Author Interviews, CMAJ, OBGYNE / 19.06.2018

MedicalResearch.com Interview with: “Birth” by Sharon Mollerus is licensed under CC BY 2.0Giulia Muraca, PhD, MPH Postdoctoral Fellow School of Population and Public Health BC Children’s Hospital Research Institute Faculty of Medicine University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings?  Response: While cesarean delivery rates have increased in Canada over the last few decades, as in most industrialized settings, the rate of forceps and vacuum deliveries have declined. These opposing trends have led to recommendations to increase forceps and vacuum delivery rates as a strategy to reduce cesarean delivery rates. We found that the rate of obstetric trauma in Canada increased significantly in recent years, especially among forceps deliveries. In first-time mothers, the rate of obstetric trauma increased by 7% among forceps deliveries (from 19.4% in 2004 to 26.5% in 2014) and in women who had a previous cesarean delivery, the rate of obstetric trauma among forceps deliveries increased by 9% (from 16.6% to 25.6%). We found that a 1% increase in the forceps and vacuum delivery rate in Canada was associated with approximately 700 additional cases of obstetric trauma and 18 additional cases of severe birth trauma annually among first-time mothers alone.  (more…)
Author Interviews, Pain Research, Rheumatology, Weight Research / 19.06.2018

MedicalResearch.com Interview with: Professor Steve Messier Director of the J.B. Snow Biomechanics Laboratory J.B Snow Biomechanics Laboratory Wake Forest University MedicalResearch.com: Why did you undertake this study? Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273. We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial. (more…)
Author Interviews, Environmental Risks, Gastrointestinal Disease, Pediatrics / 18.06.2018

MedicalResearch.com Interview with: Kris R. Jatana, MD, FAAP, FACS Associate Professor Director, Pediatric Otolaryngology Quality Improvement Department of Otolaryngology-Head & Neck Surgery Nationwide Children's Hospital & Wexner Medical Center at Ohio State University MedicalResearch.com: What is the background for this study?   Response: More than 2,500 pediatric button battery ingestions occur annually in the United States. When lodged in the esophagus, rapid injury can occur from the tissue and saliva connecting the circuit of the battery. Serious injury can occur in a matter of hours. This results in a highly alkaline caustic injury that dissolves tissue, a process called liquefactive necrosis. There was a need for novel mitigation strategies to slow the progression of esophageal injury caused by presence of a button battery. This study aimed at identifying a palatable liquid that can be given at home or hospital setting to reduce esophageal injury until the battery can be removed. (more…)
Author Interviews, Orthopedics, Rheumatology / 18.06.2018

MedicalResearch.com Interview with: Samuel Hawley | Research Assistant (NIHR PhD Project) | Pharmaco- and Device Epidemiology Group | Centre for Statistics in Medicine | NDORMS | University of Oxford  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The aim was to disentangle some of the potential reasons for the recent decline in joint replacement rates among rheumatoid arthritis (RA) patients in the developed world. The main findings from our UK patient-level analysis indicated that joint replacement rates were not significantly different for users of TNF inhibitors versus the patients who remained only on conventional synthetic DMARDS, however we did find that TNF inhibitor use amongst older RA patients was associated with a 40% reduction in hip replacement rates. (more…)
AHA Journals, Allergies, Author Interviews, Infections, JAMA / 17.06.2018

MedicalResearch.com Interview with: “Lone Star Tick” by Katja Schulz is licensed under CC BY 2.0Jeffrey Wilson, MD, PhD Research Fellow, Allergy & Immunology University of Virginia  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Galactose-α-1,3-galactose (α-Gal) represents an oligosaccharide that is present in mammalian products and is the causal allergen in a syndrome of delayed red meat allergy (commonly called α-Gal syndrome). Sensitization to this allergen has been linked to tick bites, specifically the lone star tick in the United States. Thus, sensitization to α-Gal (and the prevalence of subjects with symptomatic red meat allergy) is relatively common where the lone star tick is common, i.e- the southeast. For a variety of reasons we hypothesized that specific immune sensitization (which relates to IgE antibody production) to α-Gal would be a risk factor for coronary artery disease. To address this possibility we measured IgE specific to α-Gal in 118 adults subjects from central Virginia who had undergone advanced cardiac imaging with a technique called intravascular ultrasound. Out of the cohort 26% of the subjects in the study had the sensitivity to α-Gal. The main finding was that subjects with the IgE sensitization to α-Gal had greater amounts of atherosclerosis, as well as atherosclerotic plaques with more unstable characteristics. This association was significant when controlled for traditional cardiovascular risk factors such as hypertension, diabetes and lipids levels. (more…)
Author Interviews, Emergency Care, Opiods / 16.06.2018

