Medical research slideshare_june_18_2015

MedicalResearch.comExclusive Interviews with Medical Research and

Health Care Researchers from Major and Specialty Medical Research Journals and Meetings

Editor: Marie Benz, MD [email protected]

June 18 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Read more interviews on MedicalResearch.com

Weekend Discharge Not Associated With Higher Rate of ReadmissionMedicalResearch.com Interview with:Jordan M. Cloyd, MDDepartment of SurgeryStanford UniversityStanford, California

• Medical Research: What is the background for this study? What are the main findings?

Dr. Cloyd: The motivation for the study was that, anecdotally, we had noticed that several of our patients who had been discharged on a weekend required readmission for potentially preventable reasons. We wanted to investigate whether the data supported the idea that weekend discharge was associated with a higher risk of hospital readmission.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Cloyd: Among patients undergoing abdominal aortic aneurysm repair, colorectal surgery,

pancreatectomy and total hip replacement, discharge on a weekend was not associated with a higher rate of hospital readmission. We also found that a significant proportion of patients who required readmission were readmitted to a different hospital than the discharging one.

Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.

http://medicalresearch.com/author-interviews/weekend-discharge-not-associated-with-higher-rate-of-readmission/14895/














http://medicalresearch.com/menopause/should-the-ovaries-be-removed-at-time-of-hysterectomy-for-benign-disease/1236/

Weekend Discharge Not Associated With Higher Rate of ReadmissionMedicalResearch.com Interview with:Jordan M. Cloyd, MDDepartment of SurgeryStanford UniversityStanford, California

• Medical Research: What recommendations do you have for future research as a result of this study?

• Dr. Cloyd: Additional research into hospital level factors that reduce the need for readmission will be critical. Furthermore, based on an unexpected finding of our study, we are currently investigating which factors are associated with readmission to a hospital other than the initial, discharging hospital.

• Citation:• Cloyd JM, Chen J, Ma Y, Rhoads KF. Association Between Weekend Discharge and Hospital Rea

dmission Rates Following Major Surgery. JAMA Surg. Published online June 03, 2015. doi:10.1001/jamasurg.2015.1087.












http://archsurg.jamanetwork.com/article.aspx?articleid=2300047








Spring Babies Have Highest Lifetime Risk of Cardiovascular DiseaseMedicalResearch.com Interview with: Nicholas Tatonetti, PhDDepartment of Biomedical InformaticsDepartment of Systems Biology, Department of MedicineColumbia University

New York, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Tatonetti: For decades, researchers have studied the link between disease incidence and the seasons. We’ve known, for example, that those born when the dust mite population is highest (summer) will have an increased chance of developing asthma. Traditionally, diseases have been studied one at a time to identify these seasonal trends. Because of the rapid adoption of electronic health records, it is now possible to study thousands of diseases, simultaneously. That is what we did in this study. We evaluated over 1,600 diseases and discovered 55 that showed this seasonal trend. Many of these had been studied previously, but several are new discoveries — most prominently, we found that the lifetime risk of developing cardiovascular disease is highest for those born in the spring.


http://medicalresearch.com/heart-disease/spring-babies-have-highest-lifetime-risk-of-cardiovascular-disease/14892/

















New York, NY

• Medical Research: What should clinicians and patients take away from your report?• Dr. Tatonetti: This is from the press release:• “It’s important not to get overly nervous about these results because even though we found

significant associations the overall disease risk is not that great,” notes Dr. Tatonetti. “The risk related to birth month is relatively minor when compared to more influential variables like diet and exercise.”



















New York, NY


• Dr. Tatonetti: Probably the most exciting aspect of this study is that it opens up new avenues of research into the environmental causes of disease. In particular, we are interested in identify what the exposures are that drive the association we found between birth month and cardiovascular disease. If we can identify these environmental mechanisms we may be able to mitigate risk in the future or design new therapies.

• Citation:• Birth Month Affects Lifetime Disease Risk: A Phenome-Wide Method• Mary Regina Boland , Zachary Shahn , David Madigan , George Hripcsak , Nicholas P. Tatonetti • Journal of the American Medical Informatics Association• DOI: http://dx.doi.org/10.1093/jamia/ocv046

First published online: 3 June 2015













http://dx.doi.org/10.1093/jamia/ocv046






Preoperative Pulmonary Function Testing Decreased After ACP GuidelinesMedicalResearch.com Interview with:Louise Sun, MD SM FRCPCAssistant Professor Department of Anesthesiology,

University of Ottawa Staff | Division of Cardiac AnesthesiologyUniversity of Ottawa Heart Institute

• Medical Research: What is the background for this study? What are the main findings?• Dr. Sun: Preoperative testing provides important information for perioperative

planning and decision-making. However, given the rapid increase in healthcare costs, there has been growing emphasis on the more rational use ofresources and thus the need to better understand the utilization patternsof specific tests. Preoperative pulmonary function tests (PFTs) areimportant in helping perioperative physicians identify patients at riskfor postoperative pulmonary complications, but few appropriate useguidelines exist for this test. We conducted a population-based studyusing linked administrative databases in Ontario, Canada to describetemporal trends in preoperative pulmonary function testsand assess whether the recent 2006 American College of Physicians (ACP) guidelines on risk assessment and prevention of postoperative pulmonary complications for non-cardiothoracic surgery influenced these trends.


http://medicalresearch.com/heart-disease/preoperative-pulmonary-function-testing-decreased-after-acp-guidelines/14779/








http://medicalresearch.com/medical-research-centers/nih/copd_using_fev6_to_identify_more_affected_patients/4103/








• We examined 511,625 individuals undergoing non-cardiothoracic surgery, amongst whom3.6% underwent preoperative pulmonary function tests while 3.3% had non-operative PFTs.

• Preoperative pulmonary function tests rates decreased over the study period and following the 2006 ACP guidelines while non-operative rates remained stable. By 2013,preoperative pulmonary function tests were performed in fewer than 8% of Ontario patients with risk factors for pulmonary complications, while preoperative testingrates among individuals without known respiratory disease had approachedrates seen in the non-operative setting. The decreasing preoperative pulmonary function tests rates contrast starkly against concurrent increases in rates of otherperioperative interventions such as preoperative anesthesia consultationsand stress testing.










http://medicalresearch.com/medical-research-centers/nih/copd_using_fev6_to_identify_more_affected_patients/4103/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Sun: Given the low overall rate of preoperative pulmonary function tests, large-scale

efforts to reduce this testing are likely unnecessary. Also, the decreasingpreoperative pulmonary function tests rates were unlikely to have been solely due to the 2006 ACP guidelines and may in part be explained by increased use of bedsidespirometry, which is not captured by provincial administrative databases.While less costly and possibly more accessible at some hospitals, thesealternative tests have limitations such as measurement error.










http://medicalresearch.com/author-interviews/copd-diagnosis-often-delayed/3711/









• Dr. Sun: We believe that our findings point to the need for more research toidentify which select group of surgical patients most benefit frompreoperative pulmonary function tests.

• Citation:• Smetana GW. The Conundrum of Unnecessary Preoperative Testing. JAMA Intern Med.

Published online June 08, 2015. doi:10.1001/jamainternmed.2015.2106. • Louise Sun, MD SM FRCPC, Assistant Professor Department of Anesthesiology,, University of

Ottawa Staff | Division of Cardiac Anesthesiology, & University of Ottawa Heart Institute (2015). Preoperative Pulmonary Function Testing Decreased After ACP Guidelines










http://archinte.jamanetwork.com/article.aspx?articleid=2301142








Defects in DNA Repair Could Underlie Cognitive DeclineMedicalResearch.com Interview with:Dr. Li-Huei Tsai Ph.D.Professor and Director – Picower Institute For Learning and MemoryDepartment of Brain and Cognitive Sciences

Massachusetts Institute of Technology


Dr. Tsai: For a while now, we have been interested in observations made by many labs, including our own, that the accumulation of DNA lesions is a hallmark of the aging brain, and that mutations in DNA repair factors manifest in congenital and neurodegenerative disorders. However, the precise contribution of unrepaired DNA lesions to the development of neurological disorders remains poorly understood. A major confounding factor is that the sources that generate DNA lesions in the brain are not well characterized, and it is not known whether damage accumulates non-specifically throughout the genome, or whether there are certain regions that are more prone to accumulate DNA damage.

• In this regard, our study reports three major findings:• (1) Physiological neuronal activity itself results in the formation of DNA breaks;• (2) Neuronal activity-induced DNA breaks form at highly specific locations, including within

the promoters of a subset of immediate early genes, including Fos, Npas4, and Egr1. These genes are also rapidly expressed in response to neuronal stimulation, and play crucial roles in experience-driven changes to synapses, and learning and memory;

• (3) Neuronal activity-induced breaks are generated by a topoisomerase, Topo IIβ, and Topo IIβ-generated DNA breaks facilitate the rapid expression of these immediate early genes following neuronal stimulation.


http://medicalresearch.com/author-interviews/defects-in-dna-repair-could-underlie-cognitive-decline/14918/





















• Medical Research: What should clinicians and patients take away from your report?• Dr. Tsai: First, that DNA breaks are an important component of normal physiological activity

in neurons.• Second, because activity-induced DNA breaks form at the promoters of genes that mediate

experience-driven changes in the brain, any change in a neuron’s ability to repair such lesions is likely to have important physiological and pathological implications. Our observations underscore the importance of mechanisms that ensure that neuronal activity-induced DNA breaks are repaired accurately. Defects that compromise these repair mechanisms could underlie cognitive decline with age and in neurodegenerative disorders.
























• Dr. Tsai: An exciting avenue of future research would be to identify the mechanisms that ensure that neuronal activity-induced DNA breaks are accurately repaired. This information could then be used to address the important question of whether the formation and repair of activity-induced DNA breaks underlie cognitive decline with age or during the development of neurodegenerative disorders. Identification of mechanisms that affect these processes are also likely to provide new targets for therapeutic intervention.

