Testosterone Treatment May Reduce Depression in Men

MedicalResearch.com Interview with:

Dr. Andreas Walther

Dr. Walther

Dr. Andreas Walther PhD
Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
Department of Clinical Psychology and Psychotherapy, University of Zurich,
Zurich, Switzerland
Task Force on Men’s Mental Health of the World Federation of the Societies of Biological Psychiatry


MedicalResearch.com: What is the background for this study?

Response: The study situation with regard to endogenous testosterone level and depressive symptoms in men is currently very mixed. There are studies that show no association, but other studies show that low testosterone levels are associated with increased depressive symptoms. That is why several studies have tried to administer testosterone in men to treat depressive symptomatology among other conditions (e.g. erectile dysfunction, cognitive decline).

However, no clear conclusions could be drawn from the studies to date, as some studies reported positive results, while others did not show any effects. Likewise, some studies showed better results in certain subgroups of men such as dysthymic men, treatment resistant, men with low testosterone, which raised the question of relevant moderators.

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Advanced Prostate Cancer: Risk of Mortality with Surgery vs Radiotherapy

MedicalResearch.com Interview with:

Anthony Victor D'Amico, MD, PhD Professor and Chief, Genitourinary Radiation Oncology Harvard Medical School

Dr. D’Amico

Anthony Victor D’Amico, MD, PhD
Professor and Chief,
Genitourinary Radiation Oncology
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response: This study investigated whether surgery followed by the use of adjuvant low dose radiation and short course hormonal therapy as compared to high dose radiation and hormonal therapy could provide an equivalent low risk of death from prostate cancer amongst men presenting with aggressive and not infrequently fatal Gleason score 9 or 10 prostate cancer.

It has been shown previously (https://jamanetwork.com/journals/jama/fullarticle/2673969) and validated in the current study that surgery alone in such cases leads to a more then 2.5-fold increase in the risk of death from prostate cancer as compared to high dose radiation and hormonal therapy.  Continue reading

More Pharmacies Willing To Dispense Naloxone Without Prescription

MedicalResearch.com Interview with:
Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS
"Wolf Administration Holds a Press Conference Expanding Access to Naloxone" by Governor Tom Wolf is licensed under CC BY 2.0Clinical Assistant Professor
 College of Pharmacy, The University of Texas at Austin
Adjoint Assistant Professor
 School of Medicine, University of Texas Health Science Center at San Antonio
Ambulatory Care Pharmacist
 Southeast Clinic, University Health System
 UT Health Science Center at San Antonio
Pharmacotherapy Education and Research Center
San Antonio, TX 78229 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Previous studies in Indiana and New York City, and the similar study in California published alongside ours identified that, despite the fact that laws designed to increase naloxone access had been in place for 2-3 years, patients were still not able to obtain naloxone without first seeing a doctor in many pharmacies.

Our study showed contrasting results to the previous studies, with a much higher proportion of pharmacies stocking naloxone and stating their willingness to dispense without an outside prescription. Among the 2,317 Texas chain community pharmacies we contacted, 83.7% correctly informed our interviewers that they could obtain naloxone without having to get a prescription from their doctor before coming to the pharmacy.  We also found that 76.4% of the pharmacies had at least one type of naloxone currently in stock. Continue reading

Not All Pharmacies Have Naloxone for Opioid Overdose in Stock

MedicalResearch.com Interview with:

Talia Puzantian,  PharmD, BCPP Associate Professor of Clinical Sciences,  School of Pharmacy and Health Sciences Keck Graduate Institute 

Dr. Puzantian

Talia Puzantian,  PharmD, BCPP
Associate Professor of Clinical Sciences,
School of Pharmacy and Health Sciences
Keck Graduate Institute  

MedicalResearch.com: What is the background for this study?

Response: Naloxone has been used in hospitals and emergency rooms since the early 1970s. Distribution to laypersons began in the mid-1990s with harm reduction programs such as clean needle exchange programs providing it, along with education, to mostly heroin users. In the years between 1996-2014, 152,000 naloxone kits were distributed in this way with more than 26,000 overdoses reversed (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm).