MedicalResearch.com Interview with: Herbie Duber, MD, MPH, FACEP Associate Professor, Emergency Medicine Adjunct Associate Professor Department of Global Health Adjunct Associate Professor Institute for Health Metrics and Evaluation University of Washington MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Opioid use disorder (OUD) and opioid overdose deaths are a rapidly increasing public health crisis.  In this paper, we review and synthesize current evidence on the identification, management and transition of patients from the emergency department (ED) to the outpatient setting and present several key recommendations. For patients identified to haveOpioid use disorder, we recommend ED-initiated mediation-assisted therapy (MAT) with buprenorphine, an opioid agonist.  Current evidence suggests that it safe and effective, leading to improved patient outcomes.  At the same time, a coordinated care plan should be put into motion which combines MAT with a rapid transition to outpatient care, preferably within 72 hours of ED evaluation.  Where possible, a warm handoff is preferred, as it has been shown in other settings to improve follow-up.  Outpatient care should combine MAT, psychological interventions and social support/case management in order to maximize impact (more…)
Author Interviews, Rheumatology / 16.06.2018

MedicalResearch.com Interview with: Maarten Boers, MSc, MD, PhD Professor of Clinical Epidemiology Department of Epidemiology and Biostatistics VU University Medical Center--F wing MedFac Amsterdam, Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mortality in rheumatoid arthritis is increased. Recent (short-term) studies suggest the situation is improving, but in studies with long (>10-year) follow up the increased mortality persists. We have been following a trial cohort of rheumatoid arthritis patients treated right from the beginning of disease (the COBRA trial) for 23 years and now, for the first time, show normal mortality compared to the general population. (more…)
Addiction, Author Interviews, Cannabis, Mental Health Research / 15.06.2018

MedicalResearch.com Interview with: “Cannabis sativa” by Manuel is licensed under CC BY 2.0 Leen Naji, BHSc, MD Family Medicine Resident McMaster University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cannabis use has consistently been linked to suicide attempt in the general population, but little data exists linking the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. This is important data as we know that patients with psychiatric disorders are both more likely to use cannabis and to attempt suicide. Therefore, our goal was to study the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. Additionally, since we know that women are more likely to suffer from mental health disorders, are more likely to attempt suicide and are more likely to incur the deleterious consequences of drug use at lower doses, we sought to compare the association between cannabis use and suicide attempt in men and women amongst our study population. We conducted our analysis on a large sample of over 900 adults with psychiatric disorders (465 men, 444 women), of whom 112 men and 158 women had attempted suicide. The average age of our study sample was 40 years. We found that cannabis use is not associated with an increased risk of suicide in patients with psychiatric disorders, though this association may vary when looking at specific subpopulations and/or amount of cannabis use. For instance, we found that heavier cannabis use is associated with an increased risk of suicide attempt amongst men with psychiatric disorders. Specifically, there was a 3% increased risk of suicide attempt for every day of cannabis use per month in men with psychiatric disorders. We also found that amongst those with psychiatric conditions, women, unemployed individuals and those with a mood disorder were at increased risk of suicide attempt.   (more…)
Author Interviews, Memory, Technology / 15.06.2018

