Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 04.09.2016

MedicalResearch.com Interview with: Christian A. McNeely, M.D. Resident Physician - Internal Medicine Barnes-Jewish Hospital Washington University Medical Center MedicalResearch.com: What is the background for this study? Response: Prior research has demonstrated that readmission in the first 30 days after percutaneous coronary intervention (PCI) is common, reported around one in six or seven Medicare beneficiaries, and that many are potentially preventable. Since 2000, there have been significant changes in the management of coronary artery disease and the use of PCI. Additionally, in the last decade, readmission rates have become a major focus of research, quality improvement and a public health issue, with multiple resulting national initiatives/programs which may be affecting care. Therefore, in this study, we sought to examine contemporary trends in readmission characteristics and associated outcomes of patients who underwent PCI using the Medicare database from 2000-2012. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety, Surgical Research / 04.09.2016

MedicalResearch.com Interview with: Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes. In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well. (more…)
Author Interviews, BMJ, Education, Surgical Research / 03.09.2016

MedicalResearch.com Interview with: Miss Hui-Ling Kerr SpR Trauma and Orthopaedics Department of Trauma and Orthopaedic Bristol Royal Infirmary, Bristol, UK MedicalResearch.com: What is the background for this study? Response: Gender inequality at consultant level in surgery has not improved despite greater opportunities for women and only a small proportion of women apply to become surgical trainees. We wanted to find out if the lack of female surgical role models acted as a deterrent to first year female junior doctors and final year medical students towards a career in surgery. (more…)
Author Interviews, Duke, JAMA, Surgical Research, Weight Research / 02.09.2016

MedicalResearch.com Interview with: Matthew Leonard Maciejewski, PhD Professor in the Division of General Internal Medicine Department of Medicine Duke University School of Medicine Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care Durham VA Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: No study based on a US cohort undergoing current procedures has examined weight change comparing surgical patients and nonsurgical patients for as long as we have. This is the first study to report 10-year outcomes on gastric bypass patients and compare them to matched patients who did not get surgery. At 1 year, gastric bypass patients lost 31% of their baseline weight compared controls who only lost 1.1% of their baseline weight. At 10 years, gastric bypass had lost 28% of their baseline weight. We also compared weight loss at 4 years for Veterans who received the 3 most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric banding). At 4 years, patients undergoing gastric bypass lost more weight than patients undergoing sleeve gastrectomy or gastric banding. Given that few high quality studies have examined sleeve gastrectomy to 4 years, the 4-year sleeve outcomes contribute to filling this important evidence gap as the sleeve gastrectomy is now the most commonly performed bariatric procedure worldwide. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 02.09.2016

MedicalResearch.com Interview with: Dr Marlous Hall PhD Senior Epidemiologist Leeds Institute of Cardiovascular and Metabolic Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that death rates following heart attacks have fallen considerably over recent decades. Many studies have looked at the effect of medications and invasive strategies, and their association with better clinical outcomes is clear. However, a big question remains: why have heart attack deaths fallen? Is it due to increased use of medications and treatment, is the risk of patients simply lower over time due to things like earlier diagnosis or are patients generally healthier with fewer comorbidities such as diabetes? Answering this is not straightforward - as “gold standard” studies like clinical trials on historic data cannot be done. An alternative approach is to look for patterns in data observed from routine care to look at all these factors together. This study used a large and rich dataset covering heart attack care in the UK (Myocardial Ischaemia National Audit Project (MINAP)). This dataset was linked to outcome data from the Office for National Statistics to allow us to look at all the different factors that could influence the change in mortality over time. (more…)
Anemia, Author Interviews, Hematology, Lancet, Surgical Research / 02.09.2016