We have data showing that counties in which there was greater naloxone distribution among laypeople, there were lower opioid death rates (Walley AY et al BMJ 2013). However, not all opioid users at risk for overdose will interface with harm reduction programs, particularly prescription opioid users, hence more recent efforts to increase access to laypersons through pharmacists. Naloxone access laws have been enacted in all 50 states but very little has been published about how they’ve been adopted by pharmacists thus far. One small study (264 pharmacies) from Indiana (Meyerson BE et al Drug Alcohol Depend 2018) showed that 58.1% of pharmacies stocked naloxone, only 23.6% provided it without prescription, and that large chain pharmacies were more likely to do so.

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D-PRESCRIBE: Pharmacist-Led Intervention Can Reduce Inappropriate Medications in Older Adults

MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc Director | Directrice Canadian Deprescribing NetworkCara Tannenbaum, MD, MSc

Director | Directrice
Canadian Deprescribing Network

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The D-Prescribe trial was driven by the need to show that seniors can cut down on their medication in a safe and effective manner. Pharmacists intervened in a proactive way to flag patients who were on potentially risky meds such as sleeping pills, NSAIDs and glyburide and to inform them of the risks, using an educational brochure. Pharmacists also communicated with their physician using an evidence-based pharmaceutical opinion to spark conversations about deprescribing. As a result, 43% of patients succeeded in discontinuing at least one medication over the next 6 months.
  Continue reading

Severe Maternal Morbidity Can Be Identified, and Sometimes Prevented

MedicalResearch.com Interview with:

Joel Ray MD, MSc, FRCPC Institute of Health Policy, Management and Evaluation Faculty of Medicine University of Toronto, Toronto

Dr. Ray

Joel Ray MD, MSc, FRCPC
Institute of Health Policy, Management and Evaluation
Faculty of Medicine
University of Toronto, Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many women who die within childbirth or soon thereafter experience rapid onset of morbidity/illness before succumbing. Thus, severe maternal morbidity (SMM) offers a detectable (or set of detectable) conditions that might be dealt with before they progress to a fatality. Even so, severe maternal morbidity alone can be non-fatal, but create disability for a new mother (e.g., a stroke), or prolong separation of mother and newborn.

So, we showed that, as the number of severe maternal morbidity indicators rises, so does the probability of maternal death. This relation was exponential in nature.   Continue reading

Brain Metastases: Stereotactic Radiation vs Surgery Compared

MedicalResearch.com Interview with:

Dr. Stephanie E. Weiss MD FASTRO Chief, Division of Neurologic Oncology Associate Professor, Department of Radiation Oncology Director, Radiation Oncology Residency and Fellowship Training Program Fox Chase Cancer Center Philadelphia, Pennsylvania

Dr. Weiss

Dr. Stephanie E. Weiss MD FASTRO
Chief, Division of Neurologic Oncology
Associate Professor, Department of Radiation Oncology
Director, Radiation Oncology Residency and Fellowship Training Program
Fox Chase Cancer Center
Philadelphia, Pennsylvania

MedicalResearch.com: What is the background for this study?

Response: Brain metastasis are the most common form of brain tumor.

Historically all patients received whole brain radiation as the primary therapy. Patients required neurosurgery to remove lesions if there was a question of diagnosis, what the diagnosis is and if there was a mass effect not relieved with steroids. Surgery was also indicated for patients with a single brain lesion because this offers a survival benefit over just receiving whole brain radiotherapy.

In 2003 a randomized trial proved that radiosurgery offers a similar benefit. So the question taxing patients and doctors at tumor boards since has been: which is better? If neurosurgery is superior, we are under-treating a lot of patients with radiosurgery. If radiosurgery is superior, we are subjecting a lot of patients to unnecessary brain surgery. Attempts to study this in a head-to-head randomized trial have failed. Patient and physician preference for one treatment or the other has proven to be a barrier to randomization and accrual. The EORTC 22952-2600 trial was originally designed to compare outcomes with and without whole brain radiation for patients receiving surgery or radiosurgery for brain metastasis.

