable electronic devices (CIEDs) is increasing. Worldwide more than 4 million people rely on an implanted pacemaker (PM) or implantable cardioverter defibrillator ICD. Sensing intrinsic cardiac electrical activity is the core principle of all CIED devices, however in case of electromagnetic interference (EMI) exogenous electric and magnetic fields can be picked up by the sensing circuit and mistakenly interpreted as a cardiac signal by the CIED. PM can respond to EMI with pacing-inhibition, leading to bradycardia or asystole and resulting in syncope. In ICDs EMI may be detected as a life threatening ventricular arrhythmia with the subsequent delivery of inappropriate shocks.
Early studies on EMI, run more than 10 years ago, have identified mobile phones as a source of EMI with pacemakers. Based on these pacemaker studies the CIED manufacturer and the regulatory authorities (e.g. Food and Drug Administration [FDA]) currently recommend a safety distance, i.e. hold the phone to the contra-lateral ear and avoid placing a turned-on phone next to the generator pocket.
In the meantime telecommunication and the CIED techniques have dramatically evolved. The classic mobile phone has been replaced by modern smartphones, furthermore the network standards have changed from GSM to UMTS (3G) and LTE (4G). New cardiac devices are now in use including more devices for cardiac resynchronisation therapy (CRT) or for the protection from sudden cardiac death (ICD); some of them are even compatible for MRI diagnostics.
With the use of a hemertic titanium shell, new filtering properties of the feed-throughs, sense amplifiers and noise protection algorhythms as well as the predominant use of bipolar leads the CIED may be better shielded against external influences and adverse effects of EMI.
In light of the above, the purpose of our study was to evaluate if previous precautions recommended to cardiovascular implantable electronic devices recipients are still up-to-date or if they can be abandoned. By today there are neither studies focusing on EMI between modern smartphones and modern CIEDs nor on newer mobile network standards (UMTS or LTE).
In a cross-sectional study we enrolled 308 patients and exposed them to the electromagnetic field of three smartphones (Samsung Galaxy 3, Nokia Lumia, HTC One XL) by placing the handhelds directly over the pulse generator. Installing an own base mobile network station we ensured that each smartphone went through a standardized protocol that included the entire calling process (connecting, ringing, talking), the handovers between all current network standards (GSM, UMTS, LTE where applicable) and operation at maximal transmission power.
More than 3.400 tests on electromagnetic interference were performed. One out of 308 patients (0.3%) was repeatedly affected by EMI caused by smartphones. The patient’s MRI compatible CRT-defibrillator malfunctioned with short-term ventricular and atrial oversensing when exposed to Nokia or HTC smartphones operating at GSM and UMTS. (more…)
MedicalResearch.com Interview with:
Vanita Ahuja, MD, MPH
Department of General Surgery
York Hospital, York, Pennsylvania
MedicalResearch: What is the background for this study? What are the main findings?Dr. Ahuja: Robotic-assisted surgery has been slowly accepted within the medical community. Felger et al. (1999), Falk et al. (2000), and Loumet et al. (2000) state that specific to cardiac surgery, the advantages of the robot in coronary artery bypass grafting (CABG) and valvular operations were demonstrated with increased visualization, ease of harvest, and quality of vascular anastomoses as early as 1999. However, Giulianotti, et al. (2003), Morgan et al. (2005), and Barbash et al. (2010) suggest that although safety and efficacy are supported, it is not conclusive yet that robot-assisted surgery is cost-effective, given the high cost of the robot itself, longer operating times, and the short life of the robotic instruments. The purpose of our paper was to compare outcomes of complications, length of stay (LOS), actual cost, and mortality between non-robotic and robotic-assisted cardiac surgery.
In general surgery and subspecialties, the use of the robot has increased significantly over the past few years. It has been noted that robotic surgery improves on laparoscopic surgery by providing increased intra-cavity articulation, increased degrees of freedom, and downscaling of motion amplitude that may reduce the strain on the surgeon.
The biggest growth in robotic surgery has been seen in the fields of gynecology and urology. Recently, Wright et al. reported an increase in robotic assisted hysterectomy from 0.5 percent of the procedures in 2007 compared to 9.5 percent in 2010 for benign disease. In their study, robotic assisted surgery had similar outcomes to laparoscopic surgery but higher total cost of $2,189 more per case. In urologic surgery, Leddy et al. reported in 2010 that radical prostatectomy remains the biggest utilization of robotic assisted surgery in urology with 1% in 2001 to 40% of all cases in 2006 performed in the United States.