MedicalResearch.com Interview with: Eric Krokos 5th-year Ph.D. student in computer science Augmentarium visualization lab augmentarium.umiacs.umd.edu University of Maryland  MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am interested in exploring the use of virtual and augmented reality in high-impact areas like education, medicine, and high-proficiency training. For VR and AR to excel as a learning tool, we felt there needed to be a baseline study on whether people would perceive information better, and thus learn better, in an immersive, virtual environment as opposed to viewing information on a two-dimensional desktop monitor or handheld device. Our comprehensive user-study showed initial results that people are able to recall information using virtual reality—there was an 8.8 percent improvement in recall ability from our study participants using VR. (more…)
Addiction, Author Interviews, Smoking, Tobacco, Tobacco Research / 15.06.2018

MedicalResearch.com Interview with: e-cigarette CDC imageDr Lynne Dawkins, PhD Associate Professor London South Bank University MedicalResearch.com: What is the background for this study? Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals. (more…)
Author Interviews, Hand Washing, Infections, MRSA, Pediatrics / 15.06.2018

MedicalResearch.com Interview with: “Bart Infant” by Bart Everson is licensed under CC BY 2.0Gwen M. Westerling, BSN, RN, CIC Infection Preventionist Helen DeVos Children's Hospital MedicalResearch.com: What is the background for this study? Response: The setting of this study is a Level III Neonatal Intensive Care Unit (NICU) with 106 beds. In 2016, an increase in Hospital Acquired Infections (HAI) was noted in the Neonatal Intensive Care Unit (NICU) caused by Staphylococcus aureus (SA) through diligent Infection Prevention Surveillance. When we reviewed the literature we found the SA is a common skin colonizer and can be a problem for neonates with immature skin and immune systems. Staphylococcus aureus is easily transmitted through direct contact with skin, the contaminated hands of health care workers, the environment and equipment. We also found one study that listed skin to skin care as a risk factor for acquisition of SA. Before we saw the increase in infections some process changes occurred in our NICU that included increased skin to skin care, meaningful touch between neonates and parents, and two person staff care. We hypothesized that the process changes were exposing neonates to increased amounts of Staphylococcus aureus and contributing to the increase in infections. (more…)
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension / 15.06.2018

MedicalResearch.com Interview with: Professor Archana Singh-Manoux, PhD, HDR Epidemiology Research Director (DR1), INSERM Honorary Professor, University College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although there have been previous studies that have linked raised blood pressure in midlife to an increased risk of dementia in later life, the term ‘midlife’ has been poorly defined and ranged from 35 to 68 years. New findings from the long-running Whitehall II study of over 10,000 civil servants has found 50-year-olds who had blood pressure that was higher than normal but still below the threshold commonly used when deciding to treat the condition, were at increased risk of developing dementia in later life.  (more…)
Author Interviews, BMJ, GSK, Smoking, Tobacco, Tobacco Research / 14.06.2018

MedicalResearch.com Interview with: “Day 1 of nicotine patch, just stuffed my face with lunch at work and do NOT even want a cigarette” by David Bruce Jr. is licensed under CC BY 2.0Paul Aveyard Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences University of Oxford Radcliffe Primary Care Building Radcliffe Observatory Quarter Oxford MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Tobacco addiction occurs because of repeated pairings of the act and sensation of smoking with binding of nicotine in the midbrain leading to release of dopamine in the nucleus accumbens. These repeated pairings create associative learning and, when brain nicotine concentrations fall, this produces a compulsion to keep using tobacco. In theory, blocking the actions of nicotine released while smoking ought to reverse this learning. One way to do this is to use a nicotine patch which provides a steady state high concentration of nicotine that desensitises the nicotinic receptors in the midbrain, making them unresponsive to nicotine from a smoked cigarette. This is the theory behind nicotine preloading. The clinical trial evidence that preloading works is equivocal, with some trials suggesting a very large therapeutic effect and others no benefit at all. In the light of both the promise and the uncertainty, we aimed to complete the largest trial to date of nicotine preloading to examine its effectiveness, safety, and tolerability. (more…)
Author Interviews, Ophthalmology, Pediatrics / 14.06.2018