• Citation:• Li-Huei Tsai et al. Activity-Induced DNA Breaks Govern the Expression of Neuronal Early-

Response Genes. Cell, June 2015 DOI: 10.1016/j.cell.2015.05.032
















http://dx.doi.org/10.1016/j.cell.2015.05.032






Some Prostate Cancer Patient Decision Aids Need UpdatingMedicalResearch.com Interview with:Prajakta Adsul, MBBS, MPH, PhD; Ricardo Wray, PhD, and Sameer Siddiqui, MD Center for Cancer Prevention, Research and Outreach

Saint Louis University

• MedicalResearch: What is the background for this study? What are the main findings?• Response: Patient decision aids are interventions designed to help patients engage in shared

decision making with their providers when multiple choices with more or less equivalent efficacy are available for a particular medical decision. Several patient decision aids exists for numerous medical conditions and previous research has demonstrated them to be effective in improving the patient’s knowledge and understanding of treatment options and their relative efficacy and side-effects and resulting in a higher proportion of decision that are consistent with patient’s values and personal preferences.


http://medicalresearch.com/cancer-_-oncology/prostate-cancer/some-prostate-cancer-patient-decision-aids-need-updating/14932/



















• In the context of prostate cancer treatment, the practice of shared decision making is vital as highlighted by recent calls from the American Urological Association and the American Cancer Society. To aid with this process, several patient decision aids exist. However, the content presented, the format and presentation styles of decision aids can be variable and can have an influence on the choice made by the patients. The purpose of this study was to assess the characteristics of the patient decision aids designed for men facing prostate cancer treatment. We used the widely accepted International Patient Decision Aids Standards (IPDAS) for the assessment, supplemented with implementation criteria to strategize successful future improvement and promotion of decision aids in routine urological practice.

• The main findings of the review were that none of the decision aids reviewed met all standards. The aids had variable content, format and presentation of prostate cancer treatment information. Several decision aids were outdated and critical issues such as the risk of overtreatment and active surveillance as a treatment option for prostate cancer were not always covered in decision aids.














http://medicalresearch.com/cancer-_-oncology/prostate-cancer/prostate-cancer-unstable-chromosomes-may-predict-treatment-failures/2040/








• MedicalResearch: What should clinicians and patients take away from your report?• Response: Clinicians, especially urologists, should continue using and recommending their

patients to use decision aids when engaging in shared decision making for treatment of prostate cancer. When doing so, they need to choose decision aids with characteristics that are best suited to their patient populations and their personal practice styles. The review highlights these characteristics of currently available decision aids.

• For newly diagnosed prostate cancer patients, it is important to engage in shared decision making using decision aids and this review can help point out currently available decision aids and their characteristics.














http://medicalresearch.com/cancer-_-oncology/prostate-cancer/blood-based-biomarker-may-guide-therapy-for-advanced-prostate-cancer/14787/








• • MedicalResearch: What recommendations do you have for future research as a result of

this study?• Response: Decision aid developers need to address the IPDAS criteria more stringently and

update decision aids to reflect the current medical evidence or lack thereof. Pre-testing decision aids and feasibility of use with both patients and the clinicians can also improve decision aid efficacy and further our understanding of how to promote widespread adoption of these aids in routine practice.

• Citation:• Systematic Review of Decision Aids for Newly Diagnosed Prostate Cancer Patients Making T

reatment Decisions• Prajakta Adsul, MBBS, MPH, PhD Ricardo Wray, PhD Kyle Spradling, BA Oussama Darwish, MD

,Nancy Weaver, PhD, MS,Sameer Siddiqui, MD• Accepted: May 28, 2015; Published Online: June 05, 2015• Journal of Urology Publication stage: In Press Accepted Manuscript














http://www.jurology.com/article/S0022-5347(15)04115-4/abstract











Women and Men Have Similar Colon Cancer Recurrence-Free Death RiskMedicalResearch.com Interview with:Prof. Catherine QuantinClinical Epidemiology/Clinical Trials Unit, Dijon, France andDr Michal Abrahamowicz Ph.DDepartment of Epidemiology, Biostatistics and Occupational HealthMcGill University, Montreal, Canada

• Medical Research: What is the background for this study? Response: One difficulty, common to prognostic studies of cancer, concerns the need to separate the effects of prognostic factors on different clinical endpoints, such as disease recurrence vs recurrence-free death. Some published prognostic studies used a Cox regression model that included recurrence as a time-dependent covariate, to assess the impact of recurrence on mortality, and to adjust for recurrence when estimating the effects of other prognostic factors on mortality. However, the Cox model is limited to the assessment of the effects of covariates on a single endpoint, such as death. This limitation is overcome by multi-state models, that make it possible to model alternative pathways of disease progression and to assess the impact of prognostic factors on both recurrence-free death vs death after recurrence, and recurrence followed by death.

• Another difficulty, is that the cause of death is not available or not accurately coded. Yet, some patients are likely to die of causes not related to the disease of primary interest, especially in cancers with longer survival and in those that affect older subjects. The effects of prognostic factors estimated with Cox model, or classic multi-state models, are not able to discriminate between their effects on the mortality due to cancer of primary interest vs natural mortality. However, age is a very strong predictor of overall mortality, but is not systematically associated with higher cancer-specific mortality.

• To deal with this difficulty, many prognostic studies use relative survival methods.The general idea is to use the mortality tables for the relevant general population to estimate survival corrected for the expected natural mortality, due to other causes of death.


http://medicalresearch.com/cancer-_-oncology/women-and-men-have-similar-colon-cancer-recurrence-free-death-risk/14964/





















Women and Men Have Similar Colon Cancer Recurrence-Free Death RiskMedicalResearch.com Interview with:Prof. Catherine QuantinClinical Epidemiology/Clinical Trials Unit, Dijon, France andDr Michal Abrahamowicz Ph.DDepartment of Epidemiology, Biostatistics and Occupational HealthMcGill University, Montreal, Canada

• Medical Research: What are the main findings?

Response: Relative survival multistate model provides more information on prognosis and expected outcomes of patients with different characteristics than usual models (Cox or non multi-state relative survival models).

• Medical Research: What should clinicians and patients take away from your report?• Response: • Women with colorectal cancer have a similar risk of recurrence-free death to men.• Almost all deaths among patients who had recurrence were due to colorectal cancer.• Many deaths among patients without recurrence may be due to natural causes, not related to

colorectal cancer.• Medical Research: What recommendations do you have for future research as a result of this

study?• Response: Future prognostic registry-based studies of different cancers should consider the relative

survival multi-state Markov analyses.• Citation:• Cancer Epidemiol. 2015 Jun;39(3):447-55. doi: 10.1016/j.canep.2015.03.005. Epub 2015 Mar 25.• Multi-state relative survival modelling of colorectal cancer progression and mortality.• Gilard-Pioc S1, Abrahamowicz M2, Mahboubi A1, Bouvier AM3, Dejardin O4, Huszti E5, Binquet C6

, Quantin C7.


















http://www.ncbi.nlm.nih.gov/pubmed/25819431
























Both Gastric Banding and Bypass Surgery Reduce Medical CostsMedicalResearch.com Interview with:Kristina H. Lewis, MD, MPH, SMKaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta

Department of Population MedicineHarvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts

• Medical Research: What is the background for this study?

Dr. Lewis: The prevalence of severe obesity (BMI ≥40 kg/m2) in the U.S. is rising. This is concerning, because patients with severe obesity tend to be sicker and have higher healthcare costs. Bariatric surgery produces substantial weight loss and remission of a number of obesity-related comorbidities, but there have been very few studies directly comparing current procedure types. This leaves patients, providers and insurers with little information to help them decide about the pros and cons of different surgeries.

• We wanted to compare outcomes after two of the most common bariatric surgeries in the US – laparoscopic adjustable gastric banding (band) and laparoscopic roux-en-y gastric bypass (bypass). To do this, we examined commercial claims data from almost 10,000 U.S. band and bypass patients who were very similar with respect to age, gender, and medical conditions. We looked at what happened to these patients from one year before their surgeries through 3 years after surgery. We compared changes in medical costs and use of healthcare services before and after surgery.


http://medicalresearch.com/weight-research/both-gastric-banding-and-bypass-surgery-reduce-medical-costs/14966/















• Medical Research: What are the main findings?• Dr. Lewis: When performed laparoscopically, both gastric bypass and adjustable gastric

banding appear to result in lower total medical costs after surgery. Bypass patients see a greater immediate drop in prescription drug costs than band patients – this is not surprising given that we know that this surgery is more likely to induce weight loss and diabetes remission. Unfortunately, bypass patients also have an initial increase in emergency department visits after surgery that is not present for banding patients.

• When we compared total annual medical costs between band and bypass, we found no difference between procedures in the first 2 years after surgery. But, by year 3, bypass patients’ total annual medical costs are about 16% lower than those for band patients.

















• Medical Research: What should clinicians and patients take away from your report?• Dr. Lewis: Patients and clinicians considering one of these procedures should see these

findings as good news. On balance, it looks like, for a group of very sick patients whose annual medical costs are trending upwards before surgery, these procedures result in overall lower levels of healthcare use after they are performed. Deciding between the two procedures, or opting for even newer procedure types, such as sleeve gastrectomy, would require a conversation between patients and their providers about their specific medical needs and their personal health goals.


















• Dr. Lewis: Studies are needed that examine the newer “vertical sleeve gastrectomy” procedure in a similar fashion. That procedure has become very popular in the U.S. recently but very little is known about longer-term outcomes after it. Also – formal cost effectiveness studies that weigh the costs of the procedures against any potential benefits to patients would be important to conduct.

• Citation:• Lewis KH, Zhang F, Arterburn DE, Ross-Degnan D, Gillman MW, Wharam J. Comparing Medical

Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg. Published online June 03, 2015. doi:10.1001/jamasurg.2015.1081.

• Kristina H. Lewis, MD, MPH, SM, Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (2015). Both Gastric Banding and Bypass Surgery Reduce Medical Costs


















Diet and Supervised Exercise May Be Helpful In Preventing Excessive Pregnancy Weight GainMedicalResearch.com Interview with:Theresa A LawrieWorld Health OrganizationDepartment of Reproductive Health and ResearchGeneva, Switzerland

• MedicalResearch: What is the background for this study? • Response: Excessive weight gain in pregnancy is associated with various undesirable

outcomes in pregnancy. The aim of the review was to assess data from all relevant clinical trials in the field, to determine whether diet and/or exercise interventions during pregnancy were effective in reducing the chance of excessive weight gain in pregnancy. We also wanted to know whether these interventions could reduce the chance of having large babies (macrosomia), as this is associated with difficult labor, c/section, postpartum hemorrhage, birth injuries and other complications.


http://medicalresearch.com/weight-research/diet-and-supervised-exercise-may-be-helpful-in-preventing-excessive-pregnancy-weight-gain/14969/















• MedicalResearch: What are the main findings?