Utilizing a nationwide database from 2008-2011, subjects were propensity matched by 14 patient characteristics to reduce selection bias in a retrospective study. The patients were then divided into three groups by operation types: valves, vessels and other type. Univariate analysis revealed that robotic-assisted surgery, compared to non-robotic surgery, had higher cost ($39,030 vs. $36,340), but lower LOS (5 vs. 6 days) and mortality (1% vs. 1.9%, all p<0.001). For those who had one or more complications, robotic-assisted cardiac surgery had fewer complications (27.2%) to non-robotic cardiac surgery (30.3%, p < .001).
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MedicalResearch.com Interview with:
Dan Dongeun Huh, Ph.D.
Wilf Family Term Chair & Assistant Professor
Department of Bioengineering
University of Pennsylvania
Philadelphia, PA 19104
Medical Research: What is the background for this study? What are the main findings?
Response: The placenta is a temporary organ central to pregnancy and serves as a major interface that tightly regulates transport of various endogenous and exogenous materials between mother and fetus. The placental barrier consisting of the closely apposed trophoblast epithelium and fetal capillary endothelium is responsible for maintaining this critical physiological function, and its dysfunction leads to adverse pregnancy outcomes. Despite its importance, barrier function of the placenta has been extremely challenging to study due to a lack of surrogate models that faithfully recapitulate the key features of the placental barrier in humans. Our study aims to directly address this long-standing technical challenge by providing a microengineered in vitro system that replicates architecture, microenvironment, and physiological function of the human placenta barrier. This “placenta-on-a-chip” device consists of microfabricated upper and lower cell culture chambers separated by a thin semipermeable membrane, and the placental barrier is generated by culturing human trophoblasts and fetal endothelial cells on either side of the membrane with steady flows of culture media in both chambers. This microfluidic cell culture condition allowed the cells to form confluent monolayers on the membrane surface and to create a bi-layer tissue that resembled the placental barrier in vivo. Moreover, the microengineered barrier enabled transport of glucose from the maternal chamber to the fetal compartment at physiological rates.
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MedicalResearch.com Interview with:
Mehdi Ardavan
Concordia University/Université Concordia
Medical Research: What is the background for this study?Response: That thousands patients die each year in US hospitals due to medical errors that could be prevented if medical staff were provided with instant access to patient records. Wireless technology (such as portable tablets) is one way of providing this instant access. But using such devices can cause electromagnetic interference (EMI) with electronic medical devices and can lead to dangerous consequences for patients. Hospitals may have a policy of minimum separation distance (MSD) which means that the staff members carrying wireless devices cannot approach sensitive medical devices closer than the specified MSD. The problem was that the recommend values of the minimum separation distance were not based on a quantitative and thorough analysis of the problem. We wanted to see what is the correct value of MSD, and how it's determined.
Medical Research: What are the main findings?Response: We developed new and fast methods for estimating the electromagnetic field distribution. We also mathematically modeled the roaming nature of the staff members carrying the wireless transmitters. Then we modeled the minimum separation distance policy and added an option to account for a possibility of non-compliance with the policy.
First, we assumed a full compliance with MSD policy and found that the risk of interference decreased constantly as the minimum separation distance was increased. Quantitative recommendations are made for the value of the MSD. But once we considered a small non-compliance probability, an interesting and unexpected phenomenon was observed: the EMI risk does not decrease beyond a certain value and remains almost constant for all MSDs bigger than a value we call the optimal MSD. If we increase the minimum separation distance beyond its optimal value, the risk of EMI does not decrease but more restrictions and thus more inconvenience is put on the staff members. So larger values of MSD are not necessarily safer and are not recommended. We also find that the risk and the optimal minimum separation distance are both sensitive to the rate of compliance with the MSD policy.
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MedicalResearch.com Interview with:Neetika Garg, MD
Fellow in Nephrology
Beth Israel Deaconess Medical Center
Division of Nephrology, Department of Medicine
Boston, MA 02215
MedicalResearch: What is the background for this study? What are the main findings?Dr. Garg: One in every three Americans suffers from hypertension. Since high blood pressure (BP) frequently does not cause any symptoms, self-blood pressure monitoring at home and patient education are critical components of patient management. With more than 58% of the US adults owning a smartphone, mobile-based health technologies (most commonly in the form of applications or “apps”) can serve as useful adjuncts in diagnosis and management of hypertension. At the same time, several smartphone-based applications are advertised as having blood pressure measurement functionality, which have not been validated against a gold standard. In this cross-sectional study, we analyzed the top 107 hypertension related apps available on the most popular smartphone platforms (Google Android and Apple iPhone) to analyze the functional characteristics and consumer interaction metrics of various hypertension related apps.