We used this as the highest-quality source data available to compare local control of brain metastasis after surgery or radiosurgery, adjusted for by receipt or not of whole brain radiation.   Continue reading

Over 8% of Americans Expressed Distress About Having Difficulty Controlling Their Sexual Urges and Behaviors

MedicalResearch.com Interview with:
"Sex in stone" by Nagarjun Kandukuru is licensed under CC BY 2.0Janna A Dickenson, PhD

Doug Braun-Harvey Postdoctoral Fellow
Program in Human Sexuality
Department of Family Medicine
University of Minnesota Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Researchers and clinicians have contested the term “sex addiction” in favor of alternative definitions and symptom presentations. Recently, the ICD-11 has characterized compulsive sexual behavior disorder (CSBD) as a persistent pattern that involves failing to control intense sexual urges or sexual behaviors that results in significant levels of distress and/or impairment in one’s functioning.

Researchers estimate that CSBD affects 2-6% of the population and is much more common among cisgender men than cisgender. Using a randomized national sample, we assessed the prevalence of a key feature of CSBD that researchers and clinicians agree upon: distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors.

We performed this assessment with a screening tool called the Compulsive Sexual Behavior Inventory (CSBI). Of the 2,325 adults, 8.6 percent overall (10.3 percent of individuals who identified as men and 7 percent of individuals who identified as women) met the clinical threshold of the CSBI; meaning that 8.6% of people expressed difficulty controlling their sexual feelings, urges and behaviors and experienced distress and/or impairment as a result. To be clear, this does not mean the 8.6% of the sample endorsed CSBD, but that 8.6% of our sample exhibited significant distress or impairment related to difficulty controlling one’s sexual behaviors.

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Age-Related Hearing Loss Linked to Dementia, Depression, Heart Attacks and Stroke

MedicalResearch.com Interview with:

David Loughrey PhD Atlantic Fellow for Equity in Brain Health Global Brain Health Institute DeafHear Research Partner NEIL Programme Trinity College Institute of Neuroscience

Dr. Loughrey

David Loughrey PhD
Atlantic Fellow for Equity in Brain Health
Global Brain Health Institute
DeafHear Research Partner
NEIL Programme
Trinity College Institute of Neuroscience

MedicalResearch.com: What is the background for this study?

Response: The World Organisation (WHO) estimate that one-third of older adults aged 65 and over have a disabling hearing loss. Increasingly, research is finding that age-related hearing loss (ARHL) may be associated with other negative health outcomes, including dementia which currently affects 50 million people worldwide.

A study recently published in The Lancet reported that of nine possible modifiable risk factors, addressing age-related hearing loss (ARHL) could potentially lead to the largest reduction in the prevalence of dementia globally.

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Which Questionnaires Best Reflect Dry Eye Symptoms?

MedicalResearch.com Interview with:
Jennifer P. Craig, Associate Professor

Department of Ophthalmology
New Zealand National Eye Centre
Auckland, New Zealand

MedicalResearch.com: What is the background for this study?

Response: Dry eye disease is a complex multi-factorial condition, which affects between 5% to 50% of the adult population in different parts of the world. The condition can have profound effects on the ocular comfort, visual function, and quality of life of sufferers. In both clinical practice and academic research settings, validated questionnaires are frequently used to screen for dry eye symptomology, before clinical assessment of tear film homeostatic markers is conducted to make an overall diagnosis of dry eye disease.

Although a large number of validated symptomology questionnaires has previously been developed, the recently convened Tear Film and Ocular Surface Dry Eye Workshop II (TFOS DEWS II) identified that the considerable heterogeneities in the study populations, methodologies, and reference standards used in earlier diagnostic accuracy studies introduced significant challenges when trying to compare the diagnostic performance of these screening instruments.

The current study is the first to offer a direct comparison of five commonly used validated questionnaires within the same study population, and uses the global consensus criteria for tear film homeostatic disturbance developed by the TFOS DEWS II as the reference standard.