Response: Altogether 49 trials contributed data to the review. Approximately half the trials recruited women of any pre-pregnancy weight, the other half recruited women who were overweight or obese at the start of pregnancy. Most of the trials were conducted in high income countries. Interventions varied, some involved individual counseling, others group sessions, some were counseling interventions only, other programs were actively supervised by fitness trainers. Health outcomes for women receiving the intervention programs in addition to routine antenatal care (the intervention group) were compared with those of women receiving the routine antenatal care only (the control group).

• We found that diet or exercise or combined interventions led to an average 20% reduction in the number of women gaining excessive weight in pregnancy. This reduction was fairly consistent across the different types of interventions, although the largest effect was observed for combined diet and supervised exercise interventions. Overall findings suggested a small reduction in caesarean section (of about 5%) and in large babies (of about 7%). However, a bigger reduction in large babies (in the region of a 19% reduction) was noted for exercise-only interventions, which were more likely to be supervised interventions.

















• Other findings: We also found no difference in the risk of preterm birth between groups. Fewer women in the intervention group were assessed as having high blood pressure during pregnancy (although we assessed this as low quality evidence). Low quality evidence also suggested that women in the intervention group were likely to retain less weight at six months postpartum compared with the control group. Interestingly, data from two studies suggested that women receiving diet and exercise interventions were less likely to have babies with breathing difficulties at birth. These findings will hopefully be corroborated by other studies. A limitation of the review, is that we did not include gestational diabetes as an outcome as this is partly covered in a separate Cochrane review. Our exploratory analyses, however, suggested that there may be a reduction in gestational diabetes for certain types of interventions, and we hope to include these data in future review updates.

• In general, we did not find differences in outcomes for women according to pre-pregnancy weight or BMI.

















• MedicalResearch: What should clinicians and patients take away from your report?• Response: Pregnancy is a good time to establish or reinforce healthy lifestyle choices, which

have measurable benefits for mother and child. Regular, moderate-intensity exercise is an important component of this healthy lifestyle. Refer to the RCOG guidelines on exercise in pregnancy for guidance.

• For clinicians: Consider how your service is geared towards consistently supporting pregnant women to make healthy lifestyle choices. Diet and/or exercise interventions need not be hugely resource intensive; the review shows that counseling interventions alongside routine care can lead to improvements in health outcomes.

• For clinicians: Consider how your service is geared towards consistently supporting pregnant women to make healthy lifestyle choices. Diet and/or exercise interventions need not be hugely resource intensive; the review shows that counseling interventions alongside routine care can lead to improvements in health outcomes.

• For women: Talk to your doctor or midwife about your ideal weight gain in pregnancy and find out what guidance, support and antenatal activities are available in your area to help you monitor and attain it.

















• What recommendations do you have for future research as a result of this study?• Response: There is currently a lot of research interest in this area – we identified 40

registered ongoing trials which have not yet published results. Incorporating data from these trials, once completed, into future versions of this review will hopefully shed more light on the relative benefits or risks of the different types of interventions. Longer term follow-up data from trials are needed to assess postpartum and childhood outcomes relevant to these interventions. In addition, economic evaluation of different types of interventions is needed, as is more research on diet and exercise interventions in low-income countries.

• Citation:• Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for prevent

ing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub2











http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007145.pub3/abstract








Despite Guidelines, Many Physicians Still Ordering Routine Preoperative TestsMedicalResearch.com Interview with:Joseph A. Ladapo, MD, PhDAssistant Professor of MedicineSection on Value and EffectivenessDepartment of Population Health

NYU School of Medicine


Dr. Ladapo: Routine tests before elective surgery are largely considered to be of low value, and they may also increase costs. In an attempt to discourage their use, two professional societies released guidance on use of routine preoperative testing in 2002. We sought to examine the long-term national effect of these guidelines from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians’ use of routine preoperative testing. While we found that overall rates of routine testing declined across several categories over the 14-year study period, these changes were not significant after accounting for overall changes in physicians’ ordering practices. Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice.


http://medicalresearch.com/author-interviews/despite-guidelines-many-physicians-still-ordering-routine-preoperative-tests/14971/











http://medicalresearch.com/ophthalmology/patients-may-still-be-getting-unnecessary-pre-cataract-surgery-testing/13556/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Ladapo: While it’s important to ensure patients can safely undergo surgical procedures,

many of these procedures are low-risk, and the tests rarely improve patient management. Clinicians are responsible for reducing these low-value tests, and this harkens all the way back to residency training.





















• Dr. Ladapo: While the evidence suggests that physicians are not readily adopting the published guidelines, we don’t know why. Research that informs how to facilitate greater adherence to evidence-based guidelines should significantly improve quality of care.

• Citation:• Sigmund AE, Stevens ER, Blitz JD, Ladapo JA. Use of Preoperative Testing and Physicians’ Resp

onse to Professional Society Guidance . JAMA Intern Med. Published online June 08, 2015. doi:10.1001/jamainternmed.2015.2081.





















Dual Hormone Artificial Pancreas Reduces Nocturnal Hypoglycemia in Type 1 DiabetesMedicalResearch.com Interview with:Dr. Ahmad Haidar Ph.DDivision of Experimental Medicine, Department of MedicineMcGill University, Montreal, QC, Canada


Dr. Haidar: This is the first head-to-head-to-head comparison in outpatient setting of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional pump therapy in children and adolescents with type 1 diabetes.

• The main finding is that the dual-hormone artificial pancreas seems to outperform the other two systems in reducing nocturnal hypoglycemia in camp settings when the patients are very physically active during the day.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Haidar: Glucagon has the potential to reduce nocturnal hypoglycemia if added to the

artificial pancreas. However, this needs to be confirmed in larger and longer studies as the single-hormone artificial pancreas might be sufficient in home settings (this study was conducted at a camp, which is an environment different that home).


http://medicalresearch.com/diabetes/dual-hormone-artificial-pancreas-reduces-nocturnal-hypoglycemia-in-type-1-diabetes/15000/










http://medicalresearch.com/diabetes/dual-hormone-artificial-pancreas-reduces-hypoglycemia-risk/10485/






Dual Hormone Artificial Pancreas Reduces Nocturnal Hypoglycemia in Type 1 DiabetesMedicalResearch.com Interview with:Dr. Ahmad Haidar Ph.DDivision of Experimental Medicine, Department of MedicineMcGill University, Montreal, QC, Canada


• Dr. Haidar: We need to conduct longer and larger day-and-night outpatient studies (our study was for only 3 nights per intervention).

• Citation:• Outpatient overnight glucose control with dual-hormone artificial pancreas, single-hormone

artificial pancreas, or conventional insulin pump therapy in children and adolescents with type 1 diabetes: an open-label, randomised controlled trial

• DOI: http://dx.doi.org/10.1016/S2213-8587(15)00141-2• Haidar, Ahmad et al.• The Lancet Diabetes & Endocrinology Published Online: 08 June 2015












http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00141-2/abstract











Antibiotic Impregnated Sponges Reduced Chest Wound Infections After Heart SurgeryMedicalResearch.com Interview with:Mariusz Kowalewski, MDDepartment of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital Bydgoszcz,

Systematic Investigation and Research on Interventions and OutcomesMedicine Research Network, Poland


Dr. Kowalewski: Sternal wound infections occurring after heart surgery performed via median sternotomy, and in particular, after coronary artery bypass grafting (CABG), although rare, still pose serious postoperative complications that increase the length of hospital stay and healthcare costs. One of many ways to prevent them from happening, except from optimal glucose control, tight-fixed closure of the sternum at the end of surgery and perioperative iv. antibiotics, is to insert a gentamicin collagen sponge between two sternal edges, just before wiring them together. High local concentrations of gentamicin were shown to eliminate any microbial growth in the area, in the same time, not affecting the kidneys, as would be the case with systemic administration. Gentamicin sponges are widely used in orthopadic, gastro-intestinal and vascular surgery and were shown to reduce postoperative infection rates. Although extensively tested in the field of heart surgery, findings of one recent multicenter study have questioned their true benefit. We aimed to perform a comprehensive meta-analysis of studies assessing the efficacy of implantable gentamicin-collagen sponges in sternal wound infection prevention.


http://medicalresearch.com/infections/antibiotic-impregnated-sponges-reduced-chest-wound-infections-after-heart-surgery/14994/


























After screening multiple databases, a total of 14 studies (N = 22,135 patients, among them 4 randomized controlled trials [N = 4,672 pts]) were included in the analysis. Implantable gentamicin-collagen sponges significantly reduced the risk of sternal wound infection by approximately 40% when compared with control (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P = .04 for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P = .01 for observational studies). A similar, significant benefit was demonstrated for deep sternal wound infection (RR, 0.60; 95% CI, 0.42-0.88; P = .008) and superficial sternal wound infection (RR, 0.60; 95% CI, 0.43-0.83; P = .002). The overall analysis revealed a reduced risk of mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P = .01). The risk of death was unchanged.




























In addition, we investigated, by means of meta-regression, the correlation between sternal wound infections and extent to which the bilateral internal thoracic artery (BITA) was harvested. We found that the benefit provided by the gentamicin sponge was attenuated when BITA was harvested; these results suggest that another potentially preventive measure must be taken in such patients, as with severely reduced blood supply to the sternum (as is the case with BITA), sponge itself might not be enough to prevent wound infection.




























• Medical Research: What should clinicians and patients take away from your report?• Dr. Kowalewski: Current report is the largest to date database analyzed to assess the role of

gentamicin sponge in sternal wound prevention after heart surgery. While international guidelines are not conclusive regarding topical antibiotic administration after heart surgery, findings of the present report, suggest reduced infection rates in patients in whom, gentamicin sponge was implanted. The evidence was strikingly consistent across randomized and observational studies.





























• Dr. Kowalewski: We would encourage cardiac surgeons to introduce the gentamicin sponge to their institutional protocols, at least in patients at high risk of developing sternal wound infections (BMI >30, type 2 DM, COPD, BITA). What remains to be ascertained is the best combination of gentamicin sponge and iv. antibiotic. Also the results of 2×2 study comparing pedicled vs skeletonized internal thoracic artery and gentamicin sponge vs control could shed a new light to the topic.

