medical research Tag
11 Sep VA Effectively Uses Telemedicine To Screen for Diabetic Eye Disease
MedicalResearch.com Interview with:
Mary G. Lynch, MD
Professor of Ophthalmology
Atlanta Veterans Affairs Medical Center Decatur, Georgia.
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
Medical Research: What are the main findings of the study?
Dr. Lynch:
- Since 2006, the VA has been systematically using teleretinal screening of patients with diabetes to screen for retinopathy in the Primary Care Clinics. Under this program, 90% of veterans with diabetes are evaluated on a regular basis. A number of patients who are screened have findings that warrant a face-to-face ophthalmic exam. No information exists on the effect of such a program on medical center resources.
- 1,935 patients underwent teleretinal screening through the Atlanta VA over a 6 month period. We reviewed the charts of the 465 (24%) of the patients who were referred for a face to face exam in the Eye Clinic.
- Data was collected for these patients to determine the reasons for referral, the accuracy of the teleretinal interpretation, the resources needed in the Eye Clinic of the Medical Center to evaluate and care for the referred patients over a two year period and possible barriers to patient care.
- Of the 465 patients referred for an exam, 260 (55.9%) actually came in for an exam. Community notes were available for an additional 66 patients. Information was available for 326 (70.1%) of the referred patients.
- The most common referring diagnoses were nonmacular diabetic retinopathy (43.2% of referrals), nerve related issues (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%) and diabetic macular edema (5.6%).
- 16.9% of the referred patients had 2 or more concurrent problems that put them at high risk for visual loss.
- The percentage agreement between teleretinal screening and the ophthalmic exam was high: 90.4%. Overall sensitivity was 73.6%. The detection of diabetic macular edema had the lowest sensitivity.
- A visually significant condition was detected for the first time through teleretinal screening for 142 of the patients examined (43.6%).
- The resource burden to care for referred patients was substantial.
- 36% of patients required 3 or more visits over the ensuing 2 year period.
- The treatment of diabetic macular edema had the highest resource use involving on average 5 clinic visits, 6 diagnostic procedures and 2 surgical procedures
- The most common non-refractive diagnostic procedures were visual fields and optical coherence tomography.
- The average cost to care for the referred patients (in Medicare dollars) in work RVUs alone was approximately $1,000 per patient. The cost to care for a patient with diabetic macular edema was $2673.36.
11 Sep Stigma Hampers Patients From Seeking Mental Health Care
MedicalResearch.com Interview with:
Patrick Corrigan Psy.D.
Distinguished Professor of Psychology
Illinois Institute of Technology
PI: National Consortium on Stigma and Empowerment
www.NCSE1.org
Medical Research: What are the main findings of this review?
Dr. Corrigan: People with serious mental illness often do not seek out services, or drop out early, when in need. Stigma is a major reason for why this happens. Stigma refers to the stereotypes about a group that undermine status and lead to discrimination. Discrimination refers to the behaviors that block the opportunities of group members. Some employers do not hire people with mental illness, some landlords do not rent to them, and some primary care practitioners offer a substandard of care. Stereotypes and discrimination undermine engagement in mental health services in three ways (Corrigan, 2005):
Label Avoidance: In order to escape the pernicious effects of stigma, people avoid settings where they are labeled mentally ill; for example, people coming out of a psychiatrist’s office may be perceived as “nuts.”
Self-Stigma: Some people who internalize stereotypes suffer diminished self-esteem and self-efficacy leading to the “why try” effect. “Why should I try to get a job? Someone like me is not worthy.” “Why should I try to get mental health treatment? I am not able to benefit from it.”
Structural Stigma: Stereotypes and discrimination become institutionalized in the laws and practices of government and business. For example, insurance coverage for mental health services was significantly below that for most other conditions.