Nearly three-quarters of the apps record and track blood pressure, heart rate, salt intake, caloric intake and weight/body mass index. These app features can facilitate patient participation in hypertension management, medication adherence and patient-physician communication. However, it was concerning to find that 6.5% of the apps analyzed could transform the smartphone into a cuffless BP measuring device. None of these had any documentations of validation against a gold standard. Furthermore, number of downloads and favorable user ratings were significantly higher for these apps compared to apps without blood pressure measurement function. This highlights the need for greater oversight and regulation in medical device development.
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MedicalResearch.com Interview with:
Jacob Hollenberg M.D., Ph.D.
Assistant Professor, Cardiologist
Head of Research, Centre for Resuscitation Science
Karolinska Institutet, Stockholm, Sweden
Editor’s note: Dr. Hollenberg and colleagues published two articles in the NEJM this week discussing CPR performed by bystanders in out-of-hospital cardiac arrests.MedicalResearch: What is the background for the first study?Dr. Hollenberg: There are 10,000 cases of cardiac arrest annually in Sweden. Cardiopulmonary Resuscitation (CPR) has been taught to almost a third of Sweden’s population of 9.7 million. In recent years the value of bystander CPR has been debated, largely due to a lack of a randomized trial demonstrating that bystander CPR is lifesaving.
In this study, which included all cases of emergency medical services (EMS) treated and bystander-witnessed out-of-hospital cardiac arrests recorded in the Swedish Cardiac Arrest Registry from January 1, 1990, through December 31, 2011, our primary aim was to assess whether CPR initiated before the arrival of EMS was associated with an increase in the 30-day survival rate.
MedicalResearch: What were the main findings?Dr. Hollenberg: Early CPR prior to arrival of an ambulance more than doubled the chance of survival. (30-day survival rate was 10.5% among patients who underwent CPR before EMS arrival, as compared with 4.0% among those who did not (P<0.001).)
This association held up in all subgroups regardless of sex, age, cause of cardiac arrest, place of arrest, EKG findings or time period (year analyzed).
MedicalResearch: How did the patients who survived cardiac arrest do from a disability standpoint?Dr. Hollenberg: We had cerebral performance scores from 474 patients who survived for 30 days after cardiac arrest. (higher scores indicate greater disability).
At the time of discharge from the hospital, 81% of these patients had a score of category of 1. Less than 2% had category scores of 4 or 5.
MedicalResearch: What should patients and providers take away from this report?Dr. Hollenberg:
For patients with an out-of-hospital cardiac arrest, CPR performed by bystanders before the arrival of emergency medical personnel, saves lives. This has been validated by both the size of this study and the consistency of the results over three decades.
CPR education needs to continue and to increase. In Sweden about one-third of the population has been taught CPR. Legislation has recently been passed that mandates CPR be taught to all teenagers in school which should allow an entire generation to become familiar with this lifesaving technique.
The willingness of the public to become involved also needs to increase. We need new ways of educating lay people to recognize cardiac arrest and to motivate them to perform it. The knowledge that bystander CPR saves lives may enhance that motivation.
MedicalResearch.com Interview with:
Andrew Bastawrous, MRCOphth
International Centre for Eye Health, Clinical Research Department
London School of Hygiene and Tropical Medicine (LSHTM), London, England
Medical Research: What is the background for this study? What are the main findings?
Dr. Bastawrous: As part of my PhD with the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, I led the follow-up of a major cohort study of eye disease [http://www.biomedcentral.com/1471-2415/14/60] following up 5,000 people in 100 different locations across the Great Rift Valley in Kenya. It was really challenging, two-thirds of the locations had no road access or electricity and we were carrying over £100,000 worth of fragile eye equipment and a team of 15 people in two vans to be able to carry out high quality measures of eye disease and answer some important questions for planning eye services.
What we found was that in the most difficult to reach locations we would find lots of people waiting to see us who had been unnecessarily blind from preventable/treatable diseases. Despite the locations having no roads, electricity and often no water, nearly all the locations had good phone signal.
Together with a brilliant team of developers, engineers and ophthalmologists we developed a suite of smartphone based tests to see if we could replace some of the standard equipment being used, in the hope that we could make it more portable and easier for non-specialists to perform so that ultimately the most high-risk individuals could be reached and treated.
This paper describes one of those tests, the visual acuity test - Peek Acuity.