• Citation:• J Thorac Cardiovasc Surg. 2015 Jun;149(6):1631-1640.e6. doi: 10.1016/j.jtcvs.2015.01.034. Ep

ub 2015 Jan 23.• Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery:

Meta-analysis.• Kowalewski M1, Pawliszak W2, Zaborowska K3, Navarese EP4, Szwed KA5, Kowalkowska ME6

, Kowalewski J7, Borkowska A5, Anisimowicz L2.

















































Craniofacial Anomalies Provide More Evidence Pedophilia Develops PrenatallyMedicalResearch.com Interview with:Fiona Dyshniku, M.A.Ph.D. Candidate, Clinical Psychology – Adult Clinical trackDepartment of PsychologyUniversity of Windsor

• MedicalResearch: What is the background for this study?

• Response: This study was conducted in the context of previous research that has found other evidence that pedophilia has biological roots that start before birth, such as shorter stature and left-handedness. Both of these correlates have prenatal origins, meaning that their development necessarily precedes the onset of more socially oriented correlates, such as parenting styles, sexual abuse during childhood, etc. Moreover, these neurodevelopmental correlates appear permanent and immune to later psychosocial influences. Much like handedness and stature, minor physical anomalies (MPA) develop prenatally, are permanent, and remain immune to psychosocial influences. There are additional benefits to examining minor physical anomalies, including the fact that they tend to develop in a set sequence, are actually formed from the same tissue that gives rise to the central nervous system, and have been widely studied in other well-established neurodevelopmental disorders, such as schizophrenia.


http://medicalresearch.com/author-interviews/the-take-way-message-for-clinicians-and-patients-is-that-there-is-now-a-good-amount-of-evidence-to-suggest-that-pedophilia-or-at-least-a-propensity-for-it-develops-prenatally/14991/

















• MedicalResearch: What are the main findings?• Response: We found that individuals simultaneously possessing more craniofacial anomalies

and fewer peripheral anomalies scored higher on several well-established pedophilia indices, including phallometric testing, possession of child pornography, and number of child victims. We also found that craniofacial anomalies on their own were more prevalent among individuals classified as pedophiles through phallometric testing. Taken together, these results suggest that there is further evidence for a biological cause of pedophilia. Moreover, since craniofacial anomalies develop around week 5 of gestation, it would appear that biological differences occur quite early on during foetal developmental.



















• MedicalResearch: What should clinicians and patients take away from your report?• Response: The take way message for clinicians and patients is that there is now a good

amount of evidence to suggest that pedophilia or at least a propensity for it develops prenatally.

• The differences are merely statistical, however. None of these correlates, be it shorter stature, left handedness, or craniofacial anomalies, together or separately, should be interpreted as tell-tale signs that someone is a pedophile. What a still-broadening field of evidence is suggesting is that people do not choose to be sexually interested in children: They discover that they are aroused by children. The best means of preventing child sexual abuse may therefore be to assist such people to deal with their sexual interests. Instead, most current policies drive these people underground and make it impossible for them to get sex-drive-reducing medications or other treatments.



















• MedicalResearch: What recommendations do you have for future research as a result of this study?

• Response: We hope other researchers, especially researchers from other fields, try not only to replicate this finding, but also to identify other markers of developmental perturbations. Each of these findings is a clue to when and how pedophilia develops. We need more clues like these to narrow down the possibilities and, potentially, find a means of reducing the probability of developing pedophilia in the first place.

• Citation:• Minor Physical Anomalies as a Window into the Prenatal Origins of Pedophilia• Fiona Dyshniku,Michelle E. Murray,Rachel L. Fazio,Amy D. Lykins,James M. Cantor

Archives of Sexual Behavior June 2015 Date: 10 Jun 2015













http://link.springer.com/article/10.1007/s10508-015-0564-7









JAK1-2 inhibitor Baricitinib May Limit Progression of Diabetic Kidney DiseaseMedicalResearch.com Interview with:Frank C. Brosius, MDProfessor, Internal Medicine and PhysiologyChief, Division of NephrologyUniversity of Michigan Ann Arbor, MI


Response: Our University of Michigan team had found that JAK-STAT gene expression was increased in kidneys in patients with diabetic kidney disease and that these changes correlated with progression of kidney disease. We subsequently substantiated these changes in other studies and have found that by increasing expression of just one of these genes, JAK2, in a single kidney cell type (podocytes) in mice that we can make their diabetic kidney disease much worse.

• At around the same time, investigators at Eli Lilly and Co. had FDA approval to test a JAK1-2 inhibitor, baricitinib, in patients with rheumatoid arthritis. The Lilly scientists saw our human results and thought about using baricitinib in patients with diabetic kidney disease. After initial discussions with Dr. Kretzler and myself they concluded that there was good reason to move ahead with this study and just 14 months after the initial meeting the phase 2 clinical trial of baricitinib in the treatment of patients with diabetic kidney disease was initiated.


http://medicalresearch.com/diabetes/jak1-2-inhibitor-baricitinib-may-limit-progression-of-diabetic-kidney-disease/14984/


















• Medical Research: What are the main findings? What should clinicians and patients take away from your report?

• Response: This is an initial report and so there will need to be further testing of the effectiveness and safety of baricitinib before it is a new treatment to prevent progression of diabetic kidney disease. However, the results are very encouraging. The drug reduced abnormal losses of protein in the urine, a marker of kidney injury, by about 40 percent. Furthermore, it reduced levels of compounds in the blood and urine that are markers of inflammation in the kidneys and elsewhere in the body. This result strongly suggests that baricitinib is tamping down the inflammation that is very important in causing progressive kidney injury in diabetes. There were no major side effects except a modest and expected reduction in the hemoglobin in patients on the highest dose of baricitinib.





















• Response: Discussions are ongoing about next steps, but we are very hopeful that Lilly will move ahead with further definitive trials of baricitinib in diabetic kidney disease. Positive results in bigger and longer trials could set the stage for FDA approval of baricitinib in the treatment of the millions of patients worldwide that have this disease. We hope that other investigators look carefully at the JAK-STAT pathway to determine its role in other kidney diseases and to potentially find other methods to inhibit this pathway to increase the likelihood of finding new, safe and effective agents for all individuals with chronic kidney disease.

• Citation: Presented at American Diabetes Association June 2015• Baricitinib in Diabetic Kidney Disease: Results from a Phase 2, Multicenter, Randomized, Doubl

e-Blind, Placebo-Controlled Study. Katherine R. Tuttle et al. American Diabetes Association 75th Scientific Sessions (2015):














http://www.abstractsonline.com/pp8/%23!/3699/presentation/12757








Children With Traumatic Brain Injuries Can Have Poor Sleep QualityMedicalResearch.com Interview with:Kimberly Allen PhD, RN Assistant ProfessorCenter for Narcolepsy, Sleep and Health Research

Department Women Children and Family Health ScienceChicago, IL 60612

• Medical Research: What is the background for this study? • Dr. Allen: Pediatric traumatic brain injuries (TBI) are a leading cause of morbidity and

mortality worldwide.Each year in the United States over 1Ž2 million children are admitted to the hospital for traumatic brain injuries (TBIs). Depending on the severity of the injury and how the individual child responds to the primary injury, a range of medical care may be necessary from an overnight hospital admission for observation to admission in the intensive care unit (ICU) and inpatient rehabilitation facility to re-teach and help to recover skills children once knew. The short- and long-term consequences of traumatic brain injuries include: motor and sensory impairments; cognitive, emotional, psychosocial impairments; headaches, and sleep disruptions.


http://medicalresearch.com/sleep-disorders/children-with-traumatic-brain-injuries-may-have-poor-sleep-quality-and-daytime-sleepiness/15014/
















Medical Research: What are the main findings?

Dr. Allen: The main finding from this pilot study with two groups with 15 children in each group: one of children with traumatic brain injuries and one of typically, developing healthy children was that children with traumatic brain injuries have significantly more daytime sleepiness and worse sleep quality compared to the control group. Additionally, children with TBI also had lower overall functional scores (e.g, school, social) compared to the controlled children. All of the surveys were completed by the child’s parent.


















• Medical Research: What should clinicians and patients take away from your report?• Dr. Allen: This study has a small number of children and must be interrupted with caution.

We can recommend that clinicians continue asking questions about sleep to this population, as we continue to explore who is most a risk and eventually determine if treatment is necessary.



















• Dr. Allen: Future research needs to identify the trajectory to the sleep symptoms in larger populations, and determine if severity and other medical factors effect sleep problems. Additionally, more objectively and subjective data are need in conduction to determine the whole picture of what changes are necessary for the child and family.

• Citation:• SLEEP 2015 abstract: June 2015• Allen K, et al “Sleep after pediatric traumatic brain injury: a survey study” SLEEP 2015; Abstra

ct 1050.











http://www.sleepmeeting.org/

http://www.sleepmeeting.org/






Your Smartphone May Help You Control Your Blood PressureMedicalResearch.com Interview with: Neetika Garg, MDFellow in NephrologyBeth Israel Deaconess Medical CenterDivision of Nephrology, Department of MedicineBoston, MA 02215

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Garg: One in every three Americans suffers from hypertension. Since high blood pressure

(BP) frequently does not cause any symptoms, self-blood pressure monitoring at home and patient education are critical components of patient management. With more than 58% of the US adults owning a smartphone, mobile-based health technologies (most commonly in the form of applications or “apps”) can serve as useful adjuncts in diagnosis and management of hypertension. At the same time, several smartphone-based applications are advertised as having blood pressure measurement functionality, which have not been validated against a gold standard. In this cross-sectional study, we analyzed the top 107 hypertension related apps available on the most popular smartphone platforms (Google Android and Apple iPhone) to analyze the functional characteristics and consumer interaction metrics of various hypertension related apps.


http://medicalresearch.com/author-interviews/your-smartphone-may-help-you-control-your-blood-pressure/14982/




















Nearly three-quarters of the apps record and track blood pressure, heart rate, salt intake, caloric intake and weight/body mass index. These app features can facilitate patient participation in hypertension management, medication adherence and patient-physician communication. However, it was concerning to find that 6.5% of the apps analyzed could transform the smartphone into a cuffless BP measuring device. None of these had any documentations of validation against a gold standard. Furthermore, number of downloads and favorable user ratings were significantly higher for these apps compared to apps without blood pressure measurement function. This highlights the need for greater oversight and regulation in medical device development.






















• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Garg: Physicians should incorporate use of mobile-based health technology into

discussions at patient visits for various reasons:• First, tracking their blood pressure can motivate patients to participate in their own care.• Secondly, many apps allow patients to transmit data entered over a period of time directly

and conveniently to their physicians, thereby facilitating patient-physician communication and health management.

• Thirdly, our study highlights the need for cautioning patients regarding use of very popular, but as yet unvalidated use of smartphone-based apps as blood pressure measuring devices.