MedicalResearch.com Interview with: Alhossain A. Khalafallah, Clinical Professor Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Launceston General Hospital Australia MedicalResearch.com: What is the background for this study? Response: There are limited data regarding the effect of postoperative anemia on patient’s outcomes. The issue of postoperative anemia was noticeably to affect a large cohort of patients world-wide. This study was aiming at comparing the new approach with a single ferric carboxymaltose infusion versus standard or routine usual care for management of postoperative anemia. (more…)
Author Interviews, Heart Disease, Lancet, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Prof Lars Wallentin, MD PHD Senior Professor Cardiology Uppsala Clinical Research Center, Uppsala University  MedicalResearch.com: What is the background for this study? Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). The results at 6 months, 1, 2 and 5 years were published in The Lancet and pivotal in changing the treatment guidelines and thereby improving outcomes in patients with NSTE-ACS. These findings were within the next few years verified in the TACTICS-TIMI18 and RITA3 trials. However the later performed ICTUS trial, starting after these results were published and accordingly with a substantial early crossover to the invasive arm, showed neutral results. Recently the reduction in event rates by an early invasive strategy was again validated in patients above 80 years of age, which were less well represented in the initial trials. These benefits of an early invasive strategy have previously been shown sustained for at least five years based on results from the FRISC2, RITA3, and ICTUS trials. The FRISC2 and TACTICS-TIMI18 trials also showed that the benefits with an early invasive strategy seemed confined to patients with signs of myocardial necrosis as indicated by elevated troponin level at entry. In addition the FRISC2 trial found that the benefits were larger in patients with signs of inflammatory activity as indicated by a high level of growth differentiation factor 15 (GDF-15) at entry. These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. (more…)
Author Interviews, Heart Disease, NEJM, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Dr. Kaare Harald Bønaa Principal investigator University of Tromsø, Norway MedicalResearch.com: What is the background for this study? Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known. Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Jason H. Wasfy, MD, MPhil Assistant Medical Director, Massachusetts General Physicians Organization Director of Quality and Analytics Massachusetts General Hospital Heart Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Surgical Research / 30.08.2016

MedicalResearch.com Interview with: Gennaro Giustino MD Resident Physician - Department of Medicine The Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: A period of dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The pathophysiological rationale for DAPT after DES-PCI is predicated on the need to prevent stent-related thrombotic complications while vascular healing and platform endothelialization are ongoing, a process that seems to last between 1 and 6 months with new-generation DES. Whether to extend DAPT after this mandatory period in order to provide a broader atherothrombotic risk protection (for stent-related and non-stent-related atherothrombotic events) is currently a matter of debate. Current guidelines recommend at least 6 months of DAPT after PCI in patients with stable coronary artery disease (CAD) and at least 12 months of DAPT in patients presenting with acute coronary syndrome (ACS). While, several risk scores have been developed to guide clinical decision making for DAPT intensity and duration (namely the DAPT score and the PARIS risk scores) little attention has been payed so far to PCI complexity and the extent of CAD to guide duration of DAPT. In fact irrespective of clinical presentation, patients undergoing more complex PCI procedure (likely due to greater coronary atherosclerotic burden) may remain at greater risk for ischemic events and therefore may benefit of prolonged, or more intense, DAPT. (more…)
Author Interviews, Heart Disease / 26.08.2016

MedicalResearch.com Interview with: John A. Elefteriades, MD William W.L. Glenn Professor of Surgery Chief of Cardiothoracic Surgery Yale New-Haven Hospital Director, Aortic Institute at Yale-New Haven Yale University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the late 1990’s, Dr. Milewicz’s group in Texas and our group at Yale recognized that thoracic aortic aneurysms and aortic dissections (internal tears of the aorta) ran in families. This paper explores for the first time the ages at which aortic dissections occur among members within a family. Interestingly, we found that once one family member has suffered an aortic dissection, other family members tend to suffer dissection at about the same age (mostly within ten years of the age of the original dissector). (more…)
Author Interviews, Breast Cancer, Cancer Research, Cost of Health Care, Sloan Kettering, Surgical Research / 18.08.2016