11 Sep Diabetes: Patients Demonstrate Negative and Positive Coping Mechanisms
MedicalResearch.com: Interview with:
Dr. Heather Stuckey D.Ed
Department of Medicine
Pennsylvania State University College of Medicine, Hershey, PA
MedicalResearch: What are the main findings of this study?
Dr. Stuckey: The main findings were that people with diabetes had both negative psychosocial and positive (adaptive) ways of coping with diabetes.
Negative themes included: 1) Anxiety/fear, worry about hypoglycemia and complications of diabetes, depression and negative moods/hopelessness and 2) Discrimination at work and public misunderstanding about diabetes.
Two psychosocial themes demonstrated adaptive ways of coping with diabetes: 1) Having a positive outlook and sense of resilience in the midst of having diabetes and 2) Receiving psychosocial support through caring and compassionate family, friends, healthcare professionals and other people with diabetes.
Most diabetes social sciences research focuses on only the negative aspects of having diabetes. Although this paper discussed negative aspects, it also focused on the adaptive, or positive, ways in which people with diabetes viewed their disease. "We found that although these negative experiences with diabetes exist, people also held on to the positive aspects. Some said diabetes made their lives a little richer because they ate healthier foods, or they were able to connect with their family more to overcome challenges. It gave them a better appreciation of what they have. The discrimination at work and from society was a finding that was unexpected, but was evident throughout both the quantitative and qualitative data.
11 Sep Eating Fish May Reduce Risk Of Hearing Loss In Women
MedicalResearch.com Interview with:
Sharon G. Curhan, MD, ScM
Channing Division of Network Medicine
Department of Internal Medicine
Brigham and Women's Hospital
Harvard Medical School
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Curhan: We followed more than 65,000 women who were participants in the Nurses’ Health Study II over 18 years and found that eating 2 or more servings of fish per week was associated with a lower risk of hearing loss. For example, after adjusting for potential confounders in multivariable analyses, in comparison with women who rarely or never ate fish, women who consumed 2 or more servings of fish per week had a 20% lower risk of hearing loss. Eating any type of fish (tuna, dark fish, light fish or shellfish) tended to be associated with lower risk. Also, we found that higher intake of long-chain omega-3 polyunsaturated fatty acids (PUFAs) was inversely associated with risk. For example, in comparison with women with the lowest intake, women with the highest intake of long-chain omega-3 PUFAs had a 22% lower risk of hearing loss.
11 Sep Poor Appetite in Elderly Increases Mortality Risk
MedicalResearch.com Interview with:
Professor Mark L. Wahlqvist, M.D., Ph.D.
Institute of Population Health Sciences, National Health Research Institutes, Taiwan
National Defense Medical Center, School of Public Health, Taiwan
Monash Asia Institute, Monash University Melbourne, Australia
Medical Research: What are the main findings of the study?
Prof. Wahlqvist: Poor appetite and dietary quality as judged by diversity separately (each by about 50%) and together (by about 80%) increase the mortality risk in older persons living in the community.
11 Sep Study Examines Risk of Alopecia Areata and Vitiligo in Stem Cell Recipients
MedicalResearch.com Interview with: Rena Zuo, BA MD Candidate at Duke University School of Medicine and Edward W. Cowen, MD, MHSc Senior Clinician Head, Dermatology Consultation Service Dermatology Branch Center for Cancer Research National Cancer Institute National Institutes of Health MedicalResearch: What are the main findings of the study? Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood. Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed. Several particularly interesting results were found:- Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
- Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
- Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.
11 Sep Isotretinoin Associated With Lower Risk of Inflammatory Bowel Disease
MedicalResearch.com Interview with:
Shadi Rashtak, MD
Department of Dermatology
Mayo Clinic College of Medicine
Rochester, Minnesota
Medical Research: What are the main findings of the study?
Dr. Rashtak: We found that among a population of mainly acne patients those who received isotretinoin had a lower risk of inflammatory bowel disease as compared to those who did not take this medication. We carefully reviewed the medical records of patients to ensure that this finding was not simply because the drug was avoided in patients with a previous personal or family history of IBD.