• Similarly, patients should use smartphone-based applications for tracking their blood pressure as these data can help with diagnosis and management of chronic health conditions such as hypertension. At the same time, patients should be aware of the presence of popular yet potentially misleading resources. They should look for information/methodologies that are approved/validated by reliable professional organizations. Also, if they are using any smartphone-based technologies for blood pressure measurement, they should discuss the same with their physicians.























• Dr. Garg: There is an unmet need in mobile-based health technologies that can effectively and conveniently assist with management of chronic health conditions such as hypertension. Future research should focus on development and validation of various blood pressure measurement devices that can facilitate management of this chronic health condition.

• Many groups are in fact working on smartphone-based devices that can measure blood pressure without use of the traditional cuff.

• Secondly and more importantly, it would be important to determine the actual impact of use of these resources on hypertension management and related outcomes.

• Citation:• J Am Soc Hypertens. 2015 Feb;9(2):130-6. doi: 10.1016/j.jash.2014.12.001. Epub 2014 Dec 11

.• A content analysis of smartphone-based applications for hypertension management.• Kumar N1, Khunger M2, Gupta A3, Garg N4.

































MedicalResearch.com Interview with:Wei Zheng, MD, PhD, Professor of MedicineAnne Potter Wilson Chair in Medicine Director, Vanderbilt Epidemiology Center andDanxia Yu, PhD Research FellowVanderbilt Epidemiology Center Vanderbilt

University School of MedicineNashville, TN, 37203

• Medical Research: What is the background for this study? What are the main findings?• Response: The Dietary Guidelines for Americans (DGA) provide the most authoritative advice

in the US about healthy eating. Higher adherence to the DGA, reflected by a higher Healthy Eating Index (HEI) score, has been found to be associated with lower risk of developing or dying from chronic diseases (e.g. diabetes, cardiovascular disease, and certain cancers) in several US studies. However, these studies recruited mostly non-Hispanic white individuals and middle to high income Americans. It has been reported that racial/ethnical background and socioeconomic status may influence food choices and diet quality. However, no previous study has adequately evaluated the association between adherence to the DGA and risk of death due to diseases in racial/ethnical minorities and low-income Americans. Therefore, it is uncertain whether the health benefits of adherence to the current DGA can be generalized to these underserved populations.


http://medicalresearch.com/author-interviews/healthy-diet-may-reduce-mortality-in-low-income-populations/14980/






















• We analyzed diet and mortality data from the Southern Community Cohort Study (SCCS), a large, prospective cohort study including approximately 85,000 American adults, 40-79 years old, enrolled from 12 southeastern states between 2002 and 2009. Two-thirds of the SCCS participants were African-American and more than half reported an annual household income <$15,000.

• During a mean follow-up of 6.2 years, we identified 6,906 deaths in the SCCS, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. Using multivariate analysis methods, we found that participants in the top 20% of the HEI score (highest adherence to the DGA) had only about 80% of the risk of death due to any diseases compared with those in the bottom 20% of the HEI score. This protective association was found regardless of sex, race and income levels.
























• Medical Research: What should clinicians and patients take away from your report?• Response: Similar to what was reported previously in studies conducted in mostly non-

Hispanic white individuals and middle to high income Americans, our study suggests that having a healthy diet, as described in the DGA, may help to reduce disease mortality in African Americans and low-income populations.

























• Response: African Americans and low-income populations experience a disproportionally high disease burden. Future studies are needed in these underserved populations to directly evaluate cost-effective disease prevention strategies to reduce the morbidity and mortality of diseases in these populations.

• Citation:• Yu D, Sonderman J, Buchowski MS, McLaughlin JK, Shu X-O, Steinwandel M, et al. (2015)

Healthy Eating and Risks of Total and Cause-Specific Death among Low-Income Populations of African-Americans and Other Adults in the Southeastern United States: A Prospective Cohort Study. PLoS Med 12(5): e1001830. DOI: 10.1371/journal.pmed.1001830

















http://medicalresearch.com/tobacco-research/prevalence-of-a-healthy-lifestyle-among-individuals-with-cardiovascular-disease-in-high-middle-and-low-income-countriesthe-prospective-urban-rural-epidemiology-pure-study/621/

http://dx.doi.org/10.1371/journal.pmed.1001830






Simple and readily available patient characteristics predicts death and dialysis dependence in critically ill patients with severe acute kidney injuryMedicalResearch.com Interview with: Raghavan Murugan

MD, MS, FRCP, FCCP and John Kellum, MDDepartment of Critical Care MedicineUniversity of Pittsburgh Pittsburgh, PA

• Medical Research: What is the background for this study? What are the main findings?• Response: In our prior studies, we found that nearly one-half of critically ill patients in the

intensive care unit who receive dialysis die by 2 months after acute illness and more than one-third of surviving patients are dialysis dependent. We sought to examine whether simple patient characteristics and inflammatory biomarkers predicted death and non-recovery of kidney function after severe acute kidney injury.

• We found that a combination of four simple and readily available patient characteristics including older age, lower mean arterial pressure, need for mechanical ventilation, and higher serum bilirubin levels predicted death and dialysis dependence. Higher plasma concentration of interleukin (IL)-8 in combination with the clinical characteristics also increased risk prediction. To our knowledge, this study is the first large study to examine risk prediction for outcomes after severe acute kidney injury using a panel of biomarkers in a large cohort of critically ill patients receiving dialysis.


http://medicalresearch.com/author-interviews/simple-and-readily-available-patient-characteristics-predicts-death-and-dialysis-dependence-in-critically-ill-patients-with-severe-acute-kidney-injury/15025/























• Medical Research: What should clinicians and patients take away from your report?• Response: Our findings have important implications for patients and clinicians. First, the four

clinical characteristics along with plasma IL-8 could be used to estimate patient prognosis and clinical decision-making by nephrologists and intensivists. For instance, the clinical variables and IL-8 marker levels measured on the day when dialysis initiation is being considered by a clinician could be useful to better inform patients and families about prognosis. Because patients who are older, are mechanically ventilated, and have lower mean arterial pressure, high bilirubin, and IL-8 levels, are likely to have worse outcomes, they may not wish to undergo dialysis and clinicians may treat those patients accordingly. Second, early prediction of renal recovery is likely to be helpful with regard to post-discharge planning by nephrologists after critical illness and monitoring for subsequent progression to chronic kidney disease and end-stage renal disease in patients who are unlikely to have complete renal recovery.


























• Response: First, although IL-8 is not yet used in clinical practice to treat patients with acute kidney injury, the assay is easy to perform and could easily be developed into a clinical test. Second, identification of a homogeneous group of patients using biomarker-guided risk assessment allows for examination of new interventions or interventions that have previously failed in clinical trials that included a heterogeneous population of patients with severe acute kidney injury. Third, although we did a cross-validation within our study, our findings require external validation before they can be applied to other patient populations with severe acute kidney injury.

• Citation:• Biomarker Enhanced Risk Prediction for Adverse Outcomes in Critically Ill Patients Receiving R

RT• Francis Pike, Raghavan Murugan, Christopher Keener, Paul M. Palevsky, Anitha Vijayan, Mark

Unruh, Kevin Finkel, Xiaoyan Wen, John A. Kellum, and for the Biological Markers for Recovery of Kidney (BioMaRK) Study Investigators

• CJASN CJN.09911014; published ahead of print June 5, 2015, doi:10.2215/CJN.09911014






















http://cjasn.asnjournals.org/content/early/2015/06/05/CJN.09911014.abstract








Biologics in Rheumatic Disease Reduce Missed WorkdaysMedicalResearch.com Interview with:Cécile Gaujoux-Viala, MD, PhDUniversité Montpellier I Chef de Service de RhumatologieCHU de Nîmes CarémeauFrance

• Medical Research: What is the background for this study?• Response: Chronic inflammatory rheumatic diseases – such as rheumatoid arthritis (RA),

ankylosing spondylitis (AS), and psoriatic arthritis (PsA) – confer significant patient and economic burdens : 1/5 of people with rheumatic conditions has been forced to change career, 1/3 will have stopped working within two years of onset and 1/2 will be unable to work within ten years.

• The addition of biological agents in treatment strategies for rheumatic diseases have improved the possibility of controlling disease activity and slowing the progression of joint damage. But these treatments are very expensive and their effect on work participation remains unclear.


http://medicalresearch.com/author-interviews/biologics-reduce-missed-workdays-in-rheumatic-disease/15034/























Medical Research: What are the main findings?

Response: Our study demonstrates a positive effect of biological disease-modifying antirheumatic drugs ( DMARDs) on work participation with reduction of absenteeism (missed work days and number of patients losing workt ime due to rheumatic disease) and improvement of presenteeism. The positive effect on job loss was nearly significant. Thus the high costs of these treatments could be at least partly offset by the savings they deliver in indirect costs.


























• Response: There is a real lack of published results especially for ankylosing spondylitis and psoriatic arthritis, for recent rheumatic diseases and for some biological agents. Studies in patients with shorter disease duration, longer follow-up periods and preferably adjusted for secular trends using the general population as a control group to understand employment outcome, are urgently needed. There is also a large heterogeneity in ‘Work evaluation’ scales. Hopefully, work impact is increasingly studied and standardized.

• Citation:• Presented at European League Against Rheumatism. “Biologics improve productivity and

reduce missed workdays in rheumatic disease: Treatment could reduce economic burden on patients and society.



















http://www.eular.org/






ACA Medicaid Expansion Will Require More Primary Care Providers, Especially In Low Income AreasMedicalResearch.com Interview with:Eric T. Roberts and Darrell GaskinJohns Hopkins University Bloomberg School of Public HealthBaltimore, MD


Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults.

• We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps.


http://medicalresearch.com/author-interviews/aca-medicaid-expansion-will-require-more-primary-care-providers-especially-in-low-income-areas/15003/







http://medicalresearch.com/author-interviews/study-finds-medicaid-improves-depression-but-not-physical-health/13041/







• Medical Research: What should clinicians and patients take away from your report?• Response: Policies that focus on the recruitment of physicians to low-income areas that are

medically under-served can help to meet the health care needs of newly-insured adults. Although training more health care workers – to meet the needs of an aging population and workforce turnover – is important, clinicians and policy makers should also pay close attention to the effects of workforce policies on where providers work.

• Physicians entering the workforce after completing their training may take a number of factors into consideration when deciding where to practice. Young physicians should consider the valuable opportunities for hands-on training and financial assistance paying off student debt that are available through programs like the National Health Service Corps (NHSC). Physicians should also work closely with policy makers to identify strategies that can improve recruitment to the NHSC and promote the long-term retention of Corps members in the communities they serve.