MedicalResearch.com Interview with: multiple choice test takingKrista Kelly, PhD Postdoctoral Fellow Crystal Charity Ball Pediatric Vision Evaluation Center Retina Foundation of the Southwest Dallas, TX 75231 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were interested in seeing whether the fine motor deficits typically seen in amblyopia (lazy eye) and strabismus (crossed eyes) translate to an academic setting. Namely, transferring answers to a multiple choice answer form widely used in standardized testing in schools. Children with amblyopia and strabismus took about 28% longer than their peers transferring answers to a multiple choice answer form, even though they have good vision in one or both eyes.  (more…)
Accidents & Violence, Author Interviews, Autism, Pediatrics / 14.06.2018

MedicalResearch.com Interview with: “Driving” by Martin Alvarez Espinar is licensed under CC BY 2.0Kristina Elise Patrick, Ph.D Nationwide Children’s Hospital Columbus, OH 43205 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Many families of young adults with autism spectrum disorder (ASD) are concerned that they may have difficulty acquiring driver’s licenses and driving safely because of symptoms of ASD. However, the ability to drive opens the door to a variety of social, occupational, and educational experiences. We aimed to assess differences in simulated driving behaviors of young adults with ASD and those with typical development and to evaluate whether differences depended on level of driving experience and complexity of the driving task. On average, young adults with ASD had more difficulty regulating their speed and position within their lane compared with typically developing individuals even on a very basic rural route. After completing the basic route, drivers were required to engage in more complex tasks such as changing the radio or engaging in conversation while driving, driving through a construction zone, and following behind a truck. On complex driving tasks, drivers with ASD who had acquired licensure drove similarly to typically developing drivers who had acquired licensure. However, novice drivers with ASD had more difficulty than typically developing drivers regulating their speed and position within the lane. (more…)
Author Interviews, Heart Disease, Lipids, Statins / 14.06.2018

MedicalResearch.com Interview with: Fatima Rodriguez, MD, MPH Division of Cardiovascular Medicine Stanford University Stanford, CA 94305-5406, MedicalResearch.com: What is the background for this study? What are the main findings? Response: Individuals with LDL-cholesterol levels above 190mg/dL are often underdiagnosed and undertreated, yet remain at high-risk of cardiovascular disease. In a national sample of veterans, we identified over 60,000 patients who met criteria for uncontrolled, severe hypercholesterolemia based on an index LDL-C value ≥190mg/dL. We found that only half of these high-risk patients are being treated with statins, and less than 10% are on high-intensity statin therapy as recommended by the 2013 ACC/AHA guidelines. We also found that both older and younger patients were less likely to be treated with statins. Women were less likely to be treated with statins, whereas minority groups and those with a diagnosis of hypertension were more likely to be treated. Disparities in use of statins were also noted by geographic region and hospital teaching status. (more…)
Author Interviews, Duke, Heart Disease, JAMA, Lipids, Race/Ethnic Diversity, Statins / 14.06.2018

MedicalResearch.com Interview with: Michael G. Nanna, MD Fellow, Division of Cardiology Duke University Medical Center Durham, NC MedicalResearch.com: What is the background for this study? Response: We know that African Americans are at higher risk for cardiovascular disease than white patients. We also know that African American individuals have been less likely to receive statin therapy compared to white individuals in the past. However, the reasons underlying these racial differences in statin treatment are poorly understood. We set out to determine if African American individuals in contemporary practice are treated less aggressively than whites and, if so, we wanted to investigate potential reasons why this might be the case. (more…)
Author Interviews, Microbiome, PNAS / 13.06.2018

MedicalResearch.com Interview with: Dr. Josh D. Neufeld PhD Professor; Department of Biology Ashley A. Ross MSc University of Waterloo Waterloo, Ontario, Canada  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Given important implications for skin health and our relationship to the microbial world, we are curious about the microorganisms on human skin, how these microbial communities are formed and passed on from generation to generation, and how these communities differ between mammalian species. Our main finding is that human skin microbial communities are distinct from nearly all of the other animals that we sampled, in terms of both diversity and composition. We also found initial evidence that animals and their skin microbial communities have co-evolved over time.  (more…)
Author Interviews, PLoS, Vaccine Studies / 13.06.2018

