medicalresearch.com: medical research exclusive interviews may 12 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]

May 13 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Emergency Room Coding Of Heart Failure Diagnosis ValidatedMedicalResearch.com Interview with:Justin A. Ezekowitz, MBBCh MScAssociate Professor, University of AlbertaCo-Director, Canadian VIGOUR Centre Director, Heart Function ClinicCardiologist,

Mazankowski Alberta Heart Institute

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

Dr. Ezekowitz: Heart Failure is a prevalent health issue that carries high morbidity and mortality. Most epidemiologic research derives information from hospital discharge abstracts, but emergency department visits are another source of information. Many have assumed this code is accurate in the emergency department but uncertainty remains.

• In our study, we assessed patients at their presentation to Emergency Department, which is usually the first medical contact for acutely ill patients with heart failure.

• The objective of our study was to compare administrative codes for acute heart failure (I50.x) in the emergency department against a gold standard of clinician adjudication.

Read 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/emergency-room-coding-of-heart-failure-diagnosis-validated/13910/




















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



• Medical Research: What are the main findings?

Dr. Ezekowitz: Emergency department administrative data is highly correlated with a clinician adjudicated diagnosis. The positive predictive value of acute heart failure as the main diagnosis was 93.3% when compared to clinician adjudication, supported by standardized scoring systems and elevated BNP.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Ezekowitz: The code for acute heart failure in emergency department administrative data

has a high Positive Predictive Value and may be used in outcomes research.


















http://medicalresearch.com/heart-disease/which_bnp_better_predicts_cv_events_in_stable_cad/6830/








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

• Dr. Ezekowitz: Studies using administrative codes should exercise caution when evaluating codes related to the acute disease, especially when a diagnosis may evolve, such as in the emergency department. Further validation of other disease states is required, and researchers should use validated, disease-specific scoring systems supported by biomarker or imaging where possible.

• Citation:• • Frolova N, Bakal JA, McAlister FA, et al. Assessing the Use of International Classification of Dis

eases-10th Revision Codes From the Emergency Department for the Identification of Acute Heart Failure. JCHF. 2015;3(5):386-391. doi:10.1016/j.jchf.2014.11.010.

• • MedicalResearch.com Interview with: Justin A. Ezekowitz, MBBCh MSc (2015). Emergency

Room Coding Of Heart Failure Diagnosis Validated


















http://heartfailure.onlinejacc.org/article.aspx?articleID=2289001










Bystander CPR Allows Many Cardiac Arrest Patients To Return To WorkMedicalResearch.com Interview with:Kristian Kragholm, MD, PhD-studentCardiovascular Research Center, Department of Anesthesiology,Aalborg University Hospital

Medical Research: What is the background for this study?

Dr. Kragholm: During 2001-2010 in Denmark, survival to 30 days and 1 year more than doubled. Whether this substantial improvement in survival was accompanied by good functional recovery in survivors was not clear. Discharge neurological status or post-discharge follow-up assessments were not systematically recorded in Denmark but through nationwide registries employment outcomes were available. Therefore, we examined return to work as a marker of favorable neurological outcome in 30-day survivors of out-of-hospital cardiac arrest in a nationwide study in Denmark between 2001-2011.


http://medicalresearch.com/heart-disease/13897bystander-cpr-allows-many-cardiac-arrest-patients-to-return-to-work/13897/



















Dr. Kragholm: More than 75% of all 30-day out-of-hospital survivors in Denmark during 2001-2011 who were employed prior to arrest returned to work

• Not only did the majority of these survivors return to work, survivors also sustained work without any long-term sick absences for a median time of 3 years and maintained the same income after arrest as before arrest.

• Finally, relative to survivors who did not receive bystander cardiopulmonary resuscitation (CPR), chances for return to work were increased by approximately 40% if bystanders had provided CPR in multivariable adjusted modeling.














http://medicalresearch.com/heart-disease/bystander-cpr-dispatcher-assistance-improves-outcomes/5034/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Kragholm: Contrary to a belief that survival and cognitive outcomes following out-of-

hospital cardiac arrest are poor, we show that the great majority of survivors of working age who were employed prior to arrest recovered not only to return to work but also to maintain employed to earn the same salary as prior to arrest.