• result of this study?• Response: Policy makers need evidence about the effectiveness of the Affordable Care Act’s

various workforce development programs in order to prioritize funding for future initiatives. The ACA expanded support for the NHSC, in addition to Title VII funding for medical education and clinic-based graduate medical education, in an effort to expand the pipeline of professionals entering the primary care workforce in high-need communities. Evaluating the effectiveness of these different programs, on both the short-term recruitment and the long-term retention of professionals in primary care, will help policy makers invest in programs that deliver care to populations that need it the most.

• Citation:• Projecting Primary Care Use in the Medicaid Expansion Population Evidence for Providers and

Policy Makers

Eric T. Roberts and Darrell J. Gaskin Med Care Res Rev 1077558715588435, first published on June 10, 2015 doi:10.1177/1077558715588435









http://medicalresearch.com/medication-research/aca-enrollees-more-likely-to-use-medicines-for-hepatitis-and-hiv/14568/

http://mcr.sagepub.com/content/early/2015/06/04/1077558715588435.abstract










Bone Marrow Receptor Opens Door To New Therapy For a Pediatric LeukemiaMedicalResearch.com Interview with:Susan Schwab, PhDAssistant professor at NYU LangoneSkirball Institute of Biomolecular Medicine

• Medical Research: What is the background for this study? What are the main findings?• Dr. Schwab: T cell acute lymphoblastic leukemia (T-ALL) remains a devastating pediatric

disease. Roughly 20% of children do not respond to current therapies. Furthermore, metastasis to the central nervous system is common in T-ALL, and intrathecal chemotherapy, even when successful at eradicating the cancer, causes serious long-term cognitive side-effects.

• Here we report that the chemokine receptor CXCR4 is essential for T cell acute lymphoblastic leukemia progression in both mouse and human xenograft models of disease. Consistent with sustained disease remission in the absence of CXCR4, loss of CXCR4 signaling results in decreased levels of c-Myc, which is required for leukemia initiating cell activity. T-ALL cells reside near cells generating the CXCR4 ligand CXCL12 in the bone marrow, and our data suggest that vascular endothelial cells may be an important part of the T-ALL niche.


http://medicalresearch.com/cancer-_-oncology/leukemia/bone-marrow-receptor-opens-door-to-new-therapy-for-a-pediatric-leukemia/15042/

















• Medical Research: What should clinicians and patients take away from your report?• Dr. Schwab: The importance of CXCR4 in T-ALL was unexpected because CXCR4 plays only

limited roles in normal T cell development and peripheral T cell maintenance. Yet because several potent and well-tolerated CXCR4 antagonists are in clinical trials for other blood cancers, this finding may be rapidly translated into improved therapy for T cell acute lymphoblastic leukemia patients.




















• Dr. Schwab: One very high priority is to perform further preclinical testing of CXCR4 antagonists in T-ALL, using a wider spectrum of patient samples.

• A second priority is to understand why CXCR4 is indispensable for T-ALL, which would help identify patients who would most benefit from CXCR4 antagonism.

• Citation:• CXCL12-Producing Vascular Endothelial Niches Control Acute T Cell Leukemia Maintenance• Pitt, Lauren A. et al.• Cancer Cell , Volume 27 , Issue 6 , 755 – 768













http://www.cell.com/cancer-cell/abstract/S1535-6108(15)00178-6








Parkinson’s Disease Can Be Stratified Into Three Distinct GroupsMedicalResearch.com Interview with:Ron Postuma, MD, MScAssociate Professor Department of NeurologyMontreal General Hospital Montreal, Quebec

• Medical Research: What is the background for this study? What are the main findings?• Dr. Postuma: The background is that we often think about Parkinson’s Disease as a single

disease. However, every clinician knows that there is a great deal of variability from patient to patient. If we can understand the main aspects that separate patients into groups, we can target therapy better.

• The analysis used a semi-automated means to divide Parkinson’s patients into groups, using extensive information about motor and non-motor aspects of disease. We found that the non-motor symptoms, especially cognition, sleep disorders, and blood pressure changes were the most powerful predictors of which group a patient would be in. Based on these non-motor (and some motor aspects), the most accurate way to divide patients was into three groups – diffuse (many non-motor symptoms), pure motor, and intermediate (halfway between the other). We then followed patients over time. The diffuse group had, by far, the worse prognosis. This was not only for the non-motor aspects, but the motor as well.


http://medicalresearch.com/author-interviews/parkinsons-disease-can-be-stratified-into-three-distinct-groups/14988/



















• Medical Research: What should clinicians and patients take away from your report?• Dr. Postuma: Most importantly, we can start to stratify patients into groups and predict their

prognosis, based especially upon non-motor aspects of disease.• Not all patients are the same – if you are seeing mild cognitive changes, REM sleep behavior

disorder, orthostatic hypotension and predominant gait dysfunction, prepare for a dramatically worse progression of disease, and be especially vigilant for cognitive changes.






















• Dr. Postuma: The most critical thing is that these finding must be confirmed in other long term studies. Any patient population can have its own individual characters (for example, we think that because of the way we recruited patients, we may have had more of the ‘diffuse-malignant’ patients than other groups might have (for example, if they select highly-motivated cognitively well patients)). So, we have to see not only whether the classification holds up, but what the proportions in each group are.

• Then, we have to start to understand why there is this variation. Is the underlying pathology different. Does genetics play a role (we already know that certain genetic causes have different phenotypes). Is it partially determined by the presence of other, even very early stage neurologic disease (like prodromal Alzheimer’s)? And finally, should these patients receive different types of therapy?

• Citation:• Fereshtehnejad S, Romenets S, Anang JM, Latreille V, Gagnon J, Postuma RB. New Clinical Sub

types of Parkinson Disease and Their Longitudinal Progression: A Prospective Cohort Comparison With Other Phenotypes. JAMA Neurol. Published online June 15, 2015. doi:10.1001/jamaneurol.2015.0703.















http://archneur.jamanetwork.com/article.aspx?articleid=2318972










Dramatic Increase In Young Children Accidentally Exposed To PotMedicalResearch.com Interview with:Dr. Gary Smith MD, DrPHCenter for Injury Research and PolicyNationwide Children’s HospitalColumbus, Ohio

• Medical Research: What is the background for this study? What are the main findings?• Dr. Smith: As of January 2015, 23 states and Washington D.C. have legalized marijuana for

medical use. Four of those same states and Washington D.C. have also voted to legalize marijuana for recreational use. The debate about legalization often focuses on health effects among adults, economic benefits, and crime rates. Lost in the discussion is the potential harm to young children from unintentional exposure to marijuana.

• The study found that the rate of marijuana exposure among children 5 years of age and younger rose 147.5 percent from 2006 through 2013 across the United States. The rate increased almost 610 percent during the same period in states that legalized marijuana for medical use before 2000.

• In states that legalized marijuana from 2000 through 2013, the rate increased almost 16 percent per year after legalization, with a particular jump in the year that marijuana was legalized. Even states that had not legalized marijuana by 2013 saw a rise of 63 percent in the rate of marijuana exposures among young children from 2000 through 2013.

• Most children were exposed when they swallowed marijuana – that may be related to the popularity of marijuana brownies, cookies and other foods.


http://medicalresearch.com/pediatrics/dramatic-increase-in-young-children-accidentally-exposed-to-pot/15048/









http://medicalresearch.com/heart-disease/secondhand_marijuana_smoke_may_be_as_bad_for_you_as_tobacco/9033/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Smith: Marijuana exposure among young children is a growing problem. Most exposures

resulted in minor clinical effects, but some children experience coma, respiratory depression, or seizures. Health care providers need to inform parents and other child caregivers of the hazard, and talk to them about proper storage if marijuana is in the household.

• The same precautions used to protect children from medicines and dangerous household chemicals need to be used with marijuana products – for example, keeping the products in child-resistant, opaque containers and storing products up, away and out of sight of children, preferably in a locked cabinet.











http://medicalresearch.com/stroke/does_marijuana_increase_stroke_risk_in_young_adults/5195/








• Dr. Smith: Future research should be done to evaluate the effect of the safety requirements included in marijuana legalization laws. Are additional child protections needed? What is the most effective way to enforce child safety provisions? Study of future trends in marijuana exposure among children should be done to continue to inform public policy and child safety efforts.

• Citation:• Bridget Onders, Marcel J. Casavant, Henry A. Spiller, Thiphalak Chounthirath, and Gary A.

Smith. Marijuana Exposure Among Children Younger Than Six Years in the United States. CLIN PEDIATR, June 7, 2015 DOI: 10.1177/0009922815589912











http://dx.doi.org/10.1177/0009922815589912






Skin Mottling Associated In Increased Mortality In ICU PatientsMedicalResearch.com Interview with:Rémi Coudroy MDCHU de Poitiers, Service de Réanimation MédicaleCIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France


Dr. Coudroy: Skin mottling is characterized by a red-violaceous discoloration of the skin. Its occurrence, as impaired consciousness and decreased urinary output are well-known clinical signs of shock. Skin mottling has been investigated only in patients with septic shock and recent studies have found that the extent and the persistence of skin mottling for more than 6 hours were associated with mortality. However, in daily clinical practice, we noticed that skin mottling occurred in patients without septic shock, and there was no data supporting the impact of skin mottling on the prognosis of critically ill patients.

• In a retrospective monocentric observational study over a 1-year period in a 15-bed tertiary medical ICU where skin mottling over the knees is assessed by nurses, we found that skin mottling occurred in 29% of patients admitted to ICU. Nurses’ evaluation of skin mottling was highly reliable. In 60% of cases, mean arterial pressure was ≥ 65 mmHg without vasopressors. The occurrence of skin mottling was associated with mortality independently from calculated severity scores at admission (i.e. Simplified Acute Physiology Score II). Similarly, the persistence of skin mottling for more than 6 hours was associated with mortality independently from organ failure at the onset of skin mottling (i.e. the use of vasopressors, the need for mechanical ventilation and hyperlactatemia).


http://medicalresearch.com/critical-care-intensive-care-icus/skin-mottling-associated-in-increased-mortality-in-icu-patients/15061/















http://medicalresearch.com/infections/hospital-acquired/antibacterial-gloves-may-reduce-cross-contamination-in-icu-setting/13727/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Coudroy: Skin mottling is an easy to assess clinical sign. Clinicians should be aware that

skin mottling occurs frequently, mainly in patients without hypotension, and that its occurrence and its persistence for more than 6 hours can be considered as severity signs. We believe that systematic and serial assessment of skin mottling should be encouraged.

















http://medicalresearch.com/heart-disease/risk-benefit-of-pre-surgery-beta-blockers-varies-by-cardiac-profile/14439/








• Dr. Coudroy: Pathophysiology of skin mottling is actually unknown. A better understanding of factors associated with skin mottling may lead to improve of critically ill patients’ management.