MedicalResearch.com Interview with: Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan-Kettering Cancer Center MedicalResearch.com: What is the background for this study? Response: DCIS, ductal carcinoma in situ, intraductal cancer or Stage 0 cancer refers to what some people call the earliest form of cancer we can find and others term “precancerous”. This difference in terms is due to the fact that DCIS lacks the ability to spread to other parts of the body, a fundamental characteristic of cancer. The goal of treatment in DCIS is to prevent progression to invasive cancer which has the ability to spread. DCIS accounted for only 2-3 % of breast cancers seen in the pre-screening mammography era, but it comprises 25-30% of the malignancies detected in screening mammography programs. For this reason it is uncommon in women under age 40, and more commonly seen in women over 50 years of age. Approximately 70% of the women in the US diagnosed with DCIS are treated with lumpectomy (removal of the DCIS and a margin of surrounding normal breast tissue), and additional surgeries to obtain clear, or more widely clear, margins are done in approximately 30% of women. For this reason, the Society of Surgical Oncology, the American Society for Therapeutic Radiation Oncology, and the American Society of Clinical Oncology undertook the development of an evidence based guideline to determine the optimal clear margin for women with DCIS treated with lumpectomy and whole breast radiotherapy. (more…)
Author Interviews, PAD, Surgical Research / 18.08.2016

MedicalResearch.com Interview with: George Adams, M.D., M.H.S., F.A.C.C., F.S.C.A.I. Director of Cardiovascular and Peripheral Vascular Research Rex Hospital Raleigh, North Carolina Summary: The early findings of a novel all-comers PAD study (LIBERTY 360°) suggest that ‘watchful waiting’ in Rutherford class 2-3 and ‘primary amputation’ in Rutherford class 6 may not be necessary. Peripheral vascular intervention can be successful in these patient populations as well. MedicalResearch.com: What is the background for this study?  Response: Approximately 18 million Americans have peripheral artery disease (PAD), and 2 million of these patients suffer from critical limb ischemia (CLI)1,2, the end stage of PAD3. CLI is highly prevalent in older patients with diabetes and/or end-stage renal disease4, and is associated with high risk of amputation and mortality5. Briefly, the LIBERTY 360° study6 is a prospective, observational, multi-center study with liberal inclusion criteria and few exclusions, meant to evaluate procedural and long-term clinical and economic outcomes of endovascular device interventions in patients with symptomatic lower extremity PAD, including CLI. The study included any FDA-approved technology to treat claudication and CLI. Four core laboratories were utilized for independent analysis. (more…)
Author Interviews, NEJM, Neurological Disorders, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: Gil I. Wolfe, MD, FAAN Irvin and Rosemary Smith Professor and Chair Dept. of Neurology/Jacobs Neurological Institute Univ. at Buffalo Jacobs School of Medicine and Biomedical Sciences/SUNY Buffalo General Medical Center Buffalo, NY 14203-1126 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thymectomy has been used in myasthenia gravis (MG), in particular those patients who do not have a tumor of the thymus gland, known as a thymoma, for over 75 years without randomized data to support its use. A practice parameter in 2000 on behalf of the American Academy of Neurology stated that the benefits of thymectomy in this population of non-thymomatou smyasthenia gravis patients remained uncertain, classified thymectomy as a treatment option in this group, and called for rigorous, randomized studies. What we found is that compared to an identical prednisone protocol alone, that extended transsternal thymectomy confers significant benefits to non-thymomatous MG patients over a period of three years after the procedure. The benefits include better disease status, reduced prednisone requirements, fewer hospitalizations to manage  myasthenia gravis worsenings, and a lower symptom profile related to side effects from medications used to control the disease state. (more…)
Author Interviews, Clots - Coagulation, Diabetes, Heart Disease, JACC / 12.08.2016

MedicalResearch.com Interview with: Raffaele Piccolo, MD Department of Cardiology Bern University Hospital University of Bern Bern, Switzerland MedicalResearch.com: What is the background for this study? Response: Over the past two decades, the prevalence of diabetes mellitus has doubled in Western countries and future projections are even worse by showing a 55% increase by 2035 when approximately 592 million of people are expected to live with diabetes all over the world. Acute myocardial infarction still represents the most common diabetes-related complication and its occurrence is associated with a higher risk of mortality. Timely recanalization of the occluded coronary vessel with primary percutaneous coronary intervention (PCI) represents the therapy of choice for acute ST-segment elevation myocardial infarction (STEMI). Our study investigated whether the direct application of an intracoronary bolus of abciximab, which is an antiplatelet drug blocking the glycoprotein IIb/III a receptor, at the time of primary PCI improves the outcomes at 1-year follow-up compared with the standard intravenous route. The study was in individual patient-level pooled analysis of 3 randomized trials including 2,470 patients, of whom 473 (19%) had diabetes. (more…)
Author Interviews, Heart Disease, Surgical Research, Weight Research / 12.08.2016