• Importantly, more survivors were capable of returning to work if bystanders had provided CPR. In Denmark, CPR courses became mandatory in elementary schools in 2005 and when acquiring a driver’s license in 2006 as well as dispatcher-assisted CPR was introduced at emergency dispatch centers. Healthcare providers and policy makers should set the scene for offering community-based CPR courses as well as dispatcher-assisted guidance of bystanders to perform CPR should be implemented.














http://medicalresearch.com/heart-disease/telephone-cpr-may-improve-hospital-cardiac-arrest-survival/9170/








• Dr. Kragholm: It would be interesting to see results on return to work rates from other sites and countries. Although our findings are very uplifting, return to work is only meaningful to study in survivors of working age. Therefore, together with my research team, we are currently examining other long-term function parameters that can be assessed in all survivors irrespective of their age.Citation:

• Return to work in out-of-hospital cardiac arrest survivors : A nationwide register-based follow-up study. / Sørensen, Kristian Dahl Kragholm ; Wissenberg, M.; Fonager, Kirsten; Jensen, Svend Eggert; Lippert, F. K.; Christensen, E. F. ; Hansen, P. A. ; Lang-Jensen, T.; Henriksen, O. M. ; Torp-Pedersen, Christian; Rasmussen, Bodil Steen














http://www.ncbi.nlm.nih.gov/pubmed/25941005










Connecting Chronically Ill Patients To Safety Net Clinics Reduced ER VisitsMedicalResearch.com Interview with:Karoline Mortensen, Ph.D. Assistant ProfessorDepartment of Health Services Administration University of Maryland

College Park, MD


Dr. Mortensen: For twenty years, use of hospital emergency departments has been on the rise in the United States, particularly among low-income patients who face barriers to accessing health care outside of hospitals including not having an identifiable primary health care provider. Almost half of emergency room visits are considered “avoidable.” The Emergency Department-Primary Care Connect Initiative of the Primary Care Coalition, which ran from 2009 through 2011, linked low-income uninsured and Medicaid patients to safety-net health clinics.


http://medicalresearch.com/author-interviews/connecting-chronically-ill-patients-to-safety-net-clinics-reduced-er-visits/13952/


















College Park, MD

Medical Research: What are the main findings?

Dr. Mortensen: “Our study found that uninsured patients with chronic health issues – such as those suffering from hypertension, diabetes, asthma, COPD, congestive heart failure, depression or anxiety – relied less on the emergency department after they were linked to a local health clinic for ongoing care,” says Dr. Karoline Mortensen, assistant professor of health services administration at the University of Maryland School of Public Health and senior researcher. “Connecting patients to primary care and expanding the availability of these safety-net clinics could reduce emergency department visits and provide better continuity of care for vulnerable populations.”














http://medicalresearch.com/author-interviews/early-primary-care-follow-may-reduce-readmissions-high-risk-surgery-patients/6054/







College Park, MD

• Medical Research: What should clinicians and patients take away from your report?• Dr. Mortensen: The project provides promise not only for hospitals in Maryland but

throughout the nation to improve health care experiences and outcomes for their patients. Shared learning systems were an integral component of the project so participants were learning from each other and sharing best practices throughout the project and that learning has now been documented and can be replicated in other communities.

• “We created a learning system that permits us to sustain improved communication between patients and their providers, between hospital discharge planners and community based clinics, and across five hospitals operating in Montgomery County” says Barbara H. Eldridge, Manager of Quality Improvement at the Primary Care Coalition.

• The initiative has proven successful in Montgomery County, Maryland and is being replicated in communities in other parts of the country.

• Citation:• Linking Uninsured Patients Treated In The Emergency Department To Primary Care Shows So

me Promise In Maryland • Theresa Y. Kim, Karoline Mortensen, and Barbara Eldridge• Health Aff May 2015 34:5796-804; doi:10.1377/hlthaff.2014.1102














http://content.healthaffairs.org/citmgr?gca=healthaff;34/5/796









Genes Identified That May Be New Drug Targets In HER2 Breast CancerMedicalResearch.com Interview with:Ahmad M. Khalil, PhDAssistant professor, Department of Genetics and Genome Sciences

Case Western Reserve University School of Medicine

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Khalil: This study aimed to identify other genes that work synergistically with the

oncogene HER2 in HER2positive (HER+) breast cancer. The gene HER2 is amplified in those patients, which results in excess activities that promote uncontrolled cell growth. There are drugs that target HER2 and diminish its activity. However, these drugs can work initially, but patients relapse; or sometimes, the drugs don’t work at all in some patients.

• Thus, by identifying other genes that work synergistically with the HER2 gene, we now have more genes to target by various drugs or compounds to destroy the tumor. The challenge was how to identify the key genes that work synergistically with HER2, especially in human subjects. To that end, we used clinical samples from a clinical trial of a drug that is known to inhibit HER2 activity to identify those genes. To further refine our list, we used cell culture models of the disease to also inhibit HER2. By combining those data sets, we identified 44 protein-coding genes.

