Quality Performance Measures Should Include Hypoglycemia Assessments

MedicalResearch.com Interview with:

Victor M. Montori, MD Mayo Clinic

Dr. Victor Montori

Victor M. Montori, MD MSc
Knowledge and Evaluation Research Unit in Endocrinology
Mayo Clinic, Rochester, Minnesota

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

Response: Hypoglycemia can acutely disrupt patients’ lives through symptoms ranging from bothersome to life-threatening; worsen quality of life; and hinder medication adherence and glycemic control. Hypoglycemia is now known to increase risk of mortality, cognitive impairment, and cardiovascular events. In order to improve the quality of diabetes care, healthcare organizations use publicly reported performance measures for quality measurement and improvement, and pay-for-performance initiatives. The degree to which existing performance measures are aligned with guidelines, particularly in regard to hypoglycemia avoidance, is uncertain.

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COPD and Risk of Mild Cognitive Impairment

Michelle M. Mielke, Ph.D. Associate Professor Department of Health Sciences Research, Division of Epidemiology Department of Neurology Mayo Clinic Rochester, MN 55905MedicalResearch.com Interview with:
Michelle M. Mielke, Ph.D.
Associate Professor
Department of Health Sciences Research, Division of Epidemiology
Department of Neurology
Mayo Clinic Rochester, MN 55905

MedicalResearch.com: What are the main findings of the study?

Dr. Mielke: Using a population-based sample of cognitively normal individuals, aged 70-89 at baseline, we found that a medical-record confirmed diagnosis of COPD was associated with an increased risk of mild cognitive impairment, specifically non-amnestic mild cognitive impairment.  The risk of mild cognitive impairment increased with a longer duration of COPD such that individuals who had COPD for more than 5 years had a 2.5-fold increased risk of developing non-amnestic mild cognitive impairment.
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Bipolar Disorder: Genome-Wide Association Study

MedicalResearch.com Interview with:
Prof. Dr. Sven Cichon, PhD
Director, Division of Medical Genetics
University Hospital Basel
Human Genomics Research Group
Department of Biomedicine
University of Basel Basel, Switzerland

MedicalResearch.com: What were the main findings of the study?

Answer: We have identified two new gene regions that represent pieces of the jigsaw puzzle of genetic and non-genetic factors that lead to the development of bipolar disorder. One is the gene ADCY2 (Adenylate Cyclase 2) which is involved in signal transmission within nerve cells. The other region comprises two genes, both presumably playing a role in neurodevelopmental processes (MIR2113 and POU3F2). Importantly, these results come out of the largest of these kinds of studies so far, involving altogether more than 24,000 people.
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Should Dental Extractions Be Done Prior to Heart Surgery?

Dr. Kendra J. Grim Department of Anesthesiology Mayo Clinic, Rochester, MN 55905MedicalResearch.com Interview with:
Dr. Kendra J. Grim
Department of Anesthesiology
Mayo Clinic, Rochester, MN 55905


MedicalResearch.com
: What are the main findings of the study?

Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent.  Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “

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Hypothyroidism and Mild Cognitive Impairment Risk?

Ajay K Parsaik, MD, MS Department of Psychiatry and Behavior Sciences The University of Texas Medical School, Houston Department of Neurology and Mayo Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with:
Ajay K Parsaik, MD, MS
Department of Psychiatry and Behavior Sciences
The University of Texas Medical School, Houston
Department of Neurology and Mayo Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, Minnesota

MedicalResearch.com: What are the main findings of the study?

Dr. Parsaik: Main findings of our study are that clinical and subclinical hypothyroidism is not associated with mild cognitive impairment in an elderly population after accounting for possible confounding factors and interactions.
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Mild Cognitive Impairment: Progression to Dementia Risk

Dr. Ronald C. Petersen M.D., Ph.D. Division of Epidemiology Department of Health Sciences Research; Department of Neurology Mayo Clinic, Rochester, MNMedicalResearch.com Interview with:
Dr. Ronald C. Petersen M.D., Ph.D.
Division of Epidemiology
Department of Health Sciences Research; Department of Neurology
Mayo Clinic, Rochester, MN

MedicalResearch.com: What are the main findings of the study?