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Few Than 10% in Large Study Have Optimal Cardiovascular Health

MedicalResearch.com Interview with:

Dr. JeanPhilippe Empana, MD, PhD Research Director, INSERM U970 Paris Cardiovascular Research Center (PARCC) Team 4 Cardiovascular Epidemiology & Sudden Death Paris Descartes University

Dr. Empana

Dr. Jean Philippe Empana, MD, PhD
Research Director, INSERM U970
Paris Cardiovascular Research Center (PARCC) Team 4 Cardiovascular Epidemiology & Sudden Death Paris Descartes University

MedicalResearch.com: What is the background for this study? 

Response: In 2010, the American Heart Association (AHA) has emphasized the primary importance of the Primordial prevention concept, i.e. preventing the development of risk factors before they emerge, as a complementary prevention strategy for cardiovascular disease (CVD).

Accordingly, the AHA has developed a simple 7-item tool, including 4 behavioral (nonsmoking, and ideal levels of body weight, physical activity and diet) and 3 biological metrics (ideal levels of untreated blood pressure, fasting blood glucose and total cholesterol) for promoting an optimal cardiovascular health (CVH). The relevance of the concept and of the tool has been several times reported by individual studies and meta-analyses (combining the results of several studies) showing substantial and graded benefit for cardiovascular disease but also mortality, quality of life and even cancer risk with higher level of CVH. However, most studies relied on one measure of  cardiovascular health.

In the present work, using serial examinations from the well-known Whitehall Study II, we described change in CVH over time and then quantified the association of change in cardiovascular health over 10 years with subsequent incident cardiovascular disease and mortality. This analysis is based on 9256 UK men and women aged 30 to 55 in 1985-88, and thereafter examined every 5 years on average during 30 years.

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Treatment Delays Linked To High Mortality for Head and Neck Cancer

MedicalResearch.com Interview with:

Dr. Evan M. Graboyes is a otolaryngologist-head and neck surgeon with the Medical University of South Carolina. CREDIT Emma Vought, Medical University of South Carolina

Dr. Graboyes

Dr. Evan M. Graboyes MD
Otolaryngologist: Head and Neck Surgeon
Medical University of South Carolina

MedicalResearch.com: What is the background for this study?

Response: Unfortunately, there is no screening test for head and neck cancer like there is for colorectal, prostate, breast, lung, or cervical cancers. As a result, two-thirds of patients with head and neck cancer (HNC) present with loco-regionally advanced disease, making other aspects of timely treatment that much more critically important. We therefore sought to understand the association between treatment delay at different points along the cancer care continuum and oncologic outcomes for patients with head and neck cancer.

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Cannabis May Raise Risk of Diabetic Ketoacidosis

MedicalResearch.com Interview with:

Viral Shah, MD Assistant Professor of Medicine & Pediatrics Barbara Davis Center for Diabetes, Adult Clinic School of Medicine University of Colorado Anschutz Medical Campus

Dr. Shah

Viral Shah, MD
Assistant Professor of Medicine & Pediatrics
Barbara Davis Center for Diabetes, Adult Clinic
School of Medicine
University of Colorado Anschutz Medical Campus

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cannabis use is increasing in Colorado and many patients with type 1 diabetes (which is an autoimmune form of diabetes that requires life insulin therapy) are using cannabis. Therefore, we surveyed adult patients with type 1 diabetes to study the association between cannabis use and glycemic control and diabetes acute complications (such as diabetic ketoacidosis) in adults with type 1 diabetes.

Main findings of the study:  The risk for diabetic ketoacidosis (a serious condition where body produces high levels of acids called ketones in patients with diabetes)  was two times higher among adults with type 1 diabetes who reported using cannabis in the past 12 months compared to adults with type 1 diabetes who reported not using cannabis. Continue reading

Canadians Enjoy High Level of Health and Longevity

MedicalResearch.com Interview with:
"Drapeau au Parlement du Canada" by abdallahh is licensed under CC BY 2.0Dr. Justin Lang, PhD

Research Analyst, Public Health Agency of Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is based on the Global Burden of Disease Study, which is led by the Institute of Health Metrics at the University of Washington. In this study, we present estimates from the Global Burden of Disease Study to describe the major causes of health loss among Canadians, and how these have changed from 1990 to 2016.