MedicalResearch.com Interview with: “Syringe and Vaccine” by NIAID is licensed under CC BY 2.0Melissa S Nolan, PhD, MPH Assistant Professor of Epidemiology Department of Epidemiology and Biostats Arnold School of Public Health University of South Carolina Columbia, SC 2920 MedicalResearch.com: What is the background for this study? Response: As the CDC says, “vaccines are one of the greatest success stories in public health”. In the US, fifteen different vaccines are currently available and recommendations are based on age group and medical indication. Estimates suggest that the US childhood vaccination program has prevented 381 million infections and avoided 855,000 deaths. Despite these astounding public health successes, a movement opposing childhood vaccinations has been growing. Medical contraindications do exist, and these children rely on others to be fully vaccinated to provide herd immunity for children that cannot get vaccinations for medical reasons. In contrast to this important vulnerable clinical population, other reasons for non-vaccination include religious and philosophical beliefs. A major reason for philosophical belief-exemptions is based on the erroneous belief that vaccines cause autism. With philosophical-belief based non-vaccinated populations on the rise, our current study aimed to better understand why some parents seek exemptions for their children. (more…)
ASCO, Author Interviews, Cancer Research, Radiation Therapy / 13.06.2018

MedicalResearch.com Interview with: Jonathan Strosberg MD Moffitt Cancer Center, Tampa, FL MedicalResearch.com: What is the background for this study? Response: Neuroendocrine tumor (NET) progression is associated with deterioration in quality of life. We assessed the impact of 177Lu-Dotatate treatment on time to deterioration in health-related quality of life in patients with advanced midgut neuroendocrine tumors in the NETTER-1 study. (more…)
Author Interviews, Cancer Research, Genetic Research, Nature, Prostate Cancer / 13.06.2018

MedicalResearch.com Interview with: Fredrick R. Schumacher, PhD, MPH. Associate Professor, Department of Population & Quantitative Health Sciences Case Western Reserve University Cleveland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Our study examines the genetic underpinnings of prostate cancer initiation using technology to test variants across the genome. Our study focused on men of European ancestry and included over 80,000 men with prostate cancer and 60,000 men without disease. We discovered 63 novel genetic variants associated with prostate cancer risk, which increases our knowledge of prostate cancer genetic risk factors by more than 60%. A genetic risk score created from the combination of 163 new and known prostate cancer risk variants revealed men with the highest genetic risk score are nearly seven times more likely to develop disease compared to the average man. Additionally, men with the lowest genetic risk score have a 85% risk reduction of developing prostate cancer compared to the average. Lastly, these new discoveries uncover several biological mechanisms involved in the initiation of prostate cancer. (more…)
Author Interviews, HIV, University of Michigan / 13.06.2018

MedicalResearch.com Interview with: Rogério M. Pinto, LCSW, Ph.D. Associate Professor Associate Dean for Research School of Social Work University of Michigan Ann Arbor, USA MedicalResearch.com: What is the background for this study? Response: This integrative review, published in the journal AIDS and Behavior, includes content from 47 peer-reviewed scholarly articles reporting multiple barriers to high-risk individuals trying to access pre-exposure prophylaxis (PrEP), the HIV drugs that reduce subsequent risk of infection. We found 31 potential solutions to 30 barriers at the patient, provider and health-system levels. In synthesizing this research from a multi-level perspective, based upon a socioecological model, our report contributes much-needed analysis to the rapidly expanding field of PrEP implementation research. At this stage in the scale-up of U.S. PrEP programs, it is important to systematically and comprehensively analyze and integrate knowledge about the successes of and the barriers to PrEP implementation. Our review provides a comprehensive analysis and informs the direction of PrEP implementation across a variety of settings. (more…)
Author Interviews, Health Care Systems, Infections, JAMA, Outcomes & Safety / 13.06.2018

MedicalResearch.com Interview with: Sarah L. Krein, PhD, RN Research Career Scientist VA Ann Arbor Healthcare System Ann Arbor, MI  Sarah L. Krein, PhD, RN Research Career Scientist VA Ann Arbor Healthcare System Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: We conducted this study to better understand the challenges faced by health care personnel when trying to follow transmission based precaution practices while providing care for hospitalized patients.  We already know from other studies that there are breaches in practice but our team was interested in better understanding why and how those breaches (or failures) occur so we can develop better strategies to ensure the safety of patients and health care personnel. (more…)
Author Interviews, Genetic Research, Schizophrenia, UCSD / 12.06.2018