Our field workers tested patients in their own homes using a standard card based Snellen chart (the type of vision test most non-ophthalmic healthcare workers are familiar with and has been the most commonly used acuity test for several decades now) and Peek Acuity. The same tests were repeated by the same healthcare worker in the clinic the following day as well as a reference standard vision test (LogMAR ETDRS) performed by an eye trained clinical officer.
This allowed us to perform "test re-test", a measure of a tests repeatability. i.e. if you have the same test at two separate time points we would expect the the measures to be very close. We found that for both Peek Acuity and Snellen they were highly repeatable. An advantage of Snellen is the speed of the test, Peek Acuity came out slightly quicker overall. We also found when compared to the reference standard test, Peek Acuity was highly comparable and within a clinically acceptable limit of difference.
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MedicalResearch.com Interview with:
R. Kenneth Marcus, FRSC & FAAAS
Professor of Chemistry
Clemson University
Medical Research: What is the background for this study? What are the main findings?
Prof. Marcus: We had previously shown that chromatographic columns formed from aligned capillary-channeled polymer (C-CP) fibers were highly effective in analytical scale and preparative separations of proteins from diverse media. The C-CP fibers are extracted from commodity fibers such as polyester, nylon, and polypropylene. The key aspects in using the C-CP fibers are very high bed porosity and rapid protein-surface mass transfer, this allows for very rapid separations. Packing of the fibers in narrow-bore polymer tubing (0.8 mm id x 1 cm long) allows them to be fixed to the end of a micropipette tip. Urine samples of 10 microliter-to-milliliter volumes can be spun through on a microcentrifuge, washed with DI-water, and then eluted with a solvent. Thus the proteins are isolated and pre-concentrated on the fiber surface. The elution solvent can be chosen based on the analytical method employed (e.g., MALDI- or ESI-MS). (more…)
MedicalResearch.com Interview with:
Gabriel Popescu PhD Associate Professor and
Shamira Sridharan, Ph.D. candidate
Quantitative Light Imaging Laboratory, Department of Bioengineering, Beckman Institute for Advanced Science and Technology University of Illinois at Urbana
Champaign Urbana, IL
Medical Research: What is the background for this study? What are the main findings?
Dr. Popescu: We developed a new optical tool that can identify patients at high risk for recurrence of prostate cancer after undergoing radical prostatectomy as treatment. Early identification of risk for recurrence can allow early treatment of disease.
Our main finding was that among individuals with worse disease outcomes, the tissue is more disorganized. This manifests as a decrease in anisotropy, or light scattering angle, which reports on nano-scale differences in tissue architecture.
(more…)
MedicalResearch.com Interview with:
Dr. Linnea A. Polgreen, Ph.D.
Assistant Professor, Health Services Research
Department of Pharmacy Practice and Science
Iowa City, IA
Medical Research: What is the background for this study? What are the main findings?
Dr. Polgreen: Many patients with hypertension are unaware that they have hypertension. Furthermore, a substantial number of patients diagnosed with hypertension are poorly controlled. Unfortunately there is no point-of-care test to diagnose hypertension. For most patients with multiple to moderate hypertension, multiple measurements are needed over time to confirm the diagnosis. This need to obtain multiple measurement often delays the diagnosis of hypertension, and delays potential for changes in therapy for those who are diagnosed but poorly controlled. Patients are routinely reminded to check their blood pressure measurements at home. However, these measurements often do not occur or are not collected in a timely fashion. Recently electronic medical records (EMRs) have built portals for patients to enter data such as blood pressure measurements, but it is unclear how effective these portals will be for diagnosing and treating high blood pressure.We studied 121 patients with at least one high blood pressure measurement in the past year and randomized them to three groups.
The first group received text messages to which they were told to reply with their blood pressure measurements.
The second group was sent text messages reminding them to enter their blood pressures measurements in the hospital’s EMR portal.
The third group was instructed to enter their blood pressure measurements in the EMR portal, but they were not given reminders. Automated messages were sent to each patient in the bi-directional text messaging and EMR+reminder groups twice daily for up to 15 days. For the EMR only group, only 47.8% of patients successfully recorded a total of 14 blood pressure measurements within 15 days. For the EMR + reminder group, this percentage was 81.2%, and for the bi-directional text messaging group, it was 97.7%. (more…)
MedicalResearch.com Interview with:
Michael Rebold, PhD, CSCS
Assistant Professor
Department of Exercise Science
Bloomsburg University
Bloomsburg, PA 17815
Medical Research: What is the background for this study? What are the main findings?