In 2016, cancers, cardiovascular diseases, musculoskeletal disorders, and mental and substance use disorders, combined, resulted in over half of the total health loss among Canadians as measured by disability adjusted life years. Disability-adjusted life years is a measure that combines both mortality, through years of life lost, and morbidity, through years lived with disability, into a single measure that allows us to compare health loss from different causes using the same metric.

The all-cause age-standardized years of life lost rate declined 12% between 2006 and 2016, while the all-cause age-standardized years lived with disability rate remained stable (+1%) and the all-cause age-standardized disability-adjusted life year rate declined by 5%.

Finally, between 1990 and 2016, there has been a shift in what contributes to health loss in Canada from premature mortality to disability. In 1990, 45% of total all-cause disability-adjusted life years were due to years lived with disability. By 2016, this proportion grew to 52%.  Continue reading

Benefits of Treating Mild Hypertension Not Clear Cut

MedicalResearch.com Interview with:

James Sheppard PhD Population Health Scientist  Nuffield Department of Primary Care Health Sciences

Dr. Sheppard

James Sheppard PhD
Population Health Scientist
Nuffield Department of Primary Care Health Sciences

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The best quality evidence for making clinical decisions comes from clinical trials. Unfortunately there are occasions where trials have not been done, or are not possible and so we rely of ‘expert opinion’ from clinical guidelines. Treatment for low risk mild hypertension is an example of this.

In our study, we looked at the medical records of more than 38,000 patients over a period of 15 years. The patients we studied were aged between 18 and 74, had mild hypertension and had not received any previous treatment. We compared patients who went on to be treated to those who were not, and found no evidence of benefit (in terms of reduced risk of heart attack or stroke), but there was an increased risk of adverse events (such as hypotension [low blood pressure], fainting or kidney damage) over the follow-up period of 5-6 years. 

MedicalResearch.com: What should readers take away from your report?

Response: The benefits of treating patients with low risk mild hypertension are not clear cut. It is possible that some patients may suffer more harm than good, so doctors should be cautious when considering treatment in this population.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: It is likely that some patients with low risk mild hypertension would benefit from treatment, whilst others would not. Future research should focus on understanding which patients have the most to gain, using the wealth of information we now collect about our patients every single day.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study was not a clinical trial and therefore the results must be interpreted with caution. Observational studies such as this can sometimes give biased or unreliable results.

This work was funded by the Medical Research Council in the UK. I have no conflicts of interest to declare.

Citation: 

Shepard, J. P., Stevens, S., Stevens, R., Martin, U., Mant, J. W., Hobbs, R., & McManus, R. J. Benefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults. JAMA Internal Medicine https://doi.org/10.17863/CAM.27445

Nov 1, 2018 @ 12:27 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Really Scary! Pediatric Pedestrian Fatalities 10x Higher on Halloween

MedicalResearch.com Interview with:
"Halloween Parade 2014" by GoToVan is licensed under CC BY 2.0Dr. John A. Staples, MD
Clinical Assistant Professor
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: At this time last year, my co-author Candace Yip and I noticed an impressive number of advertisements for Halloween-themed parties at bars taped to lamp-posts. We wondered if the combination of dark costumes, dark evenings, alcohol and trick-or-treaters made the streets more dangerous for pedestrians.

To see if our hunch was correct, we examined 42 years of data on all fatal vehicle crashes in the United States between 1975 and 2016. We compared the number of pedestrian fatalities between 5 p.m. and midnight on Halloween with the number during the same hours on control days one week earlier and one week later. We found that 14 pedestrian deaths occurred on the average Halloween, while only 10 pedestrian deaths occurred on the average control evening. This corresponded to a 43% increase in the relative risk of pedestrian fatality on Halloween.