MedicalResearch.com Interview with: Marcelo Pablo Coba PhD Assistant Professor of Psychiatry Zilkha Neurogenetic Institute Keck School of Medicine of USC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psychiatric diseases such as schizophrenia (SCZ) are complex brain disorders where a multitude or risk factors have been implicated in contributing to the disease, with a low number of genes that have been strongly implicated in a very low number of cases. One of these genes is Disrupted in schizophrenia 1 (DISC1), which was first described in 2000 as a balanced translocation that segregates with schizophrenia and related psychiatric disorders in a large Scottish family. Because DISC1 does not have an identified protein function such as enzymatic, channel, transporter, etc… the field moved to try to understand what proteins are associated (physically connected) to DISC1 and to try to explain DISC1 function through the function of its protein interactors. This means that if DISC1 binds proteins X, Y and Z, then mutations in the DISC1 gene should affect the functions of   these proteins. Therefore, there has been much effort in trying to identify DISC1 protein interactors. However this task has not been straightforward. (more…)
Asthma, Author Interviews, Biomarkers / 12.06.2018

MedicalResearch.com Interview with: Dr. Supinda Bunyavanich MD Pediatric Allergy and Immunology Physician and researcher at the Icahn School of Medicine. MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In this study, we report on an accurate asthma biomarker we have developed based on a simple nasal brush. Nasal Brush-based Classifier of Asthma Asthma is a chronic respiratory disease that affects 10% of children and adults in the U.S. Mild to moderate asthma can be difficult to diagnose because symptoms change over time and can be complicated by other respiratory conditions. Given the high prevalence of asthma, there is high potential impact of improved diagnostic tools on reducing morbidity and mortality from asthma. Current diagnostic tools for asthma, including spirometry and bronchoscopy, require specialized equipment and expertise to operate properly. Many individuals, particularly young children, have difficulty with pulmonary function testing because it requires, coordinated, forced breaths into a device. Spirometry results are unreliable when done with poor technique. Bronchoscopy is not practical for mild to moderate symptoms. For these reasons, asthma is often diagnosed and managed based on self-reporting of symptoms  This can be unreliable, resulting in repeated doctor visits and even trips to the ER. Thus, a biomarker test for asthma that is easy to implement and interpret is highly desirable for the diagnosis and management of asthma. (more…)
Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hip Fractures, Surgical Research / 12.06.2018

MedicalResearch.com Interview with: Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours). (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Medical Imaging, Memory / 12.06.2018

MedicalResearch.com Interview with: Arno de Wilde, MD / PhD candidate Department of Neurology & Alzheimer Center Amsterdam Neuroscience VU University Medical Center Amsterdam, the Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies assessing the clinical utility of amyloid imaging used very selected research populations, limiting the translatability to clinical practice. In contrast, we used an unselected memory clinic cohort, offering amyloid PET to ALL patients visiting our memory clinic, and for the purpose of this study, we implemented amyloid PET in our routine diagnostic work-up. Our results demonstrate that amyloid PET has important consequences, in terms of diagnosis and treatment changes, for a significant number of patients within a situation that closely resembles clinical practice. I think that these results are an important step in 'bridging the gap' between using amyloid PET in a research setting versus daily clinical practice. (more…)
Author Interviews, JAMA, MRI, Prostate Cancer / 11.06.2018