• Citation:• Is skin mottling a predictor of high mortality in non-selected patients with cirrhosis admitted

to intensive care unit?• Coudroy, Rémi et al.• Journal of Hepatology

DOI: http://dx.doi.org/10.1016/j.jhep.2015.05.025

















http://dx.doi.org/10.1016/j.jhep.2015.05.025






High Coronary Calcium Score May Encourage Healthier LifestyleMedicalResearch.com Interview with:Ms. Rikke Elmose MolsDepartment of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark.

• MedicalResearch.com: What is the background for this study? What are the main findings?• Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-

test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD.


http://medicalresearch.com/radiology/high-coronary-calcium-score-may-encourage-healthier-lifestyle/15063/

















http://medicalresearch.com/heart-disease/aortic-calcification-presents-increased-cabg-risk-in-octogenarians/13494/







Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.



















http://medicalresearch.com/heart-disease/high-intensity-statin-therapy-underutilized-after-heart-attack/10631/







• MedicalResearch: What should clinicians and patients take away from your report?• Response: Within two weeks after randomization, patients in the intervention group were

invited to a 25 minutes nurse consultation, during which the individual calcium score image was demonstrated. The exact AS was not mentioned. We used the European guidelines on cardiovascular prevention to standardize the information about risk factors of CAD and the relation between CAC and cardiovascular outcome. The information also included recommendations on target levels of total- and LDL-cholesterols, and the purpose of and potential side effects by statin and aspirin prophylaxis. Moreover, recommendations about the beneficial effects of physical activities, a healthy diet, and smoking cessation were provided. We used a motivational counselling approach in order to optimize the patient-nurse communication



















http://medicalresearch.com/heart-disease/bad_cholesterol_ldl_linked_to_aortic_valve_disease/8628/








• Response: There may be several mechanisms for the beneficial effect of intervention in this study. The relatively short time between the coronary CTA examination and the first follow-up consultation may have captured patients in a state of health threat, and consequently, readiness for behavioral and lifestyle changes. The latter is supported by data showing a higher efficacy in improving particularly smoking cessation in the setting of acute myocardial infarction if offering smoking counseling in-hospital and supportive contacts immediately after discharge. Moreover, previous research on strategies to communicate cardiovascular risk to patients indicate that visual displays have desirable properties enhancing understanding of risk and thus may be considered as a “wake-up call”. The use in this study of a motivational communicative approach, reflecting a patient-centered way of communication for facilitating behavioral changes, may have contributed to the tendency towards improved adherence to medication. However, whether such improved adherence and resultant reduction in total-cholesterol is associated with improved clinical outcome in patients with non-obstructive CAD identified by coronary computed tomography angiography remains to be settled in future studies.

• The article published: • Mols RE, Moller JJ, Sand NP et al. Visualization of Coronary Artery Calcification: Influence on

Risk Modification. Am J Med 2015;S0002-S9343Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.


















http://medicalresearch.com/heart-disease/calcium-score-and-coronary-ct-offer-additive-prognostic-value-in-cad/10477/






Epigenetic Profiling Of Tumor Metastases May Improve Therapeutic OptionsMedicalResearch.com Interview with:Eric Jonasch, MDAssociate Professor Department of Genitourinary Medical OncologyUniversity of Texas MD Anderson Cancer Center

Houston, TX


Dr. Jonasch: The blueprints of a cell are encoded in DNA strands (its genome) which are highly compressed in order to fit into a tiny cell. The reading (called the epigenome) of these DNA ‘blueprints’ determines whether that cell will develop into a kidney cell or another type of cell. However, in cancer, errors occur either in the blueprints themselves or the cell makes mistakes in reading the blueprints. Cancers of the kidney affect more than 61,000 patients annually and over 13,000 patients die annually, making it one of the top 10 leading causes of cancer deaths. Studies have revealed that mutations occur in genes that regulate how our DNA ‘blueprints’ are compacted in greater than >50% of kidney cancers, making these genes as a group the most frequently mutated. In our study, we identified that these errors that initially arise in an early kidney cancer lead to propagation of these same errors in metastases, a phenomenon in which the cancer has spread to another organ and is a major cause of death. Furthermore, we generated a detailed map of these epigenomic changes in patient-derived tumors.


http://medicalresearch.com/cancer-_-oncology/epigenetic-profiling-of-tumor-metastases-may-improve-therapeutic-options/15068/










http://medicalresearch.com/cancer-_-oncology/treatment-for-small-kidney-cancers-has-evolved/14663/







Houston, TX

• Medical Research: What should clinicians and patients take away from your report?• Dr. Jonasch: Standard treatments in kidney cancer rarely produce a durable response and

most studies focus on the primary tumor. Expanding the epigenomic profiling to patient derived tissue metastases may improve upon therapeutic selection and is currently being offered as part of a research protocol at Mayo Clinic.

• http://newsnetwork.mayoclinic.org/discussion/beating-advanced-cancers-new-epigenomic-block-for-cancer-progression/












http://newsnetwork.mayoclinic.org/discussion/beating-advanced-cancers-new-epigenomic-block-for-cancer-progression/

http://newsnetwork.mayoclinic.org/discussion/beating-advanced-cancers-new-epigenomic-block-for-cancer-progression/







Houston, TX


• Dr. Jonasch: Future research studies could use kidney cancer as a paradigm for identifying vulnerabilities in metastases, a major cause of mortality, and alter the course of other tumors with similar errors.

• Citation:• High-resolution profiling of histone h3 lysine 36 trimethylation in metastatic renal cell carcino

ma• T H Ho1,2,17, I Y Park3,17, H Zhao4, P Tong4, M D Champion2,5, H Yan2,6, F A Monzon7,18, A Hoang8

, P Tamboli9, A S Parker10, R W Joseph11, W Qiao12, K Dykema13, N M Tannir8, E P Castle14

, R Nunez-Nateras14, B T Teh13, J Wang4, C L Walker3, M-C Hung and E Jonasch• Oncogene advance online publication 15 June 2015; doi: 10.1038/onc.2015.221












http://www.nature.com/onc/journal/vaop/ncurrent/full/onc2015221a.html%23aff8
















































Telemedicine May Improve Access to Chronic Kidney DiseaseMedicalResearch.com Interview with:Judy K. Tan, MDDepartment of NephrologyMount Sinai HospitalNew York, New York

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Tan: Chronic kidney disease (CKD) is a common life-threatening medical condition,

affecting approximately 26 million adults in the U.S. In Veterans Integrated Service Network (VISN) 3, veterans with CKD who reside in the Hudson Valley Veterans Affair Medical Center (VAMC) catchment area travel to the James J. Peters VAMC, a tertiary care facility in the Bronx for their nephrology care. However, because of several barriers such as (1) distance between the two facilities (approximately 60 miles) and (2) patient complexity (medical and psychiatric illnesses), patients referred to the James J. Peters VAMC renal clinic from Hudson Valley VAMC often cancel or “no show”. This poor compliance increases the long-term risk of rapid progression of CKD and the development of complications associated with it. To address this issue, the division of nephrology at the James J. Peters VAMC, in line with the veterans affairs’ focus on “patient-centered care,” developed a collaborative out-patient telenephrology service as a means to deliver care. The out-patient telenephrology service employs specialized global medical video conferencing equipment with customized medical instruments (ie stethoscopes) and Computerized Patient Record System (CPRS) accessibility to direct real-time evaluation and management of our veterans with CKD while they stay in their local VAMC. As demonstrated by Rohatgi et al, this intervention significantly increased the compliance rate of patients and reduced the travel time, miles, and cost of patients utilizing the telenephrology service.1


http://medicalresearch.com/author-interviews/telemedicine-may-improve-access-to-chronic-kidney-disease/15072/














• The hypothesis of our study is that patients with CKD remotely managed through our telenephrology service would exhibit comparable clinical outcomes and visit compliance as conventional in-person renal care.

• Our provisional analysis of the subjects followed in the telenephrology service showed 117 unique patients were evaluated between 2011-2014. The mean age was 71±11years old with 98.3% males. 70% of the patients were white and 26.5% African American. The predominant etiology of chronic kidney disease was diabetic nephropathy (31.6%) followed by hypertensive nephrosclerosis (26.5%). In the 87 patients who had 1-year follow up data, estimated glomerular filtration (eGFR) was well preserved over the year (33 mL/min vs. 32 mL/min; p=0.04). Systolic blood pressure (BP) was reduced from 138±20 to 133±16 mm Hg (p=0.03), but no difference was observed in diastolic BP. Urine protein-creatinine ratio fell from 0.58 to 0.25 (p=0.07). 94% of patients had parathyroid levels checked and 70.9% were on ACE inhibitors during the first year of follow up.










http://medicalresearch.com/heart-disease/interarm-blood-pressure-variability-linked-to-greater-cardiovascular-risk-in-ckd/12580/







• • MedicalResearch: What should clinicians and patients take away from your report?• Dr. Tan: Clinicians should actively identify barriers to medical care and once recognized,

develop innovative systems or processes to surmount these barriers. Analysis of newly implemented systems should be tested to ascertain whether the new system of care is comparable or non-inferior to current standard of care.

















• Dr. Tan: Our next step is to identify a comparable traditional in-person care group to test the non-inferiority of telenephrology program in terms of clinical outcomes (ie. progression of CKD, proteinuria, blood pressure control, anemia, etc.) and compliance to visits.

• If we demonstrate that the telenephrology service is comparable to conventional care, we would like to expand the service to include patients with other kidney diseases such as patients on hemodialysis or peritoneal dialysis and renal transplant patients. Moreover, we would like to develop an in-patient telenephrology service with our Hudson Valley VAMC partners to cater to patients suffering from electrolytes disturbances or acute kidney injury not requiring renal replacement therapy. Further studies in these areas will be needed.

