Author Interviews, Outcomes & Safety, PLoS, UCSF / 06.12.2014

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610MedicalResearch.com Interview with: Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco

MedicalResearch: What is the background for this study? What are the main findings? Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms. (more…)
Author Interviews, Brain Injury, PTSD / 05.12.2014

James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands DivisionMedicalResearch.com Interview with: James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands Division Medical Research: What is the background for this study? Dr. Spira:  Approximately 1.5 million Americans survive a traumatic brain injury (TBI) from traffic accidents, assaults, sports, and work injuries, with the vast majority of these being primarily mild (mTBI), otherwise known as concussion.1 Concussion, however, is uniquely problematic in the military given the new strategies of war encountered by service members when fighting an insurgency using improvised explosive devices. The rate of concussion experienced by United States (U.S.) service members engaging in combat during the wars in Afghanistan and Iraq has been estimated at between 15% and 22%.2–4There has been controversy in the area of neurotrauma as to whether persistent postconcussive symptoms (PPCSx) are due to neurological causes or solely due to the psychological sequelae of having been exposed to a traumatic event.  The recent wars in Iraq and Afghanistan have afforded an opportunity to examine these factors, although teasing them apart has proven difficult.  The most influential study of persistent effects of concussion in service members is that of Hoge and colleagues,5 in which they failed to find an independent effect of prior concussion on PPCSx, once depression and posttraumatic stress (PTSD) was taken into account.  They went so far as to recommend that assessment for concussion following deployment is unnecessary.  Others, however, have reported persistent cognitive, emotional, and physical symptoms following concussion. (more…)
Author Interviews, PLoS, Smoking, Weight Research / 05.12.2014

Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United KingdomMedicalResearch.com Interview with: Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Munafo: We were conducting an analysis of data on smoking behaviour and body mass index (BMI), in order to better understand the potential causal effects of smoking on different measures of adiposity. Mendelian randomisation uses genetic variants associated with the exposure of interest (in this case smoking) as proxies for the exposure, in order to reduce the risk of spurious associations arising from confounding or reverse causality. As expected, we found that, among current smokers, a genetic variant associated with heavier smoking was associated with lower BMI, providing good evidence that smoking reduces BMI. However, we also unexpectedly found that the same variant was associated with higher BMI in never smokers. This suggests that this variant might be influencing BMI via pathways other than smoking. (more…)
Alcohol, Author Interviews, Nature, University Texas / 05.12.2014

MedicalResearch.com Interview with: R. Dayne Mayfield PhD and Sean Farris Post Doc Fellow Harris Lab Waggoner Center for Alcohol and Addiction Research University of Texas at Austin MedicalResearch: What is the background for this study? Response: Alcoholism is psychiatric disorder adversely affecting the health of millions of individuals worldwide. Despite considerable research efforts, alcoholism cannot be attributed to any individual gene. We sought out to identify coordinately regulated gene networks, rather than a single candidate gene, that may be collectively driving the consumption of alcohol. (more…)
Author Interviews, BMJ, Cost of Health Care, Pediatrics / 05.12.2014

MedicalResearch.com Interview with Rosemary Dodds Senior Policy Adviser NCT (formerly National Childbirth Trust), London, UK Medical Research: What is the background for this study? What are the main findings? Response: The study, which was commissioned by UNICEF UK, was designed to take an in-depth look at how raising breastfeeding rates might save money for the health service through reducing illness. It found that low breastfeeding rates in the UK are costing the health service millions of pounds.  We calculated that from reducing rates of illnesses, where the evidence is strongest, moderate increases in breastfeeding could see potential annual savings to the health service of around £40m per year. It should be noted however, that this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account. Economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterocolitis (NEC) in the baby), show that moderate increases in breastfeeding would translate into the following cost savings for the NHS:
  •  If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:
-      865 fewer cases of breast cancer -      With cost savings to the NHS of over £21million -      Improved quality of life equating to more than £10million[1] Over the lifetime of each annual cohort of first-time mothers.
  • If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfeeding at discharge, each year there would be:
-      3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million -      5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million -      21,045 fewer GP visits for ear infection, saving £750,000 -      361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million (more…)
Aging, Author Interviews, BMJ, Brigham & Women's - Harvard, Mediterranean Diet / 05.12.2014

Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115MedicalResearch.com Interview with: Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115 MedicalResearch: What is the background for this study? What are the main findings? Dr. De Vivo: Our study found that greater adherence to the Mediterranean diet is associated with longer telomeres. Following a diet closer to the Mediterranean diet, can prevent accelerated telomere shortening. Our unique contribution to the literature is that we provide a potential molecular mechanism, preventing telomere shortening. Telomeres are bits of DNA that protect your chromosomes. MedicalResearch: Is telomere shortening reversible? Dr. De Vivo: Telomere shortening is a biological process, the shorten with age. However, lifestyle choices can help to prevent accelerated shortening. Fruits, vegetables, olive oil and nuts – key components of the Mediterranean diet have well known antioxidant and anti-inflammatory effects that could balance out the “bad effects” of smoking and obesity. (more…)
Author Interviews, Cancer Research, University of Michigan / 04.12.2014

MedicalResearch.com Interview with: Silvana Papagerakis M.S., M.D., Ph.D. Research Assistant Professor, Department of Otolaryngology-Head and Neck SurgeryDirector, Oral, Head and Neck Cancer Invasion and Metastasis Laboratory Ann Arbor MI Silvana Papagerakis M.S., M.D., Ph.D. Research Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Director, Oral, Head and Neck Cancer Invasion and Metastasis Laboratory, Ann Arbor MI MedicalResearch: What is the background for this study? What are the main findings? Dr. Papagerakis: We had suspicions that these medications somehow had a favorable impact on patient outcomes. This led us to review our large cohort of patients and screen them for common medications, focusing on antacids. In fact, our study did show that people taking antacids are doing better. What this study makes clear is that these medications may be more beneficial to the patients than just controlling side effects of chemotherapy or radiation treatment for head and neck cancer. (more…)
Author Interviews, Brain Injury, Memory / 04.12.2014

Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical SchoolMedicalResearch.com Interview with Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Sandry: We were interested in better understanding the relationship between cognitive reserve and long-term memory impairment in moderate to severe Traumatic Brain Injury, from a cognitive perspective. The theory of cognitive reserve suggests that individuals who engage in intellectually enriching activities may be less susceptible to the negative cognitive consequences of long-term memory impairment that often accompanies neurological disorders. There’s significant evidence in support of cognitive reserve; however, it’s somewhat unclear what particular cognitive processes are involved in this relationship and how those cognitive processes may differ across high and low reserve individuals. We derived our predictions on the basis of well-established cognitive theory and found that working memory capacity partially mediates the cognitive reserve – long-term memory relationship in Traumatic Brain Injury. Or to put it another way, working memory may be one underlying cognitive process involved in this relationship. Importantly, this finding corroborates some recent related work we have conducted in multiple sclerosis. (more…)
Orthopedics, Radiology / 04.12.2014

Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine Boston MA 02118MedicalResearch.com Interview with: Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term. (more…)
Heart Disease / 04.12.2014