MedicalResearch.com Interview with: Dr. Lars Boesen MD PhD Department of Urology Herlev Hospital MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The current standard of care in prostate cancer diagnosis includes untargeted transrectal ultrasound-guided biopsies for all biopsy-naïve men with clinically suspicion of prostate cancer. However, this strategy that practically has remained unchanged for decades has limited diagnostic accuracy as significant cancers are missed or under-graded and insignificant cancers are unintendedly detected by the random sampling leading to possible overtreatment. Multiparametric MRI in the diagnosis of prostate cancer has been studied extensively in recent years and has improved detection, localization, staging and risk stratification. It has been suggested that if multiparametric MRIs were used as a triage test prior to biopsies, a significant proportion of men might safely avoid prostate biopsies and the diagnostic ratio of significant vs. insignificant cancer could be improved compared to performing standard biopsies in all men. However, multiparametric MRIs are generally time-consuming (~40 min scan time), expensive and include intravenous contrast media. This reduces its feasibility for widespread clinical implementation in larger patient populations in the western community with its high PCa prevalence. The development of a simpler and faster (~15 min) biparametric MRI protocol using less scan sequences and circumvents intravenous contrast-media seems to preserve adequate diagnostic accuracy in a detection setting and could facilitate dissemination of prostate MRI as a triage test before any biopsy. Here we present a large prospective study that assesses the diagnostic accuracy of a novel biparametric MRI to rule out significant prostate cancer in N=1020 biopsy-naive men with clinically suspicion of prostate cancer. We found that a low suspicion biparametric MRI had a very high negative predictive value (97%) for ruling out significant cancer on confirmatory biopsies. Furthermore, bpMRI suspicion scores were strongly associated with prostate cancer detection rates and restricting biopsies (targeted plus standard) to men with suspicious biparametric MRIs meant 30% could avoid prostate biopsies, improved significant prostate cancer diagnosis by 11%, and reduced insignificant prostate cancer diagnosis by 40% compared to our current diagnostic approach – standard biopsies for all men with clinically suspicion of prostate cancer.  (more…)
Author Interviews, Education, JAMA / 04.06.2018

MedicalResearch.com Interview with: Kathleen M. Finn MD, MPhil Christiana Iyasere MD, MBA Division of General Internal Medicine Department of Medicine Massachusetts General Hospital, Boston MedicalResearch.com: What is the background for this study? Response: While the relationship between resident work hours and patient safety has been extensively studied, little research evaluates the role of attending supervision on patient safety. Beginning with the Bell Commission there have been increased calls for enhanced resident supervision due to patient safety concerns. At the same time, with the growth of the hospitalist movement more faculty physicians join daily resident work rounds under the assumption that increased supervision is better for patient safety and resident education. However, we know that supervision is a complex balancing act, so we wanted to study whether these assumptions were true. On the one hand patient safety is important, but on the other adult learning theory argues residents need to be challenged to work beyond their comfort level. Importantly, being pushed beyond your comfort level often requires appropriate space between teacher and learner. To investigate the role of attending supervision on patient safety and resident learning we studied the impact of two levels of physician supervision on an inpatient general medical team. Twenty-two teaching faculty were randomized to either direct supervision of resident teams for patients previously known to the team vs usual care where they did not join rounds but rather discussed the patients later with the team. Faculty participated in both arms of the study, after completing the first arm they then crossed over to the other arm; each faculty member participated in the study for a total of 4 weeks. (more…)
Anesthesiology, Author Interviews, Pulmonary Disease / 03.06.2018

MedicalResearch.com Interview with: Dr James Purcell University College Cork and South Infirmary Victoria University Hospital Cork, Ireland MedicalResearch.com: What is the background for this study? Response: Nail varnish and acrylic nails are common accessories and as such are commonly encountered by an array of healthcare professionals in various scenarios when SpO2 readings may be part of patient care.. Colloquially there was a wide variety of approaches and beliefs as to whether or not these treatments impacted on SpO2 readings. This is due to the fact that the Digital Pulse oximetry relies on the passing of a wavelength of light through a pulsatile nailbed to a sensor on the opposite side of the finger tip in order to read SpO2 levels. Any potential interference to this process by polish of certain hues, or acrylic was therefor believed to impact on the resultant readings As such it was decided to analyse the actual level of knowledge and variety of approaches to the issue by means of a multisite study involving Consultants, NCHDs, and nursing staff in areas where this issue may arise. A second, experimental part of the study was set up using healthy volunteers and venous congestion and hypoxia modelling. Nail varnish of differing hues and acrylic nails were applied and results of SpO2 readout in healthy and pathological models with and without nail treatments applies were analysed. (more…)