11 Sep Sleep Apnea May Be Improved By Moderate Calorie Restriction
MedicalResearch.com Interview with: Marcia Klein M.D., Ph.D. Adjunctive professor Rio de Janeiro State University This study was conducted at the Discipline of Clinical and Experimental Pathophysiology - Rio de Janeiro State University and the financial support of FAPERJ. Medical Research: What was the main findings of the study? Dr. Klein: The main findings were that a diet with moderate calories restriction in obese patients with obstructive sleep apnea may be able not only to reduce body fat but also to reduce obstructive sleep apnea severity and blood pressure.11 Sep Diabetics on Statins May Have Fewer Microvascular Complications
MedicalResearch.com Interview with: Børge G. Nordestgaard, MD, DMSc Professor, University of Copenhagen Chief Physician, Herlev Hospital, Copenhagen University Hospital Dept. Clinical Biochemistry Herlev Ringvej Herlev, Denmark Medical Research: What are the main findings of the study? Dr. Nordestgaard: Among all patients with diabetes in Denmark during 1996-2009 and compared with non-statin users, statin users had a 40% lower risk of diabetic retinopathy, a 34% lower risk of diabetic neuropathy, and a 12% lower risk of gangrene of the foot, while the risk of diabetic nephropathy was similar.10 Sep Do Arterial Catheters Improve ICU Patient Care?
MedicalResearch.com Interview with:
Hayley Gershengorn MD
Assistant Professor, Department of Medicine (Critical Care)
Assistant Professor, The Saul R. Korey Department of Neurology
Albert Einstein College of Medicine
Bronx, NY 10461
Medical Research: What are the main findings of the study?
Dr. Gershengorn: Using a large national database, we found there to be no association between the use of arterial catheters and mortality in mechanically ventilated medical intensive care unit patients. Similarly, we found no beneficial association between arterial catheters and mortality in any of the eight other critically ill subgroups evaluated.
10 Sep Mandatory Flu Shots For Health Care Workers Boosts Vaccination Rates
MedicalResearch.com Interview with:
Allison Weinmann MBBS, FRACP
Senior Staff, Division Infectious Diseases
Director HFHS Immunization Team
Medical Director Infection Control and Prevention, West Bloomfield Hospital
Henry Ford Health System
Clinical Assistant Professor, Wayne State University
Detroit, Mi 48202
Medical Research: What are the main findings of this study?
Dr. Weinmann: The main findings included:
- Mandatory influenza immunization for health care workers without allowing optional opt-out (and only allowing for documented medical or religious exemption) successfully raised our immunization uptake among all our employees to over 99% sustainable for the last 2 years which we consider a very important patient safety initiative.
- Less than 2% of workers met a medical or religious exemption.
- A prior optional opt out with mask wearing was problematic for staff and patients and did not reach our goal of close to 100% immunization uptake.
10 Sep Medical Research Citation Rate May Lead To Treatment Bias
MedicalResearch.com Interview with:
Mintu Turakhia, MD MAS, FHRS FACC FAHA
Assistant Professor of Medicine and (by courtesy) of Health Research & Policy
Stanford University School of Medicine
Director of Cardiac Electrophysiology
Core Investigator, Center for Innovation to Implementation
VA Palo Alto Healthcare System
Medical Research: What are the main findings of the study
Dr. Turakhia: We found that the reported success rate of a study correlated with the number of times the study was cited in the literature, even after adjustment for a wide range of factors.
10 Sep New Plastic Surgery Approach Allows For Total Face Rejuvenation
MedicalResearch.com Interview with:
Achih H. Chen, MD, FACS, FAACS
Georgia Center for Facial Plastic Surgery, Evans, Ga and the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery
Georgia Regents University, August, Ga
Medical Research: What is the significance of the study?