MedicalResearch.com Interview with: Dr. Michelle R. Lent, PhD Geisinger Obesity Institute Geisinger Clinic Danville, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than one-third of adults in the United States live with obesity. Currently, the most effective treatment for obesity is bariatric surgery. Bariatric surgery patients are expected to lose 30 to 40 percent of their body weight, but not all patients are able to lose this amount of weight and others experience weight regain. Why some patients succeed in weight loss over time, while others are less successful, remains unclear. In this study, we evaluated over 200 patient characteristics in relation to long-term weight loss after bariatric surgery (7 years or longer), including gender, age and weight at the time of surgery, lab tests, medical conditions and medications, among others. We found that patients who used insulin, had a history of smoking, or used 12 or more medications before surgery lost the most weight, while patients with high cholesterol, older patients and patients with higher body mass indexes at the time of surgery lost the least amount of weight after surgery. (more…)
Author Interviews, Heart Disease, JACC, Stroke, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future. While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR. (more…)
Anemia, Author Interviews, Hematology, Lancet, Surgical Research / 06.08.2016

MedicalResearch.com Interview with: Clinical Professor Alhossain A.Khalafallah Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Senior Staff Specialist Launceston General Hospital, Australia MedicalResearch.com: What is the background for this study? Response: 1. Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting up to one third of the population worldwide. 2. Prevalence of anaemia in orthopaedic surgery ranges between 10-20% with the main cause of anaemia identified as nutritional deficiency. 3. New intravenous iron preparations have been developed at a higher purchase price than oral iron. Iron carboxymaltose, as one example, remains underutilised in the treatment of perioperative anaemia. 4. To our knowledge, this study is the first to compare the efficacy, safety and long term effect on iron stores and length of hospital stay in the postoperative anaemia setting. (more…)
Author Interviews, Menopause, OBGYNE / 05.08.2016

MedicalResearch.com Interview with: Louise Wilson PhD Candidate The University of Queensland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hysterectomy remains one of the most common gynecological procedures worldwide, with rates highest among women aged between 40 and 50. Between 30 and 40% of women aged in their 40s and 50s experience hot flushes and night sweats (vasomotor symptoms) that can greatly impact upon their overall quality of life. There is consistent evidence that women who have a hysterectomy and both ovaries removed are more likely to report more frequent or severe vasomotor symptoms, probably due to the abrupt decline in estrogen levels post-surgery. For women who have a hysterectomy with ovaries retained, the evidence is less clear. We wanted to increase our understanding of the symptom experiences of these women. We examined 17 years of data from more than 6,000 women in the Australian Longitudinal Study on Women’s Health. Approximately one in five of the women had a hysterectomy with ovarian conservation before the age of 50. We found that a third of these women experienced hot flushes that persisted in the long term, and around one in five were afflicted by constant night sweats. These rates were double those of women who did not have a hysterectomy over the 17-year study period, and could not be explained by differences in lifestyle or socio-economic factors. (more…)
Author Interviews, OBGYNE, Science, Surgical Research / 05.08.2016

MedicalResearch.com Interview with: Dr David A MacIntyre MRC Career Development Fellow Lecturer in Reproductive Systems Medicine Institute of Reproductive and Developmental Biology Department of Surgery and Cancer Imperial College London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread - around 5mm thick - that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread - called multifilament - is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner 'fishing line' thread, while the other half had the thicker 'shoe lace' thread. The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape - 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research / 28.07.2016

MedicalResearch.com Interview with: Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance. In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either 1) reducing their mortality, 2) reducing their patients’ comorbidities and complications, or 3) sending their patients to non-safety-net hospitals for their surgery. While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy. (more…)
Author Interviews, Outcomes & Safety, Prostate Cancer, Surgical Research / 27.07.2016

MedicalResearch.com Interview with: Prof Robert A Gardiner AM The University of Queensland Centre for Clinical Research Royal Brisbane & Women’s Hospital, Herston Brisbane,Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to determine whether one approach gave better results than the other at 12 weeks and 24 months after surgery with respect to the quality of life outcomes of urinary, sexual and bowel function and return to usual activities as well as oncological outcomes. There was no significant statistical difference between the robotic and open surgical approach for these parameters at the early time-point of 12 weeks follow-up. (more…)
Author Interviews, Gastrointestinal Disease, Lancet, Surgical Research / 27.07.2016