Among children aged 4 to 8 years of age, the risk of death was ten times higher on Halloween evening compared to control evenings. Risks were highest around 6pm, which is prime trick-or-treating time. Absolute risks were small and declined throughout the four decades of the study, but the relative risk increase on Halloween persisted throughout the entire study interval.  Continue reading

Adolescent Gun Injuries Peak at Ages 15-17

MedicalResearch.com Interview with:
“Me holding USP gun” by Nghị Trần is licensed under CC BY 2.0
Faiz Gani, PhD
Postdoctoral research fellow
Department of Surgery
Johns Hopkins University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Firearm related injuries are a leading cause of injury and death in the United States, yet, due to combination of factors, limited data exist that evaluate these injuries, particularly among younger patients (patients younger than 18 years).

The objective of this study was to describe emergency department utilization for firearm related injuries and to quantitate the financial burden associated with these injuries.

In our study of over 75,000 emergency department visits, we observed that each year, over 8,300 children and adolescents present to the emergency department for the treatment / management of a gunshot injury. Within this sub-population of patients, we observed that these injuries are most frequent among patients aged 15-17 years and while these injuries decreased over time initially, were observed to increase again towards the end of the time period studied.

In addition to describing the clinical burden of these injuries, we also sought to describe the financial burden associated with these injuries. For patients discharged from the emergency department, the average (median) charge associated with their care was $2,445, while for patients admitted as inpatients for further care, the average (median) charge was $44,966.

Collectively these injuries resulted in $2.5 billion in emergency department and hospital charges over the time period studied. This translates to an annual financial burden of approximately $270 million. Continue reading

Are the Oldest of Old Necessarily Lonely?

MedicalResearch.com Interview with:
"Elderly woman speaks about Water Supply and Sanitation program in Nepal" by World Bank Photo Collection is licensed under CC BY-NC-ND 2.0Dr Sharon Leitch | MBChB, DCH, PGDipGP, FRNZCGP
General Practitioner, Clinical Research Training Fellow
Department of General Practice and Rural Health
University of Otago
New Zealand

MedicalResearch.com: What is the background for this study?

Response: Loneliness is associated with poor health, reduced quality of life, and increased mortality. Loneliness typically worsens with age. We were curious to learn what the prevalence of loneliness was among older New Zealanders, if there were age-specific associations with loneliness, whether there were any associations between demographic and psychosocial variables and loneliness, and we also wanted to compare centenarians (100 years or older) with elderly people (aged 65-99 years). Centenarians are a particularly interesting group to study because they are a model of successful ageing.

The international Resident Assessment Instrument-Home Care (interRAI-HC) assessment has been mandatory in New Zealand for anyone undergoing assessment for publically funded support services or residential care since 2012, providing us with a comprehensive data set. We conducted a retrospective, observational, cross-sectional review of the interRAI-HC data from over 70,000 people living in the community who had their first assessment during the study period (January 2013-November 2017). We analysed eight items from the interRAI-HC data set to describe the population and evaluate the core psychosocial components of aging; age, gender, ethnicity, marital status, living arrangements, family support, depression and loneliness.

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No Benefit, More Complications with Hypothermia after Traumatic Brain Injury

MedicalResearch.com Interview with:

Jamie Cooper AO BMBS MD FRACP FCICM FAHMS Professor of Intensive Care Medicine Monash University Deputy Director & Head of Research,  Intensive Care & Hyperbaric Medicine The Alfred, Melbourne

Prof. Cooper

Jamie Cooper AO
BMBS MD FRACP FCICM FAHMS
Professor of Intensive Care Medicine
Monash University
Deputy Director & Head of Research,
Intensive Care & Hyperbaric Medicine
The Alfred, Melbourne

MedicalResearch.com: What is the background for this study?

Response: 50-60 million people each year suffer a traumatic brain injury (TBI) . When the injury is severe only one half are able to live independently afterwards.

Cooling the brain (hypothermia) is often used in intensive care units for decades to  decrease inflammation and brain swelling and hopefully to improve outcomes, but clinical staff have had uncertainty whether benefits outweigh complications.