Dr. Chen : This is the first time that facial rejuvenation surgery using surgical approaches in three planes combined with ablative resurfacing has been reported in the medical literature. This approach was not previously thought possible in a single surgical setting because of the concern about disrupting the facial blood supply that may result in loss of the skin. The study demonstrates the safety of this “Total Face” approach. This approach allows simultaneous tightening of the jawline and neck, recreating the lost youthful volume of the midface region, and restoring of the smooth skin texture so characteristic of a young face. This allows for a more complete or “Total Face Rejuvenation” for patients while allowing them the flexibility for a single recovery period or downtime.
10 Sep Sleep Patterns Vary By Neighborhood and Socioeconomic Status
MedicalResearch.com Interview with Dr. Shona E. Fang Sc.D. New England Research Institutes, Inc Watertown, Massachusetts Medical Research: What are the main findings of the study? Dr. Fang: Sleep duration varied by neighborhood in Boston, a diverse urban setting. Individual factors, including socioeconomic status, explained some of this variation, while neighborhood socioeconomic status (SES) explained a much larger portion.10 Sep Obese Adolescents May Have Heightened Vulnerability To Food Commercials
MedicalResearch.com Interview with:
Dr. Sonja Yokum Ph.D.
Oregon Research Institute
Eugene Oregon, 97403
Medical Research: What are the main findings of the study?
Dr. Yokum: We found that adolescents showing elevated responses in reward regions to food commercials gained more weight over 1-year follow-up compared to those with less activation in these brain regions. This suggests that there are individual differences in neural vulnerability to food commercials that appear to identify youth at risk for excess weight gain.
10 Sep Adolescent Cannabis Use Linked To Young Adult Adverse Outcomes
MedicalResearch.com Interview with: Edmund Silins PhD, Research Fellow National Drug and Alcohol Research Centre UNSW Medicine University of New South Wales Sydney Australia Medical Research: What are the main findings of the study? Dr. Silins: There were three particularly interesting aspects to the findings.- Firstly, we found clear and consistent associations between adolescent cannabis use and the young adult outcomes investigated.
- Secondly, there was evidence of a dose-response effect such that the more frequently adolescents used cannabis the more likely they were to experience harms later in life.
- Thirdly, for most outcomes, these associations remained even after taking into account a wide range of other factors which might potentially explain them.
10 Sep Long Term Benzodiazepines May Increase Alzheimer’s Disease Risk
MedicalResearch.com Interview with:
Sophie Billioti de Gage PharmD
University of Bordeaux Segalen
France
Medical Research: What are the main findings of the study?
Answer: The risk of Alzheimer’s disease was found increased by 43-51% in persons (>65) having initiated a treatment with benzodiazepines in the past (>5 years before). Risk increased with the length of exposure and when long acting benzodiazepines were used.
10 Sep Take a Short Walk: Don’t Sit For Long Periods of Time
MedicalResearch.com Interview with:
Saurabh S. Thosar, Ph.D.,
Postdoctoral Researcher
Oregon Institute for Occupational Health Sciences,
Oregon Health & Science University
Medical Research: What are the main findings of the study?
Dr. Thosar: We discovered that 3 hours of sitting leads to an impairment in shear rate and an impairment in femoral artery endothelial function. When systematic breaks are added in the sitting time the shear rate and the endothelial function are preserved.
10 Sep Breath Temperature Test May Help Diagnose Lung Cancer
MedicalResearch.com Interview with: Dr. Giulia Scioscia Coauthor of this study with the Prof. Carpagnano University of Foggia. Medical Research: What are the main findings of this study? Dr. Scioscia: The principal and newest findings of our study are:- Airways inflammation and neoangionesis are critical component of the lung cancer pathogenesis and they contribute to the regulation of airways temperature. They cause a regional hyperthermia in the lung lesion.
- The exhaled Breath temperature has been proven to be the expression of the airways temperature and for this reason of their inflammation and neoangionesis.