MedicalResearch.com Interview with: Mr Steven Brown MBChB, BMedSci, FRCS, MD Reader in Surgery Honorary Secretary to the ACPGBI Consultant colorectal surgeon University of Sheffield, UK MedicalResearch.com: What is the background for this study? Response: Haemorrhoids are common. One in 4 of us will at some time have symptoms that can be directly attributed to piles. Whilst most symptoms will settle spontaneously or with improvement to our lifestyle, there remains a large group of patients who require intervention to reduce symptomatology. Numerous interventions exist ranging from relatively minor office therapy to procedures that may take several weeks to recover from. Haemorrhoidal artery ligation (HAL) is one of the more recent surgical operations for haemorrhoidal therapy. It has been introduced certainly into the UK associated with a significant element of media hype purporting ‘painless surgery for piles’. Substantial subsequent medical literature has also suggested an efficacy rivaling other more invasive procedures. Too good to be true? Perhaps. Several systematic reviews have highlighted the lack of good quality data as evidence for the advantages of the technique. A well designed randomized controlled trial was required. The existing literature on  haemorrhoidal artery ligation at the time of the trial suggested the procedure was most effective for less symptomatic haemorrhoids (those that are associated with bleeding and/or minor prolapse; grade II or mild III piles). These type of haemorrhoids also tend to be the most common requiring intervention. The most frequently used alternative procedure for these grade of haemorrhoids in the UK is rubber band ligation (RBL), a simple office therapy not requiring anaesthetic. Hence participants with this grade of haemorrhoids were chosen as the participants with RBL as the comparator. Multiple outcomes were investigated but a patient reported outcome measure of recurrence was chosen as the primary outcome. (more…)
Accidents & Violence, Author Interviews, Surgical Research / 25.07.2016

MedicalResearch.com Interview with: Joshua Brown, M.D., M.S., research fellow Division of Trauma and General Surgery University of Pittsburgh School of Medicine MedicalResearch.com: What is the background for this study? Response: A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the U.S., the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest). We examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. We compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate. (more…)
Author Interviews, Dermatology, JAMA / 22.07.2016

MedicalResearch.com Interview with: G. Thomas (Tom) Ray Division of Research, Kaiser Permanente 2000 Broadway Oakland, CA 94612-2304 MedicalResearch.com: What is the background for this study? Response: Basal cell carcinoma (BCC) is the most common cancer in the United States. BCCs tend to develop on sun-exposed areas such as the head and neck and are typically treated with various surgical techniques in an outpatient setting. Although BCCs are rarely fatal, they have been estimated to be among the most costly cancers in the Medicare population due to their high incidence. Yet because these cancers are not tracked by national registries the way, for example, melanoma is, basal cell carcinomas have been difficult to study. Incidence rates in the past have tended to rely on surveys such as those by the National Cancer Institute. And studies using disease codes have, until recently, been difficult because the codes used for basal cell carcinoma and squamous cell carcinoma were the same. Since 1997, Kaiser Permanente Northern California (KPNC) has had computerized pathology results that allowed us to develop an internal registry of BCC cancers. In addition to having detailed information about basal cell cancer patients, we also had detailed information on the underlying population - KPNC members – which allowed us to determine incidence rates of BCC by age, sex, and most importantly for this study, by geographic location. This is because we know the residential location of all KPNC members at any given time – both those that get basal cell cancer and those who do not. This combination of a validated BCC registry with a well-defined population at-risk gave us the unique ability to investigate the spatial distribution of BCC in Northern California and assess whether there existed geographic clustering of basal cell cancers. Although the investigation of spatial clustering of other cancers is fairly common, no such analyses have been performed for basal cell cancer in the United States. (more…)
Author Interviews, Weight Research / 15.07.2016