We conducted the largest randomised trial of hypothermia in TBI, in 500 patients, in 6 countries, called POLAR. We started cooling by ambulance staff, to give hypothermia the best chance to benefit patients. We continued for 3-7 days in hospital ind ICU. We measured functional outcomes at 6 months.

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Mortality Decreases with Increased Aerobic Fitness

MedicalResearch.com Interview with:
"treadmill" by Jeff Blackler is licensed under CC BY 2.0Wael A. Jaber, MD FACC, FESC
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Fuad Jubran Endowed Chair in Cardiovascular Medicine
Heart and Vascular Institute 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We evaluated treadmill tests on over 122, 000 patients between 1991 and 2014. We aimed to evaluate impact of functional capacity (time on treadmill) on all cause mortality.

We found that there is a gradual and incremental reduction in mortality with increased exercise capacity/aerobic fitness in all age groups, sexes, and in patients with and without history of heart disease.

MedicalResearch.com: What should readers take away from your report? 

Response: Maintaining a high aerobic functional class is associated with greater risk reduction than absence of many known traditional risk factors such as hypertension, diabetes, prior history of CAD.

The risk reduction appears to follow a dose response pattern with no upper limits of benefits; patients with highest functional class benefits most. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to test whether an improvement in functional class over time with training can move an individual patients from one mortality curve to a better one. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Maintaining a high functional aerobic class appears to be associated with low mortality in all age groups. Patients appear to derive gain in survival even with the smallest improvement in functional class. However, when it comes to aerobic functional class as measured by treadmill exercise testing, more appears to be better.

Of course, patients should always check with their healthcare provider before starting an exercise program.

No disclosures 

Citation:

Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open.2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

Oct 20, 2018 @ 8:30 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Amphetamine-Related Hospitalizations Skyrocket Costing $2 Billion per Year

MedicalResearch.com Interview with:

Tyler Winkelman MD, MSc   Clinician-Investigator Division of General Internal Medicine, Hennepin Healthcare Center for Patient and Provider Experience, Hennepin Healthcare Research Institute Assistant Professor Departments of Medicine & Pediatrics University of Minnesota 

Dr. Winkelman

Tyler Winkelman MD, MSc  
Clinician-Investigator
Division of General Internal Medicine, Hennepin Healthcare
Center for Patient and Provider Experience, Hennepin Healthcare Research Institute
Assistant Professor
Departments of Medicine & Pediatrics
University of Minnesota 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Trends in amphetamine use are mixed across data sources. We sought to identify trends in serious, problematic amphetamine use by analyzing a national sample of hospitalizations.

Amphetamine-related hospitalizations increased over 270% between 2008 and 2015. By 2015, amphetamine-related hospitalizations were responsible for $2 billion in hospital costs. While opioid-related hospitalizations were more common, amphetamine-related hospitalizations increased to a much larger degree. After accounting for population growth, amphetamine hospitalizations grew 245% between 2008 and 2015, whereas opioid-related hospitalizations increased 46%. Amphetamine-related hospitalizations were more likely to be covered by Medicaid and be in the western United States compared with other hospitalizations. In-hospital mortality was 29% higher among amphetamine-related hospitalizations compared with other hospitalizations. 

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New Point-of-Care Troponin Assay Can Rapidly Rule Out Heart Attack

MedicalResearch.com Interview with:

Dr John W Pickering, BSc(Hons), PhD, BA(Hons) Associate Professor , Senior Research Fellow in Acute Care Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board |  Christchurch Hospital Research Associate Professor | Department of Medicine University of Otago Christchurch

Prof. Pickering

Dr John W Pickering, BSc(Hons), PhD, BA(Hons)
Associate Professor , Senior Research Fellow in Acute Care
Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board |  Christchurch Hospital
Research Associate Professor | Department of Medicine
University of Otago Christchurch

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The assessment of patients with suspected myocardial infarction is one of the most common tasks in the emergency department. Most patients assessed (80 to 98% depending on the health system) are ultimate not diagnosed with an MI.   High-sensitivity troponin assays have been shown to have sufficient precision at low concentrations to allow very early rule-out of myocardial infarction. However, these are lab-based assays which typically result in a delay from blood sampling before the result is available and the physician is able to return to a patient to make a decision to release the patient or undertake further investigation. Point-of-care assays provide results much quicker, but have to-date not had the analytical characteristics that allow precise measurements at low concentrations.