• Next, we wanted to make sure that those genes stand a third independent filter. For that part, we interrogated those 44 genes in HER2+ tumors vs matched normal tissues from The Cancer Genome Atlas database — a collection of hundreds of tumors and normal tissues. Of the 44 genes, 35 genes passed this third filter. By examining the known functions of those genes, we can deduce that those genes work cooperatively with HER2 to promote carcinogenesis.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/genes-identified-that-may-be-new-drug-targets-in-her2-breast-cancer/13996/







http://medicalresearch.com/cancer-_-oncology/breast-cancer/improved-survival-combination-therapy-her2-positive-metastatic-breast-cancer/11713/








• There are currently known drugs that target some of those genes. We will use these drugs in combination with a drug that target HER2 to determine if the combination works better at destroying the tumor entirely.

• Lastly, we found that a special type of genes that we previously discovered, called lincRNAs, could also affect the oncogenic activity of HER2. These lincRNAs can also be targeted with HER2 to eliminate the tumor.
















• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Khalil: We now have a small set of genes that can be targeted for therapeutics in

HER2+ breast cancer. We still need to do those studies to identify potential drugs that can be effective and eventually safe for clinical trials, but our study has now narrowed down the number of genes to study, which is a major step.









http://medicalresearch.com/cancer-_-oncology/breast-cancer/her2-positive-breast-cancer-adjuvant-chemotherapy/2779/








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

• Dr. Khalil: It is critical to look at genes and pathways directly in human patients, in addition to cell culture models and/or animal models. In many cases, things that are discovered in these other systems do not work when tested in human patients. This is a very unique aspect of our study. We identified those genes by examining human tumors before and during inhibition of the HER2 gene in vivo.

• Citation:• Integrative transcriptome-wide analyses reveal critical HER2-regulated mRNAs and lincRNAs i

n HER2+ breast cancer• Callie R. Merry,Sarah McMahon,Cheryl L. Thompson,Kristy L. S. Miskimen,Lyndsay N. Harris, A

hmad M. Khalil

Breast Cancer Research and TreatmentApril 2015, Volume 150, Issue 2, pp 321-334









http://link.springer.com/article/10.1007/s10549-015-3327-1











Decreasing Financial Burden Of IVF May Encourage Single Embryo Transfers, Reduce Multiple BirthsMedicalResearch.com Interview with:Dmitry Kissin, MDHealth scientistCDC Division of Reproductive Health


Dr. Kissin: Due to the frequent transfer of more than one embryo during assisted reproductive technology (ART) treatments, such as in vitro fertilization (IVF), many ART-conceived children are born as multiples (twins, triplets and higher order). Multiple births, even twins, carry increased risk for both mothers and children. In the U.S., the practice guidelines published by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) provide recommendations on how many embryos to transfer in order to balance safety with the effectiveness of assisted reproductive technology. In an effort to reduce multiple births and associated complications, it is important to evaluate embryo transfer practices that contribute to these outcomes.


http://medicalresearch.com/author-interviews/decreasing-financial-burden-of-ivf-may-encourage-single-embryo-transfers-reduce-multiple-births/14000/















Medical Research: What are the main findings?

Dr. Kissin: Using data from the CDC’s National ART Surveillance System (NASS), we found that the majority of ART-related multiple births in the U.S. resulted from assisted reproductive technology cycles practiced in accordance with ASRM/SART guidelines and involved the transfer of two embryos. Almost half of ART-related multiple births resulted from transferring two fresh blastocysts (embryos cultured for 5/6 days) to favorable- or average-prognosis patients less than 35 years and donor-egg recipients, or two frozen/thawed embryos to patients less than 35 years.

















• Medical Research: What should clinicians and patients take away from your report?• Dr. Kissin: Clinicians practicing IVF know that the decision on the number of embryos to

transfer is always a balance between trying to maximize the chance of pregnancy and minimize the chance of multiple birth. The substantial reduction of assisted reproductive technology-related multiple (both twin and triplet or higher order) births in the U.S. could be achieved by single embryo transfers among young patients or recipients of donor eggs.


















• Dr. Kissin: One of the major barriers to widespread implementation of single embryo transfer in the U.S. is the high out-of-pocket cost of assisted reproductive technology, often not covered by health insurance. Some countries have been successful in achieving marked reductions in multiple births when they removed financial pressures for infertility patients by covering assisted reproductive technology in exchange for mandatory single embryo transfer in the best prognosis groups. Future research on whether such approach will work in the United States is needed and requires coordinated efforts by multiple stakeholders, as outlined in CDC’s “National Public Health Action Plan for the Detection, Prevention and Management of Infertility”.