Dr. Petersen: The diagnosis of mild cognitive impairment increases the likelihood of developing dementia.
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Sugar-Sweetened Beverages and Endometrial Cancer

Maki Inoue-Choi, PhD, MS, RD Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institute on Minority Health and Health Disparities, NIH Rockville, MD 20850MedicalResearch.com Interview with:
Maki Inoue-Choi, PhD, MS, RD
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Institute on Minority Health and Health Disparities, NIH
Rockville, MD 20850

MedicalResearch.com: What are the main findings of the study?

Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer.
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Rheumatoid Arthritis and Increased Risk of Heart Disease

Eric Matteson, M.D. Rheumatology Chair Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with:
Eric Matteson, M.D.
Rheumatology Chair
Mayo Clinic in Rochester, Minn.


MedicalResearch.com:   What are the main findings of the studies?

Dr. Matteson: “The main finding is that patients with severe rheumatoid arthritis have a higher risk of heart disease.  Further, women who experience early menopause also have a higher risk of heart disease.”
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Parkinson’s Disease: Cognitive Impairment and Plasma Ceramides

Michelle M. Mielke, Ph.D. Associate Professor Department of Health Sciences Research Division of Epidemiology Mayo Clinic 200 First Street SW Rochester, MN 55905MedicalResearch.com: Interview with:

Michelle M. Mielke, Ph.D.
Associate Professor
Department of Health Sciences Research
Division of Epidemiology
Mayo Clinic 200 First Street SW
Rochester, MN 55905

MedicalResearch.com: What are the main findings of the study?

Dr. Mielke: Among Parkinson’s disease (PD) patients, plasma levels of ceramides and monohexylceramides were higher in patients with cognitive impairment or dementia compared to patients who were cognitively normal.  Levels of these lipids were also higher in the combined group of PD patients compared to non-PD controls but the number of controls were small.

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Dementia: Lewy Body vs Parkinson’s Disease

Rodolfo Savica, MD, MSc Department of Neurology, College of Medicine Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with:
Rodolfo Savica, MD, MSc
Department of Neurology, College of Medicine
Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota

 

MedicalResearch.com: What are the main findings of this study?

Dr. Savica: This study is the first in North America to explore the incidence of DLB and PDD in a population based sample. We found that the overall incidence of dementia with Lewy bodies (DLB), considered the second leading cause of neurodegenerative dementia after Alzheimer`s disease, is lower than that of Parkinson`s disease (PD), increases steeply with age, and is markedly higher in men than in women.
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Mitral Valve Regurgitation from Flail Leaflets: Early Surgical Intervention May be Warranted

MedicalResearch.com Interview with: Rakesh M. Suri MD, D.Phil.
Mayo Clinic College of Medicine, Rochester, Minnesota

MedicalResearch.com: What might clinicians “take home” from this study?

Answers:

a. The contemporary outcomes of surgical correction of mitral regurgitation are excellent based upon results observed in this large multinational, multi-institutional study, Mitral valve surgery now has a low peri-operative risk of death or complications, and a very high likelihood of saving a patient’s own heart valve (>90% – repair); thereby avoiding the need for replacement with an artificial valve substitute.

b. All patients with severe degenerative mitral regurgitation are at risk for heart failure and/or death when surgical correction is delayed.  A safe period of “watchful waiting” in those with severe mitral regurgitation due to flail leaflets, even in the absence of traditional Class I triggers for surgery (symptoms or left ventricular dilation/dysfunction) does not exist.

c. Prompt mitral valve surgery within months following the diagnosis of severe degenerative mitral regurgitation, even in those without symptoms, is associated with important and sustained long term benefits including a 40% decrease in death and 60% less heart failure risk, sustained many years following surgical intervention

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Controlling Health Care Costs : US Physicians Views

Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo ClinicMedicalResearch.com Interview with:
Jon C. Tilburt, MD, MPH

Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
Biomedical Ethics Program, Mayo Clinic
Knowledge & Evaluation Research Unit, Mayo Clinic

Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery
Division of Health Care Policy and Research, Mayo Clinic

What did you set out to find, what was your objective in this study?

  • We wanted to know physicians perceived roles and responsibilities in addressing health care costs as well as their enthusiasm for proposed strategies to contain health care spending.

Who did you study and what did you look at?

  • Practicing US physicians under age 65, we randomly selected 3900 physicians representing all specialties and mailed them an 8-page survey entitled “Physicians, Health Care Costs, and  Society.” We received 2,556 completed surveys (65% response rate).
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Study finds Current Medical Practices often Not Re-Evaluated, Many offer little Net Benefit

MedicalResearch.com Interview with Dr. Vinay Prasad, MD
Medical Oncology Branch, National Cancer Institute
National Institutes of Health, 10 Center Dr 10/12N226, Bethesda, MD20892.