MedicalResearch.com Interview with: Xiang Gao, PhD State Key Laboratory of Pharmaceutical Biotechnology and MOE Key Laboratory of Model Animal for Disease Study Model Animal Research Center Nanjing Biomedical Research Institute and the Collaborative Innovation Center of Genetics and Development Nanjing University MedicalResearch.com: What is the background for this study? Response: Duodenum-jejunum gastric bypass (DJB) surgery has been used to treat morbid diabetic patients. However, neither the suitability among patients nor the mechanisms of this surgical treatment is well understood. Our research is based on a new mouse strain named Timo as type 2 diabetes model caused by brain-derived neurotrophic factor (Bdnf) deficiency. We hope to figure out whether DJB surgery can reverse the metabolic defects in this type of diabetes. If yes, what is the possible mechanisms. MedicalResearch.com: What are the main findings? Response: Our research showed that duodenum-jejunum gastric bypass surgery could cure diabetes of genetic (mutation) origin. We also showed that the alteration of gut microflora abundance and improved metabolism preceded the inflammation alleviation and BDNF protein levels increase after DJB surgery. (more…)
Author Interviews, Geriatrics, JAMA, Surgical Research / 15.07.2016

MedicalResearch.com Interview with: Julia Berian, MD, MS ACS Clinical Research Scholar American College of Surgeons Chicago, IL 60611 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The US population is rapidly aging and older adults consume a disproportionate share of operations. Older adults experience a high rate of postoperative complications, which can affect quality of life. In this study, function, mobility and living situation are considered together as independent living. The study examined a large surgical database for the occurrence of loss of independence (defined as a decline in function or mobility, or increased care needs in one's living situation) and its relationship to traditional outcomes such as readmission and death after the time of discharge. Patients included in the study were age 65 or older and underwent an inpatient surgical operation. Loss of independence was assessed at the time of discharge. Readmission and death-after-discharge were assessed up to 30 days postoperatively. (more…)
Author Interviews, Surgical Research / 05.07.2016

MedicalResearch.com Interview with: Stephen Ferzoco, MD, FACS Chief of General Surgery Atrius Health in Boston MedicalResearch.com Editor's Note:  Dr. Stephen Ferzoco, a prominent active, academic surgeon, discusses the complexities of surgery for hernia repair. MedicalResearch.com: What is the background for this surgery? How many patients are affected by clinically significant hernias? Response: A hernia is a common condition where soft tissue breaches a weak spot in the abdominal wall. Hernias can affect the abdomen (ventral) or the groin (inguinal). In the U.S. there are about 350,000 ventral hernia procedures each year; these hernia patients present a range of complexity to the surgeon, with some of these procedures being among the most difficult cases for surgeons to manage. Inguinal hernias are even more common, with about 750,000 total procedures performed in the U.S. each year. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, MRI, Surgical Research / 24.06.2016

MedicalResearch.com Interview with: Eva C. Gombos, MD Assistant Professor, Radiology Harvard Medical School Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? Response: Treatment of early stage breast cancer, breast-conserving therapy (BCT), which consists of lumpectomy followed by whole-breast irradiation, requires re-excision 20 %–40% of patients due to positive margins. Breast MR is the imaging modality with the highest sensitivity to detect breast cancer. However, patients who undergo breast MR imaging have not experienced reduced re-excision or improved survival rates. Our hypothesis is that supine (performed with patient lying on her back) MR imaging within the operating room can be used to plan the extent of resection, to detect residual tumor immediately after the first attempt at definitive surgery, and to provide feedback to the surgeon within the surgical suite. The aim of this study was to use intraoperative supine MR imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone performed the patient lying on her stomach) to surgery (supine) and to evaluate the residual tumor immediately after BCT. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 23.06.2016

MedicalResearch.com Interview with: Dr. Stefan Toggweiler, MD Heart Center, Luzerner Kantonsspital Lucerne, Switzerland MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of aortic stenosis in inoperable and high-risk patients. It is well known that TAVR is associated with acute and delayed occurrence of conduction disorders. Namely, delayed high-degree atrioventrcular block is a feared complication. Thus, patients are usually monitored by telemetry for a few days, but there is currently no consensus on the duration of telemetry. In this study, we evaluated how the postprocedural ECG determines the need for permanent pacemaker implantation in patients undergoing TAVR. (more…)