• Citation:• Fertil Steril. 2015 Apr;103(4):954-61. doi: 10.1016/j.fertnstert.2014.12.127. Epub 2015 Jan 27.• Embryo transfer practices and multiple births resulting from assisted reproductive technology

: an opportunity for prevention.• Kissin DM1, Kulkarni AD2, Mneimneh A2, Warner L2, Boulet SL2, Crawford S2, Jamieson DJ2

; National ART Surveillance System (NASS) group


































Timely Pertussis Vaccination Important For Preventing Infant DeathsMedicalResearch.com Interview with: Tejpratap S.P. Tiwari, MDMeningitis and Bacterial Vaccine Preventable Diseases BranchDivision of Bacterial Diseases National

Center for Immunization and Respiratory DiseasesDivision of Global HIV/AIDS, Center for Global Health Centers for Disease Control and Prevention,Atlanta, Georgia

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

Dr. Tiwari: Infants younger than one year old in the United States are at highest risk for severe outcomes from pertussis and death. The first childhood pertussis vaccine dose is recommended at 2 months old, with additional doses in the first year of life at 4 and 6 months. Studies have established that pertussis vaccines can protect against pertussis disease, complications, and hospitalization in infants when 1 to 3 doses are administered by six months old. This study’s findings suggest that the first pertussis vaccine dose and appropriate antibiotic treatment protect infants against death, hospitalization, and pneumonia. Improved on-time infant vaccination (at 2, 4, and 6 months) could potentially prevent up to 1 out of every 4 infant pertussis deaths.


http://medicalresearch.com/pediatrics/timely-pertussis-vaccination-important-for-preventing-infant-deaths/14007/


















http://medicalresearch.com/infections/whooping-cough-can-still-cause-significant-cough-even-fully-vaccinated-children/6042/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Tiwari: Clinicians should ensure timeliness of the first pertussis vaccine dose at 2 months

to help prevent infant pertussis death. Additional efforts to protect infants who are too young for vaccination also need to be prioritized. This can be done by reinforcing the recent Advisory Committee on Immunization Practices recommendation for use of the pertussis vaccine called Tdap during the third trimester of each pregnancy, so that mothers may pass on antibodies to their babies to help protect them until they are old enough for their own immunization. For more information about maternal Tdap vaccination, visit www.cdc.gov/pertussis/pregnant.




















http://medicalresearch.com/pediatrics/private_school_kids_less_likely_to_receive_all_vaccinations/6770/

http://medicalresearch.com/author-interviews/tdap_vaccine_during_pregnancy_safety_and_efficacy/5128/

http://www.cdc.gov/pertussis/pregnant









• Dr. Tiwari: In this study, 24% of nonfatal infant cases and 64% of infant deaths occurred among infants who were too young to receive the first childhood pertussis vaccine dose. This highlights the importance of protect these infants through vaccination recommendations for pregnant women in the United States as well as the need to assess how to best to protect those most vulnerable to pertussis complications and death.

• Citation:• First Pertussis Vaccine Dose and Prevention of Infant Mortality • Tejpratap S.P. Tiwari, Andrew L. Baughman, and Thomas A. Clark• Pediatrics peds.2014-2291; published ahead of print May 4, 2015, doi:10.1542/peds.2014-229




















http://pediatrics.aappublications.org/citmgr?gca=pediatrics;peds.2014-2291v1








Deficient Calcium Channels Weaken Immune Response To Chronic InfectionsMedicalResearch.com InterviewDr. Ludovic Desvignes PhD.Assistant Professor, Departments of Medicine and PathologyNYU Langone Medical Center

• MedicalResearch: What is the background for this study? • Dr. Desvignes: This study is the result of a collaboration at NYU Langone Medical Center,

between the laboratories of Dr. Stefan Feske and Dr. Joel Ernst, my mentor. Dr. Feske and colleagues had developed a mouse model of rare, inherited mutations he had identified in infants. These mutations occur in the genes for STIM1 and ORAI1, which are crucial for calcium flux in cells of the immune system. The young patients affected by these mutations suffer from severe, recurrent and chronic infections that often cause death before their first birthday. In particular, some of these patients cannot control infection with BCG, which is a normally innocuous strain of mycobacteria administered to protect against tuberculosis (TB). TB is a chronic infection and one of the leading causes of infection-related death worldwide. Going into this study, Dr. Feske and colleagues knew that without functional calcium channels, immune cells do not function properly. However, they did not fully understand how these channels contribute to immune responses to infectious pathogens in a living organism and in particular, for pathogens that cause chronic infections such as TB. This is why Dr. Ernst and I collaborated with Dr. Feske and provided him with our clinical and research expertise in TB.