- For the first time we have measured this hyperthermia in lung cancer patients with the xhalo. The patient with diagnosis of tumor shows an higher temperature than in healthy ones and this values correlate with cigarette smoking and tumor progression.
09 Sep Prediabetes Associated With Increased Cancer Risk
MedicalResearch.com Interview with:
Professor Yuli Huang
The First People's Hospital of Shunde, Daliang Town, China, and colleagues
Medical Research: What are the main findings of the study?
Professor Huang: In this meta-analysis of 16 prospective cohort studies comprising more than 890,000 individuals, we found that the presence of prediabetes at baseline associated with a 15% increased risk of cancer overall. The results were consistent across cancer endpoint, age, duration of follow-up and ethnicity. There was no significant difference for the risk of cancer with different definitions of prediabetes (impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]).
09 Sep Osteoporosis Medications Differ in Joint Fracture Reduction, Adverse Effects
MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine at University of California,
Los Angeles
Medical Research: What are the main findings of the study?
Dr. Crandall:
1. We found high-strength evidence that several medications decrease fracture risk when used by persons with bone density in the osteoporotic range and/or with pre-existing hip or vertebral fracture. While many of the medications (alendronate, risedronate, zoledronic acid, ibandronate, denosumab, teriparatide, and raloxifene) reduce vertebral fractures, a reduction in the risk of hip fracture is not demonstrated for all of the medications. In particular, hip fracture reduction is only demonstrated for alendronate, risedronate, zoledronic acid, and denosumab. Unfortunately, due to a lack of head-to-head trials, the comparative effectiveness of the medications is unclear.
2. The adverse effects of the medications vary. For example, raloxifene is associated with an increased risk of thromboembolic events, whereas denosumab and the bisphosphonate medications have been associated with increased risk of osteonecrosis of the jaw and atypical subtrochanteric femoral fractures.
09 Sep Dignified Death Still Elusive On Many Cancer Wards
MedicalResearch.com Interview with: Karin Jors MA Department of Palliative Care, Comprehensive Cancer Center, University Medical Center Freiburg, Freiburg, Germany Medical Research: What are the main findings of the study? Answer: The findings of our study shed light on the current circumstances for dying in cancer centers. Physicians and nurses in our study reported that they rarely have enough time to care for dying patients. In addition, only a minority of staff members felt that they had been well-prepared during their training to care for dying patients and their families. Overall, only 56% of participants indicated that it is usually possible for patients to die in dignity on their ward. This is likely the result of various factors such as: inadequate rooms for dying patients and their families (i.e. shared rooms), poor communication with patients regarding burdensome treatments, an overuse of life-prolonging measures, etc. Striking differences were found between the responses of palliative care staff and staff from other wards (e.g. general care, oncology, intensive care). For example, palliative care staff reported that they usually have enough time to care for dying patients. In addition, 95% of palliative care staff indicated that it is usually possible for patients to die in dignity on their ward. Overall, nurses perceived the situation for dying patients more negatively than physicians. Whereas 72% of physicians reported that patients can usually die a dignified death on their ward, only 52% of nurses shared this opinion. Although only slightly more than half of participants believed that patients can usually die in dignity on their ward, this is a considerable improvement to the situation 25 years ago. In a similar study published in 1989, researchers found that 72% of physicians and nurses experienced the situation for patients dying on their hospital ward as undignified.08 Sep US Hospitals Spend At Least Double Other Countries on Billing and Administration
MedicalResearch.com Interview with:
Steffie Woolhandler MD MPH
Professor School of Public Health and Hunter College, CUNY;
Professor of Medicine
Harvard Medical School Cambridge Hospital
Medical Research: What are the main findings of the study?
Dr. Woolhandler: In 2011, U.S. hospitals spent $215 billion on
billing and administration. Meanwhile, other
countries spent far less. None of the other
seven countries we studied spent even half as
much as the U.S., and they all have modern, high
quality hospitals. While we spent nearly
$700 per capita on hospital paperwork, Scotland
and Canada spent less than $200. This means
that if U.S. hospitals ran as efficiently as
Canada’s, the average family of four would save
$2,000 annually on health care.