MedicalResearch.com: What are the main findings of the study?

Dr. Prasad: We reviewed all original articles in the New England Journal of Medicine over ten years.  1344 articles tested some medical practice– which is a screening or diagnostic test, medication, procedure or surgery.  Only 27% or 363 articles tested current medical practice.  And of these articles 146 (40%) contradicted current standard of care, constituting a medical reversal.

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Dual energy CT accurately identifies ACL tears in emergency department

MedicalResearch.com:  Katrina N. Glazebrook, MB, ChB
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905

MedicalResearch.com:  Why did you do the study?

Dr. Glazebrook: We felt CT was being underutilized for evaluation of knee injuries. The utility of CT has been well documented in the assessment of fractures, but little attention has been made on soft tissue evaluation.

CT now has high spatial resolution with very thin reconstructions in any desirable plane, and we have previously noted that this allowed injured soft tissue structures such as cruciate ligaments to be well visualized [presented at Society of Skeletal Radiology meeting March 2013]. We had determined in that prior study that the best reconstruction plane to evaluate both normal and torn anterior cruciate ligaments was the oblique sagittal plane parallel to the lateral femoral condyle as routinely used in MRI imaging of the knee The soft tissue window, single energy bone removal and Dual energy bone removal were the best reconstructions to determine the presence or absence of ACL disruption The bone removal techniques removed the distracting bone so the soft tissue structures were more apparent.
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Newly approved device to treat gastroesophageal reflux disease (GERD)

Newswise — April 11 2012— Mayo Clinic in Florida will be one of the first health care institutions in the United States to offer a newly approved device to treat gastroesophageal reflux disease (GERD). The condition, also known as acid reflux disease, can lead to serious health problems.

The U.S. Food and Drug Administration (FDA) approved the device and treatment procedure on March 22 for patients with GERD who continue to have chronic reflux symptoms despite taking medication.

Mayo Clinic in Florida expects to offer the new treatment immediately, says C. Daniel Smith, M.D., chair of the Surgery Department at Mayo Clinic in Florida, and an internationally recognized expert on the treatment of GERD.

Dr. Smith is experienced in using the system because Mayo Clinic in Florida was one of only 14 centers nationally that participated in a clinical trial that led to the FDA’s approval of the device.

“Mayo has been a leader in the treatment of esophageal diseases, especially GERD, and we are pleased to be offering this new treatment to our patients immediately,” he says.

GERD is a condition in which liquid, or food, in the stomach flows back up into the esophagus due to the inability of a ring of muscle between the lower esophagus and the top of the stomach to close properly.

If drugs aimed at neutralizing the acid in the stomach fails to prevent GERD, an operation designed to correct the mechanical defect is considered. But between 1.5 million and 2 million patients of those patients could benefit from treatment that is much less complex than current surgical options, Dr. Smith says.

“The new system will offer a long-needed treatment option for a large group of underserved patients,” he says.

The results of the clinical study that led to approval of the device have not yet been published. But “the data presented to the FDA revealed striking results when compared to other GERD treatments that have been investigated over the past 20 years,” Dr. Smith says. “The system offers effective control of GERD with limited side effects and thus far an excellent safety record.”

The implanted device is a ring of tiny magnetic titanium beads that is wrapped around the junction between the stomach and esophagus, serving as a mechanical augmentation of the lower esophageal sphincter (the ring of muscle). The magnetic attraction between the beads is strong enough to keep the sphincter closed to refluxing acid, but weak enough so that food can pass through it into the stomach, Dr. Smith says. The device can be implanted using minimally invasive surgery methods.

Dr. Smith performs about 200 GERD-related surgeries a year and has been involved with many new treatments over the past several decades. “I expect this device to be a game changer for the treatment of GERD in select patients who have failed management with drugs,” says Dr. Smith.

Ken DeVault, M.D., chair of the Department of Internal Medicine at Mayo Clinic in Florida, also participated in these studies. “I have many patients who are searching for something more than medication for their reflux, but have been hesitant to undergo a traditional reflux surgery,” he says. “I think this procedure may well be a very attractive option for that group.”

Mayo Clinic physicians and scientists collaborated with Torax Medical in the development of this technology and Mayo Clinic licensed related technology to the company in exchange for equity. Drs. DeVault and Smith are paid consultants to Torax Medical.