Dr. Rebold: We assessed how common smartphone uses (texting and talking) interfere with treadmill exercise.
We found that when individuals use their smartphones during exercise for texting or talking, it causes a reduction in exercise intensity.
(more…)
MedicalResearch.com Interview with:Dr. Shang-Ming Zhou
Senior Lecturer in Statistical Modelling and Analytics for Epidemiology and Public Health,
Public Health Informatics Group,
Health Information Research Unit (HIRU),
UKCRC DECIPHer (Development and Evaluation of Complex Interventions for Public Health Improvement) Centre,
College of Medicine, Swansea University, Swansea, UK
Medical Research: What is the background for this study? What are the main findings?Response: In medical and sport science research, body-worn accelerometers are widely used to provide objective measurements of physical activity. However, accelerometers collect data continuously even during periods of nonwear (i.e. periods when participants may not be wearing their monitor, such as during sleeping). It is important to distinguish time of sedentary behaviours (eg. watching television) from time of nonwear. The clinical consequence of misclassification of accelerometer wear and nonwear would overestimate or underestimate physical activity level, and mislead the interpretation of the relationship between physical activity and health outcomes. Automated estimation of accelerometer wear and nonwear time events is particularly desired by large cohort studies, but algorithms for this purpose are not yet standardized and their accuracy needs to be established. This study presents a robust method of classifying wear and nonwear time events under free living conditions for triaxial accelerometers which combines acceleration and surface skin temperature data.
The new findings are: Either acceleration data or skin temperature data alone is inadequate to accurately predict wear and nonwear events in some scenarios under a free living condition; This study provides a simple and efficient algorithm on use of short time periods of consecutive data blocks for accurately predicting triaxial accelerometer wear and nonwear events; Combining both types of acceleration and skin temperature data can significantly improve the accuracy of accelerometer wear and nonwear events classification in monitoring physical activity. (more…)
MedicalResearch.com Interview with:
Maria L. Wei, M.D., Ph.D.
Associate Professor of Dermatology
Director, Melanoma Surveillance Clinic
Multidisciplinary Melanoma Program
University of California, San Francisco
Staff Physician
Veterans Affairs Medical Center, San Francisco
Medical Research: What is the background for this study?
Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN
Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University
Medical Research: What is the background for this study? What are the main findings?
Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.
Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.
(more…)
MedicalResearch.com Interview with:
Avinash Pandey, the study author, is a high school student who conducted this study under the guidance of his mentor, Niteesh K. Choudhry., M.D., Ph.D., executive director of the Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.
Medical Research: What is the background for this study? What are the main findings?Response: Numerous studies have demonstrated that there is poor adherence to medications in cardiac patients (coronary artery disease patients, CAD). Despite the fact that non-adherence to these medications can have serious consequences on long-term health like disease progression, increased risk of cardiac events and premature mortality, many patients consistently miss their medications and many stop their medications only months after they are prescribed. This non-compliance leads to high costs for the health care system and more potentially preventable cardiac events. Studies suggest, that for the vast majority of patients, non-adherence to medications is not intentional. A significant portion simply forget to take their medications. Although many systems are available today to reduce medication non-adherence, like pill boxes and blisterpacks, these have demonstrated limited effect on medication adherence. Other systems may be expensive to purchase and cumbersome to use or of limited availability. With the proliferation of cellphones, text message reminders could represent a simple, cost-effective method to improve adherence to medications.
This research began as a high school science fair project 4 years ago and has evolved into a large ongoing assessment of the impact of mobile technologies on adherence to evidence based therapies and lifestyle interventions in a broad cross-section of cardiovascular patients and those at risk for cardiovascular disease. The current report examines the impact of an automated computer program which sends free, personalized text messages to remind patients to adhere to their medications. 30 CAD patients were recruited from a single centre cardiac practice, in this 2 month cross-over study. Patients were randomized to either receive text message reminders in the first month or the second month. Adherence of each patient was compared between months. Text message reminders were shown to significantly impact medication adherence. Patients missed on average 60% less doses when receiving text message reminders. These numbers were even greater when looking at pre-specified groups identified in previous studies to be at high risk of medication non-adherence, including depression patients, dementia patients, elderly patients, and patients with less than 12 years of education. All patients improved with text message reminders but those with the lowest adherence improved the most. Although this study did not examine clinical outcomes, the text message reminder system appears to be a simple and widely applicable method to improve adherence to medications. The system is free to operate and represents no cost for patients receiving messages. Thus it could be implemented at an individual level or by physicians and clinics to improve patient adherence to medications.
(more…)
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