MedicalResearch.com Interview with: Dr. Joanne van Ryn, PhD Department of CardioMetabolic Disease Research Boehringer Ingelheim GmbH & Co., Germany MedicalResearch: What is the background for this study? What are the main findings? Response: Idarucizumab is a humanized antibody fragment, or Fab, being investigated as a specific antidote to reverse the anticoagulant effect of dabigatran. Currently, there are no specific antidotes available for any of the newer oral anticoagulants, or NOACs, to complement the existing range of bleed management options during critical care situations. Idarucizumab is being developed to provide physicians with an additional therapeutic option they could consider should a patient require emergency intervention or if a patient experiences uncontrolled bleeding. Pre-clinical studies indicated idarucizumab binds specifically to and inhibits dabigatran. Phase I data with idarucizumab in healthy volunteers demonstrated the potential of idarucizumab to achieve immediate, complete and sustained reversal of dabigatran-induced anticoagulation. In that placebo-controlled study, idarucizumab did not cause any clinically relevant side effects. This phase I sub-study in 35 healthy volunteers showed that idarucizumab restores dabigatran-induced inhibition of fibrin formation at a small wound site. Fibrin, the main component of a blood clot, was assessed by measuring levels of fibrinopeptide A (FPA), a substance that is released when fibrin is formed. Fibrin formation was assessed after a small scratch, similar to a paper cut, was made. Measurements were conducted at baseline, after administration of dabigatran, and after subsequent administration of idarucizumab or placebo. The results showed that dabigatran almost completely inhibited the production of FPA at the wound site, and that idarucizumab restored FPA production:
  • At baseline, before the volunteers took dabigatran, the average level of FPA was 3981 ng/mL.
  • On day three, 2.5 hours after the volunteers took dabigatran, the average level of FPA was 208 ng/mL, an approximate 95 percent decrease compared to baseline.
  • On day four, 2.5 hours after the volunteers took dabigatran and 30 minutes after they were infused with 1 g, 2 g or 4 g of idarucizumab, FPA levels were 24 percent, 45 percent and 95 percent, respectively, of the average baseline level.
The restored fibrin production at the wound site after idarucizumab dosing with 2g or 4g also correlated with reversal of the dabigatran-anticoagulation activity in circulating blood. (more…)
Heart Disease / 04.12.2014

dr_John-SeegerMedicalResearch.com Interview with: Dr. John Seeger, PharmD, DrPH Department of Medicine, Brigham and Women’s Hospital Dr. Seeger: What is the background for this study? What are the main findings? Response: This study is part of an ongoing research program initiated in 2013 to assess prescribing patterns and real-world safety and effectiveness of oral anticoagulants, including dabigatran, for the reduction of stroke risk. The study program is expected to run through the end of 2016. Boehringer Ingelheim and Brigham and Women’s Hospital are aiming to gather data from more than 100,000 U.S. NVAF patients. Using a sequential matched cohort design, the safety and effectiveness of dabigatran compared to warfarin among patients with non-valvular atrial fibrillation (NVAF) receiving these medications in routine care settings can be assessed periodically. The interim findings at this stage come from 38,378 non-valvular atrial fibrillation patients in two health insurance databases, MarketScan (31,058 patients) and UnitedHealth (7,320 patients). The primary analysis follows patients from start of therapy until a switch or discontinuation of the anticoagulant, an outcome event, or disenrollment. The average follow-up was five months for patients in the dabigatran group and four months for those taking warfarin. The primary outcomes measured in the analysis are stroke and major hemorrhage. Interim findings from the combined databases showed a 25 percent reduction in the rate of major hemorrhage (hazard ratio [HR] 0.75, 95 percent confidence interval [CI] 0.65-0.87, 354 vs. 395 events) and a 23 percent reduction in strokes (HR 0.77, CI 0.54-1.09, 62 vs 69 events) for dabigatran compared to warfarin among these patients with NVAF. The database-specific results indicate a reduction in the rate of major hemorrhage with dabigatran (MarketScan: HR 0.78, CI 0.67- 0.91; UnitedHealth: HR 0.56, CI 0.36-0.86). In the larger MarketScan database, dabigatran reduced the stroke rate by 36 percent (HR 0.64, CI 0.44-0.95), while in the smaller UnitedHealth database, stroke rates were not different between the two anticoagulants, as there were only 26 strokes in total which led to wide confidence intervals (HR=1.62, CI 0.72-3.66). (more…)
Breast Cancer, UCSF / 04.12.2014

Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA 94115MedicalResearch.com Interview with: Elissa R. Price, MD Assistant Professor of Clinical Radiology Director of Clinical Operations, Breast Imaging Breast Imaging Fellowship Program Director Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, CA  94115 MedicalResearch: What is the background for this study? What are the main findings? Dr. Price: Screening mammography recommendations for the 40 - 49 age group is very controversial. 2009 USPTF guidelines emphasized taking patient context into account when making decisions for these young women. Recent publications have suggested risk-based screening strategies.  Family history and breast density are important are easily accessible risk factors. Had we been using this risk-based approach to screening mammography at our institution, we would have missed more than 3Ž4 of the screen detected breast cancers in the 40-49 age group, thereby foregoing most of the survival benefit from screening mammography. (more…)
Author Interviews, Lung Cancer, PLoS / 03.12.2014

dr_Martin_C_TammemägiMedicalResearch.com Interview with: Dr. Martin C. Tammemägi Professor (Epidemiology), Brock University Department of Health Sciences St. Catharines, Ontario, Canada L2S 3A1 Medical Research: What is the background for this study? What are the main findings? Dr. Tammemägi: Lung cancer is the leading cause of cancer death in North America and the world. Lung cancer survival following diagnosis is generally poor, in the range of 10% to 15%, and has improved little over the last four decades. The biggest recent breakthrough for reducing lung cancer mortality came with the findings of the National Lung Screening Trial (NLST), a large, well-conducted randomized screening trial, which demonstrated that low dose computed tomography (LDCT) screening versus chest X-ray (CXR) screening can reduce lung cancer mortality by 20%. Currently, most guidelines for selecting screenees for lung screening use the NLST enrolment criteria of 30 or more pack-years smoked, former smokers must have quit smoking within 15 years and ages between 55 and 74, or use a variant of the NLST criteria. The US Preventive Services Task Force (USPSTF) essentially recommends using the NLST criteria but extended the inclusion age to 80 years. The current study applied the PLCOm2012 lung cancer risk prediction model1 to NLST data and identified that the risk above which lung cancer mortality is consistently lower in the LDCT arm compared to the CXR arm, is ≥1.51% 6-year risk (65th percentile). The USPSTF and the PLCOm2012 risk ≥0.0151 criteria were then applied to the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) intervention arm smokers (the PLCOm2012 was developed in PLCO controls) to determine who would be selected for lung cancer screening. Compared to USPSTF criteria, the PLCOm2012 risk ≥0.0151 threshold selected 8.8% fewer individuals, but identified 12.4% more lung cancers (sensitivity 80.1% vs. 71.2%), and had fewer false positives (specificity 66.2% vs. 62.7%). 26% of smokers who were USPSTF criteria positive had risks below the PLCOm2012 risk ≥0.0151 threshold. Of PLCO former smokers who quit more than 15 years ago, 8.5% had PLCOm2012 risk ≥0.0151, suggesting that they might benefit from screening (2.9% of them developed lung cancer in 6 year). None of 65,711 never-smokers in the PLCO had PLCOm2012 risk ≥0.0151, indicating that never-smokers should not be screened. Individuals age ≥65–80 years had significantly higher risks and more lung cancers than those 55-64 years. (more…)
Author Interviews, BMJ, OBGYNE, Weight Research / 03.12.2014

Stefan Johansson, MD PhD consultant neonatologist Stockholm, SwedenMedicalResearch.com Interview with: Stefan Johansson, MD PhD consultant neonatologist Stockholm, Sweden Medical Research: What is the background for this study? Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce. (more…)
Author Interviews, General Medicine, Genetic Research, Nature / 03.12.2014

Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, SwitzerlandMedicalResearch Interview with: Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, Switzerland   MedicalResearch: What is the background for this study? What are the main findings? Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms. (more…)
Author Interviews, Cost of Health Care / 02.12.2014

Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CAMedicalResearch.com Interview with: Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CA MedicalResearch: What is the background for this study? What are the main findings? Dr. Romley: We've known for a long time now that there is tremendous variation in how much Medicare spends across the country, and that these differences are not necessarily related to quality of care.  Researchers have devoted great time, energy and intellect to understanding the drivers of Medicare spending.  While progress has been made, our understanding remains limited.  We also have had less insight into how private health care varies across the country. We used new information on how much private health plans pay health care providers over and above cost, and found that areas with low private payment levels tended to have substantially higher Medicare spending and utilization. (more…)
Author Interviews, Ophthalmology, Statins / 02.12.2014

B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic.MedicalResearch.com Interview with: B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic. MedicalResearch: What are the main findings of this study? Dr. Mancini: The main findings are that we found evidence of a relationship between statin use and the need for cataract surgery. The unique nature of the study is that it looked for the association in two distinctly different populations (a Canadian database and a separate, American database) and found a consistent association in both populations. (more…)
Author Interviews, Infections / 02.12.2014

Jack A Gilbert PhD Department of Ecology & Evolution Graduate Program in Biophysical Sciences University of Chicago, Chicago, IL 60637,MedicalResearch.com Interview with: Jack A Gilbert PhD Department of Ecology & Evolution Graduate Program in Biophysical Sciences University of Chicago, Chicago, IL 60637 MedicalResearch: What is the background for this study? What are the main findings? Dr. Gilbert: We have performed extensive analysis of the microbial distribution between humans and home surfaces in peoples houses. And are still exploring how bacteria are distributed around hospitals. Here we wanted to explore how bacteria from humans were distributed into a space in real time. By taking samples every hour post sterilization and seeing how the community stabilized, who remained active and whether they were pathogenic. We found that communities stabilized on a skin-associated microbiome within 5 hours, that staphylococcus remained active and yet none of these were particularly pathogenic. Yet we were able to identify pathogenic MRSA on surfaces around the bathroom, but they were extremely rare. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 02.12.2014

Prof. Denise Kendrick Professor of Primary Care Research Division of Primary Care, University Park Nottingham UKMedicalResearch.com Interview with: Prof. Denise Kendrick Professor of Primary Care Research Division of Primary Care, University Park Nottingham UK Medical Research: What is the background for this study? What are the main findings? Prof. Kendrick: More than 1 million US children aged 0-4 years attend emergency departments because of  a fall each year. Approximately half of all ED attendances in this age group are for falls, and most of these are falls from furniture, most commonly from beds, chairs , baby walkers, bouncers, changing tables and high chairs. In the US around 18,000 0-4 year olds are admitted to hospital following a fall each year  and in 2012 there were 31 deaths in the US in 0-4 year olds from falls. Healthcare costs for falls in the US  were estimated at $439 million for hospitalised children and $643 million for  ED attendances in 2005. We found that children were more likely to attend hospital because of a fall from furniture in families that did not use safety gates across doorways or on stairs. For infants (aged 0-12 months) we found they were more likely to attend hospital because of a fall from furniture if they had been left on a raised surface (e.g. beds, sofas, work tops etc), had diapers changed on a raised surface or been put in a car seat or bouncing cradle on a raised surface. We also found that children aged over 3 years who had climbed or played on furniture were more likely to have a fall requiring a hospital visit than children who had not. Finally we found that children whose parents had not taught their children rules about climbing on objects in the kitchen were more likely to have a fall needing a hospital visit than children whose parents had taught these rules. (more…)
Author Interviews, Opiods / 02.12.2014

Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032MedicalResearch.com Interview with: Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032 MedicalResearch: What is the background for this study? What are the main findings? Dr. Martins: While a large proportion of young adults, ages 18 to 22, are prescribed opiates, non-medical use of opioids is second only to marijuana as the most prevalent form of illegal drug use among young adults. Until this study, little was known about nonmedical use of prescription drugs among non-college-attending young adults in the United States. Approximately 70 percent of all U.S. young adults enroll in some form of college education, but around 30% do not. We analyzed public data for 36,781 young adults between the ages of 18 and 22 over a 12-month period in 2008 through 2010 from the National Survey on Drug Use and Health, an annual cross-sectional survey of the Substance Abuse and Mental Health Administration. Using the Kessler 6 screening instrument, we also measured past-year serious psychological distress as self-reported by the respondents. Among non-college-attending young adults with at least a high school degree, 13.1 percent reported using prescription opioids for non-medical reasons. The figure rose slightly to 13.2 percent for those who did not graduate from high school, and declined to 11.3 percent among college attendees. (more…)
Author Interviews, Dermatology, Ebola / 01.12.2014

Victoria Vaughan Medical College of Georgia, Augusta, GeorgiaMedicalResearch.com Interview with: Victoria Vaughan Medical College of Georgia, Augusta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: The Global Mortality of Skin Disease study compares age adjusted mortality of disease with skin manifestations between developing and developed countries for the years 1990 and 2010. The main findings were that mortality from infectious conditions was greater in the developing world while melanoma contributed to mortality in the developed world. Ebola Virus Disease has cutaneous manifestations and affects the developing world preferentially. As of November 27, 2014, the mortality in West Africa totals 5444 according to the CDC. However, the United States has had only two deaths from Ebola Virus Disease. (more…)
Radiology, Transplantation / 01.12.2014

Frank J. Rybicki, MD PhD Director, Applied Imaging Science Laboratory Director, Cardiac CT and Vascular CT / MRI Brigham and Women's Hospital Associate Professor, Harvard Medical School Boston, MAMedicalResearch.com Interview with Frank J. Rybicki, MD PhD Director, Applied Imaging Science Laboratory Director, Cardiac CT and Vascular CT / MRI Brigham and Women's Hospital Associate Professor, Harvard Medical School Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Rybicki: Face transplantation restores form and function to patients with catastrophic facial injuries. To date, surgical planning a vascular anastamoses have been well described. While all 7 patients at BWH have had 3d printed models from their CT scans, to date the findings and impact of 3D printing has not been described. Also, the role of printing the soft tissues of the face has not been described. (more…)
Author Interviews, Emergency Care, Stroke / 01.12.2014

Stroke Wasserman Perry 006768R PDF dr_karen_greenbergMedicalResearch.com Interview with: Karen Greenberg, DO, FACOEP Capital Health Center for Neurologic Emergencies 750 Brunswick Ave, NJ 08638   Medical Research: What is the background for this study? Dr. Greenberg: Capital Health Regional Medical Center in Trenton, NJ opened the first dedicated Neurologic Emergency Department in the country in January of 2011.  Dr. Veznedaroglu, our chief neurosurgeon, recognized the importance and emergent nature of patients with neurologic complaints.  He recruited dedicated Emergency Medicine Physicians, one of which is myself, who would be assigned to see patients with neurologic complaints during peak hours of 7a-6p daily seven days a week.  Having a section of the ED dedicated to identifying, triaging, and treating patients with neurologic emergencies has led to more advanced and efficient care.  Due to the initial success of the neuro ED, 5 dedicated physicians became educated and comfortable in administering IV-tPA to acute ischemic stroke patients.  This decision was made to eliminate delays associated with teleneurology or neurology consultation prior to administering thrombolytics in order to improve door-to-needle times and outcomes in acute stroke patients.  As far as we know, we are still the only dedicated Neuro ED in the country. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs / 01.12.2014