08 Sep Tuberculosis: Moxifloxacin Likely To Be Cornerstone Of New Treatment Regimen
MedicalResearch.com Interview with:
Stephen H. Gillespie, M.D., D.Sc
University of St. Andrews Medical School, St. Andrews
Medical Research: What are the main findings of the study?
Dr. Gillespie: REMox TB was a pioneering trial that has shown that a large-scale trial can be run efficiently in resource-poor settings with a high TB burden, adhere to the highest standards of good clinical trial practices, and deliver a clear, unequivocal result. REMoxTB was among the most rigorous Tuberculosis drug trials ever conducted in the modern era of TB treatment and among the largest ever conducted for a new TB treatment. It enrolled 1,931 patients at 50 sites in nine countries, mostly in Africa and Asia. Previously, there were thought to be regional differences in way in which patients' response to treatment across the world but we showed that a rigorous approach to trial conduct there was no evidence for that difference.
The study confirmed that daily moxifloxacin was safe over four months of therapy and the moxifloxacin containing arms were more bactericidal initially. Despite its substantial anti-TB activity it did not prove possible to shorten therapy to four months. .
These findings, with the safety of moxifloxacin, and its activity against TB, support the continued clinical testing of moxifloxacin as a component of other novel regimens.
08 Sep Sleep Difficulties Linked To Shrinking Brain
MedicalResearch.com Interview with:
Dr. Claire Sexton Ph.D.
University of Oxford
Medical Research: What are the main findings of the study?
Dr. Sexton: We found that sleep difficulties (which can include trouble falling asleep, waking up during the night, or waking up too early) were associated with an increased rate of decline in brain volumes over 3-5 years.
08 Sep US Life Expectancy Varies By Sex, Race/Ethnicity and Geography
MedicalResearch.com Interview with: Dr. Benedict Truman Associate Director for Science CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Medical Research: What are the main findings of the study? Dr. Truman: In 2008, healthy life expectancy, which isthe number of years a person is expected to live in good or better health after a particular age, varied by sex, race/ethnicity and geographical regions in the United States. In each of four U.S. census regions, females were expected to live longer and healthier lives than males; non-Hispanic whites were expected to live shorter but healthier lives than Hispanics; and non-Hispanic whites were expected to live longer and healthier lives than non-Hispanic blacks.07 Sep Poor Access To SSRIs May Result In Suicide Inequalities
MedicalResearch.com Interview with:
Sean Clouston Ph.D.
Assistant Professor
Core Faculty, Program in Public Health
Department of Preventive Medicine
Stony Brook University Health Sciences Center
Stony Brook, NY 11794
Medical Research: What is the background for this study:
Dr. Clouston: A number of epidemiological studies have found that suicide rates have decreased rapidly with the widespread distribution of SSRI antidepressants. Our group has found that proliferation of preventive medicine has, with regard to other causes of death, tended to occur unequally. We hypothesized that if SSRI antidepressants prevent suicide by treating depression, then suicide might also be susceptible to such inequality. Our study used mortality data to show that decreases in suicide were concentrated in regions with higher socioeconomic status.
Medical Research: What are the main findings of the study?
Dr. Clouston We used the best available data from the US and found that socioeconomic inequalities have increased dramatically in conjunction with the proliferation of SSRI antidepressants.
07 Sep SSRIs May Increase Risk Of Dental Implants Failure
MedicalResearch.com Interview with:
Faleh Tamimi, BDS, PhD
Assistant Professor,
Faculty of Dentistry
Strathcona Anatomy & Dent,
Montreal, Quebec Canada
Medical Research: What are the main findings of the study?
Dr. Tamimi: The main finding was that SSRIs usage was associated with an increased risk of dental implants failure.