• References:• Rohatgi R, Gentille D, Cancel-Santiago R, et al. Telenephrology: A model of patient centered c

are. Abstract presented at the National Kidney Foundation Spring Clinical Meetings, 2014.










http://medicalresearch.com/diabetes/diabetic-kidney-disease-potential-new-therapeutic-target-discovered/4521/

https://www.gkaonlineacademy.com/abstracts/item/telenephrology-for-the-remote-management-of-chronic-kidney-disease-a-retrospective-cohort-study

https://www.gkaonlineacademy.com/abstracts/item/telenephrology-for-the-remote-management-of-chronic-kidney-disease-a-retrospective-cohort-study






Choosing Among Diets Did Not Improve Weight LossMedicalResearch.com Interview with:William S. Yancy, Jr., MD, MHSc Research AssociateCenter for Health Services Research in Primary Care Durham, NC 27705

Associate Professor Department of MedicineDuke University Medical Center


Dr. Yancy: A number of studies have compared different diet approaches for weight management with many of these finding that several different diets can result in significant weight loss. This has led many experts to advise that we should offer a choice among these diet options to our patients who are seeking to lose weight. We know that adherence is the best predictor of weight loss during dietary interventions, so the thought is that patients will adhere better to a diet that they prefer, resulting in more successful weight loss. In addition, allowing choice enhances patient autonomy, which is patient-centered and has been shown to increase treatment adherence. However, the previous studies of various diet approaches did not let people choose a diet, so we don’t actually know if letting them choose will lead to better weight loss. Our study specifically tested this assumption. We randomized participants to a condition where they were allowed to choose between 2 common weight loss diets or to a condition where they were randomly assigned to one of the diets. The 2 diets we used were a low-carbohydrate diet without calorie restriction and a low-fat diet combined with calorie restriction. Participants received counseling about the diets, and about behavioral strategies and physical activity, in 19 group sessions over the span of 12 months. They also received 6 phone calls with motivational counseling in the latter half of the program.


http://medicalresearch.com/weight-research/choosing-among-diets-did-not-improve-weight-loss/15074/















http://medicalresearch.com/weight-research/weight-loss-influence-of-genetics-on-success-of-high-fat-vs-low-fat-diets/1720/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Yancy: The surprising result was that the opportunity to choose among diets did not help

weight loss. Nor did it improve attendance at counseling sessions, self-reported adherence to diet or even weight-related quality of life. An interesting finding was that, among patients who were able to choose a diet, more chose the low-carbohydrate diet. Because the patient sample was composed of veterans, about 70% were men, who might prefer foods that are emphasized with a low-carbohydrate diet. Another interesting finding was that only 5 patients who got to choose their diet switched to the other diet when given the opportunity after 12 weeks on their first choice diet. We chose 12 weeks for this potential change to give patients ample opportunity to learn their first choice diet and minimize switching when the original diet was actually a good fit. Nevertheless, we were surprised to see only 5 patients took the opportunity to switch even though there were more who were struggling at that point. The results are important because it may be that some people will choose a diet based on their food preferences but their preference for those foods might make it difficult for them to scale down on the amount that they eat.

















http://medicalresearch.com/weight-research/low_carb_dieters_lost_more_weight_compared_to_low_fat_diet/7310/









• Dr. Yancy: Future research might consider matching the most effective diet to an individual using other patient characteristics such as metabolic profile or even genetic profile.

• Citation:• Effect of Allowing Choice of Diet on Weight Loss: A Randomized Trial • William S. Yancy Jr., MD; Stephanie B. Mayer, MD; Cynthia J. Coffman, PhD; Valerie A. Smith,

DrPH; Ronette L. Kolotkin, PhD; Paula J. Geiselman, PhD; Megan A. McVay, PhD; Eugene Z. Oddone, MD; and Corrine I. Voils, PhD

• Ann Intern Med. 2015;162(12):805-814. doi:10.7326/M14-2358

















http://annals.org/article.aspx?articleid=2322797










Association Between Poverty and Chronic Kidney Disease May Be Getting Stronger Over TimeMedicalResearch.com Interview with:Holly Kramer, MD, MPHDepartment of Public Health Sciences Loyola University ChicagoHealth Sciences Campus

Maywood, IL

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Kramer: The U.S. dialysis dependent population continues to grow with 636,905

prevalent cases of end-stage renal disease (ESRD) in the U.S. as of December 31, 2012, , an increase of 3.7% since 2011. Poverty is a well described risk factor for ESRD because poverty impacts access to care and nutritious foods. The definitions for poverty in the U.S. have not changed over the past several decades despite marked changes in social structure. For example, social integration in the U.S. society currently requires a cell phone, computer and internet access and access to transportation. Healthy foods also cost more now relative to unhealthy foods compared to past decades. Thus, the link between poverty and any chronic disease or health outcome is likely dynamic due to the evolving financial burden for living in a rapidly changing industrialized society. Our study defined poverty as living in a zip code defined area with > 20% of the residents living below the federal poverty line. We show that the prevalence of adults receiving dialysis who are living in poverty has increased over time. We also show that the association between poverty and ESRD may be getting stronger over time.


http://medicalresearch.com/author-interviews/association-between-poverty-and-chronic-kidney-disease-may-be-getting-stronger-over-time/15078/
















Maywood, IL

• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Kramer: Poverty remains highly prevalent among U.S. adults receiving dialysis and it now

affects approximately 1 in 3 dialysis patients. Despite the rapidly changing society with cell phones, computer, and social media, the U.S. still uses the same basic definition for poverty that has been used for the past 50 years. We may be underestimating the negative impact of poverty on health outcomes such as kidney disease.


















Maywood, IL


• Dr. Kramer: Future studies should examine time trends in the association between individual measures of poverty or utilize census tracts for defining living in a poverty area.

• Garrity, B. H., Kramer, H., Vellanki, K., Leehey, D., Brown, J. and Shoham, D. A. (2015), Time trends in the association of ESRD incidence with area-level poverty in the US population. Hemodialysis International. doi: 10.1111/hdi.12325












http://onlinelibrary.wiley.com/doi/10.1111/hdi.12325/abstract








Women Who Don’t Get HPV Vaccine May Also Not Get PAP TestsMedicalResearch.com Interview with:Ann Goding SauerEpidemiologist, American Cancer Society, Inc.Atlanta, GA 30303

• MedicalResearch: What is the background for this study? • Response: Among US women, a positive association between Pap test uptake and HPV

vaccination has been shown, though potential variation of the association by race/ethnicity had not been explored previously. The prevalence of some HPV types varies across different racial/ethnic groups so it is important to explore the association between Pap test uptake and HPV vaccination in detail.

• MedicalResearch: What are the main findings?• Response: Pap test uptake was significantly lower among those who had not initiated HPV

vaccination (81.0%) compared to women who had initiated vaccination (90.5%) (adjusted prevalence ratio = 0.93, 95% CI: 0.90–0.96). This result was seen across most of the sociodemographic factors examined, though not statistically significant for non-Hispanic blacks, Hispanics, those with lower levels of education, or those with higher levels of income.


http://medicalresearch.com/cancer-_-oncology/women-who-dont-get-hpv-vaccine-may-also-not-get-pap-tests/15087/









http://medicalresearch.com/general-medicine/pap-tests-older-women-without-cervix-still-getting/2891/






Women Who Don’t Get HPV Vaccine May Also Not Get PAP TestsMedicalResearch.com Interview with:Ann Goding SauerEpidemiologist, American Cancer Society, Inc.Atlanta, GA 30303

• MedicalResearch: What should clinicians and patients take away from your report?• Response: Among young women, uptake of both recommended cervical cancer screening

and HPV vaccination should to be increased.• MedicalResearch: What recommendations do you have for future research as a result of

this study?• Response: Data are not yet available to assess whether women who received HPV vaccination

as young girls will have similar cervical cancer screening behavior when they reach the recommended age; future research should assess Pap test uptake among those females who were adolescents when routine HPV vaccination was first recommended.

• Citation:• Differential uptake of recent Papanicolaou testing by HPV vaccination status among young wo

men in the United States, 2008–2013• Differential uptake of recent Papanicolaou testing by HPV vaccination status among young

women in the United States, 2008–2013• Sauer, Ann Goding et al.• Cancer Epidemiology

DOI: http://dx.doi.org/10.1016/j.canep.2015.05.002











http://medicalresearch.com/author-interviews/two-dose-schedule-of-hpv-vaccination-against-genital-warts-in-girls/14138/

http://medicalresearch.com/author-interviews/strong-evidence-hpv-vaccination-highly-effective-outside-trial-settings/12380/

http://www.cancerepidemiology.net/article/S1877-7821(15)00101-0/abstract












Acid-Suppression Medications Linked To Increased Pediatric C. diff InfectionsMedicalResearch.com Interview with:Daniel E. Freedberg, MD, MSAssistant Professor of MedicineDivision of Digestive and Liver DiseasesColumbia University, New York


Dr. Freedberg: Acid suppression medications are increasingly prescribed to relatively healthy children without clear indications, but the side effects of these medications are uncertain.

•Medical Research: What are the main findings?

Dr. Freedberg: Acid suppression with (proton pump inhibitors ) PPIs or (histamine-2 receptor antagonists) H2RAs was associated with increased risk for C. diff infection in both infants and older children.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Freedberg: Increased risk for C. diff should be factored into the decision to use acid

suppression medications in children. Our findings imply that acid suppression medications alter the bacterial composition of the lower gastrointestinal tract.


http://medicalresearch.com/infections/c-difficile/acid-suppression-medications-linked-to-increased-pediatric-c-diff-infections/15093/










http://medicalresearch.com/infections/c-difficile/proton-pump-inhibitors-may-increase-risk-clostridium-difficile-infection/9238/

http://medicalresearch.com/infections/c-difficile/proton-pump-inhibitors-may-increase-risk-clostridium-difficile-infection/9238/






Acid-Suppression Medications Linked To Increased Pediatric C. diff InfectionsMedicalResearch.com Interview with:Daniel E. Freedberg, MD, MSAssistant Professor of MedicineDivision of Digestive and Liver DiseasesColumbia University, New York


• Dr. Freedberg: Future studies should investigate the specific effects that acid suppression medications have on the gastrointestinal microbiome of children.

• Citation:• E. Freedberg, E. S. Lamouse-Smith, J. R. Lightdale, Z. Jin, Y.-X. Yang, J. A. Abrams. Use of Acid

Suppression Medication is Associated with Risk for C. difficile Infection in Infants and Children: A Population-Based Study. Clinical Infectious Diseases, 2015; DOI: 10.1093/cid/civ432












http://dx.doi.org/10.1093/cid/civ432






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