Christopher E. Dandoy, MD, MSc Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical CenterMedicalResearch.com Interview with: Christopher E. Dandoy, MD, MSc Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center MedicalResearch.com Editor’s Note: Dr. Dandoy discusses a novel program to reduce the frequency of cardiac alarms in the setting of a large inpatient intensive care unit. Medical Research: What is the background for this study? Why did you decide to do this study? Dr. Dandoy: During our three month investigation period we had roughly a million alarms go off in our intensive care unit. Our unit nurses reported spending 30-40 minutes per day responding to the various alarms. We first looked to see if there were established guidelines in the literature for cardiac monitors and found there were none. The alarms were a source of frustration and anxiety not just for the unit staff but also for patients and family members. Medical Research: What are the elements of your alarm reduction program? Dr. Dandoy: The first element was simply to have a plan or a process for initial ordering of monitor parameters based on age-appropriate standards. In our case, we established a standard order set in Epic, our electronic records program. Epic Cardiac Monitor Order Set Epic Cardiac Monitor Order Set (more…)
Author Interviews, Kidney Disease, Lipids / 01.12.2014

Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna AustriaMedicalResearch.com Interview with: Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna Austria Medical Research: What is the background for this study? Dr.  Weichhart: Impairment of high-density lipoprotein (HDL) function has been associated with cardiovascular events in patients with kidney failure on hemodialysis. The protein composition of HDLs is altered in these patients presumably compromising the cardioprotective effects of HDLs. In an earlier study we found that two proteins in particular, namely Serum Amyloid A (SAA) and Surfactant Protein B (SP-B), are significantly raised in the HDL of dialysis patients, and these also contribute towards HDL losing its protective effect. In the current study we have now developed an novel test that can quickly and directly measure the SAA and SP-B bound to HDL. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA, Kidney Disease / 30.11.2014

Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, MilanMedicalResearch.com Interview with: Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, Milan Medical Research: What is the background for this study? Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective. Medical Research: What are the main findings? Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension. (more…)
Author Interviews, Cancer Research / 30.11.2014

Charles Brenner, PhD Roy J. Carver Chair & Head of Biochemistry Departments of Biochemistry & Internal Medicine Carver College of Medicine University of Iowa Iowa City, IA 52242MedicalResearch.com Interview with: Charles Brenner, PhD Roy J. Carver Chair & Head of Biochemistry Departments of Biochemistry & Internal Medicine Carver College of Medicine University of Iowa Iowa City, IA  52242 Medical Research: What is the background for this study? What are the main findings? Dr. Brenner: KRAS mutations are extremely common in human malignancies. The KRAS gene is an oncogene that drives cell growth pathways and that leads to silencing and inactivation of tumor suppressor genes. It was known that KRAS mutant cancer cells silence tumor suppressor genes but the precise mechanism for gene silencing was not known. In this study, we discovered that KRAS mutations turn off the TET1 gene. TET1 functions as an "eraser" of gene silencing marks. When KRAS mutations occur, the TET1 eraser isn't expressed any longer, and a series of tumor suppressor genes become silenced. This is an essential part of the aggressiveness of KRAS-dependent cancers and is controlled by the ERK pathway that is turned on by KRAS. In short, KRAS turns on ERK, which turns off TET1. When TET1 is off, a set of tumor suppressor genes are also turned off, which drives cancer formation. (more…)
Author Interviews, JAMA, Surgical Research / 30.11.2014

Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, KoreaMedicalResearch.com Interview with: Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: Although autologous rib cartilage is a useful graft material for rhinoplasty, surgeons sometimes encounter unpleasant complication such as warping or donor-site morbidity. These complications are not infrequent, but there has been no systematic review with regarding this matter. For evidence-based practice, we aimed to assess the long-term safety of using rib cartilage by means of meta-analysis. By reviewing the 10 selected, eligible articles after extensive screening, we found that rates of warping, resorption, infection, and displacement were 3.1, 0.2, 0.6, and 0.4%, respectively. Hypertrophic scar at chest was found in 5.5%, with highest report of 23.8%. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon’s attention (more…)