In this pilot study we demonstrated that a single measurement with a new point-of-care assay (TnI-Nx; Abbott Point of Care) which can measure low troponin concentrations, could safely be used to rule-out myocardial infarction a large proportion of patients (57%). The performance was at least comparable to the high-sensitivity troponin I assay, if not a little better (44%).

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Higher BMI Linked to Increased Risk of Younger Colon Cancer

MedicalResearch.com Interview with:

Stuart Po-Hong Liu, MD, MPH

Dr. Po-Hong Liu

Stuart Po-Hong Liu, MD, MPH
Clinical and Translational Epidemiology Unit Massachusetts General Hospital and
Harvard Medical School
Boston

MedicalResearch.com: What is the background for this study?

Response: Although there were global decreases in overall colorectal cancer (CRC) incidence, CRC rates have increased dramatically in those aged 20 to 49 years in the United States, parts of Europe, and Asia. The etiology and early detection of young-onset becomes an emerging research and clinical priority. Another important fact that is that this emerging public health concern has resulted in updated guidelines from the American Cancer Society advising average-risk screening begin at age 45, rather than 50.

However, up to this point, the etiology of young onset CRC remains largely unknown. Elucidating the role of traditional CRC risk factors in the etiopathogenesis of young-onset CRC is one of the first research agenda. Continue reading

Mandated Audit-and-Feedback Did Not Improve Hospital Hand Hygiene

MedicalResearch.com Interview with:
"Hand Washing" by Anthony Albright is licensed under CC BY-SA 2.0Dr. Daniel J. Livorsi, MD
Assistant Professor
INFECTIOUS DISEASE SPECIALIST
University of Iowa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the Joint Commission’s standards is that hospitals audit and provide feedback on hand hygiene compliance among healthcare workers. Audit-and-feedback is therefore commonly practiced in US hospitals, but the effective design and delivery of this intervention is poorly defined, particularly in relation to hand hygiene improvement.

We studied how 8 hospitals had implemented audit-and-feedback for hand hygiene improvement. We found that hospitals were encountering several barriers in their implementation of audit-and-feedback. Audit data on hand hygiene compliance was challenging to collect and was frequently questioned. The feedback of audit results did not motivate positive change. 

Continue reading

Continuing Statins from Late Chronic Kidney Disease through ESRD Linked to Improved Survival

MedicalResearch.com Interview with:
"Plugged into dialysis" by Dan is licensed under CC BY 2.0

Elani Streja MPH PhD

Division of Nephrology and Hypertension
University of California, Irvine | UCI ·
Elvira O. Gosmanova, MD, FASN
Medicine/Nephrology
Albany Stratton VA Medical Center


Csaba P Kovesdy MD

Fred Hatch Professor of Medicine
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Director, Clinical Outcomes and Clinical Trials Program
Memphis TN, 38163 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity in patients with chronic kidney disease (CKD).

Statins are lipid-lowering drugs that have a proven track record in reducing risk of CVD in patients with advanced CKD who did not yet reach its terminal stage or end-stage renal disease (ESRD). Paradoxically, new prescription of statins after ESRD onset failed to reduce CVD related outcomes in three large clinical trials. However, benefits of statin continuation at transition from advanced CKD to ESRD was never formally tested.

Therefore, we identified a cohort of 14,298 US Veterans who used statins for at least half of the year during 1 year before ESRD transition and evaluated mortality outcomes based on whether statins were continued or stopped after ESRD onset.

We found that ESRD patients who continue statins for at least 6 months after transition had 28% and 18% lower risk of death from any cause or cardiovascular causes, respectively, during 12-months of follow up, as compared with statin discontinuers. Continue reading