http://medicalresearch.com/infections/deficient-calcium-channels-weaken-immune-response-to-chronic-infections/14011/














http://medicalresearch.com/infections/cancer-drug-may-overcome-physiological-resistance-to-tuberculosis-medications/11077/







• MedicalResearch: What are the main findings?• Dr. Desvignes: Dr. Feske’s mice are genetically engineered to lack STIM1 in a certain type of

immune cells, known as T cells or T lymphocytes. We infected these mice with Mycobacterium tuberculosis, the bacterium causing TB. Mycobacterium tuberculosis causes chronic infection by manipulating the immune system even in healthy people. The first very surprising result of our study was that mice lacking calcium flux in T cells handled acute TB fairly well. Only during the chronic phase of infection did they become unable to control mycobacterial growth and developed a strong inflammation in their lungs, which was due to an infiltration by different types of immune cells, including T cells. We discovered that the accumulation of STIM1-deficient T cells in the lungs resulted from the cells’ inability to die, which is a normal mechanism to limit an immune response and prevent excessive inflammation.






















• Another immune control mechanism that failed in the absence of STIM1 is mediated by a subset of T cells called induced regulatory T cells, or iTreg cells. These cells are essential to prevent normal immune responses from going “overboard” by suppressing the functions of other immune cells, including T cells. We found that calcium signals are required for the development of iTreg cells and that their numbers were strongly reduced in the lungs of infected STIM1-deficient mice. We therefore think that the lack of iTreg cells in the absence of STIM1 contributes to the severe lung inflammation in chronic TB.

• The third finding that really surprised us was that T cells accumulating in the lungs of STIM1-deficient mice produced large amounts of a protein called interferon gamma. While interferon gamma is required to control Mycobacterium tuberculosis, it is also a very potent promoter of inflammation and too much of it can lead to tissue damage. Dr. Feske and colleagues had previously observed that calcium fluxes promote the production of interferon gamma in T cells cultured in vitro and we expected the STIM1-deficient T cells to be defective in the production of that protein. During chronic TB, however, calcium signaling turned out to be not only dispensable for the production of interferon gamma by T cells but it was actually required to limit its production and thus, to control inflammation.
















http://medicalresearch.com/cancer-_-oncology/signal-pathway-allows-lung-cancer-tumor-cells-to-resist-chemotherapy/13305/







• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Desvignes: Our research is primarily aimed at understanding the fundamental

mechanisms of how calcium channels regulate the immune response to chronic inflammation and infections, and we think that our findings may help other scientists to develop new drugs and vaccines that improve immune responses to infections. Of course, we hope that this study helps clinicians understand, and maybe treat, the infectious diseases observed in those rare patients with mutations in STIM1 and ORAI1.

• From a drug discovery perspective, it is important to note that several pharmaceutical companies are currently exploring applications for calcium channel blockers, for instance in the treatment of autoimmune or inflammatory diseases, like Multiple Sclerosis, psoriasis or chronic obstructive pulmonary disease (COPD). Inhibition of calcium channels is an effective strategy to suppress certain forms of inflammation. Based on our results, inhibition of calcium channels may however suppress important immune regulatory mechanisms that are required to prevent an overwhelming immune response. During chronic or latent infections such as TB, hepatitis or with herpes viruses, constant triggering of the immune system, without appropriate shutdown mechanisms when calcium channels are inhibited, could result in harmful inflammation.
















http://medicalresearch.com/author-interviews/psoriasis-effective-two-year-response-to-il-17a-antagonist-cosentyx/13060/








• Dr. Desvignes: There are pressing and exciting avenues that should be explored as a direct follow up to our study. For example, we have experimental evidence that inhibition of calcium channels, by genetic deletion or pharmacological inhibition of STIM1 or ORAI1 proteins, prevents the development of T cell-mediated autoimmune diseases such as Multiple Sclerosis and Crohn’s disease in mice. To assess the safety of calcium channel inhibition in patients with these diseases, it will be necessary to test if the degree of inhibition required for treatment increases the risk of reactivating latent or chronic infections such as TB.






















• TB remains a global health issue and we are in dire need of a new, more efficacious vaccine. In this respect, our study serves as a cautionary tale and provides ideas to develop better vaccines. For example, a vaccine preparation that would induce large amounts of interferon gamma may seem like a good idea to control Mycobacterium tuberculosis but it could result in uncontrolled, harmful inflammation, and even fuel the infection. Now that we understand better some of the players and the mechanisms of the immune response to TB, we can target specific elements of the immune response that will help fight the infection while limiting its deleterious effects.

• Citation:• STIM1 controls T cell–mediated immune regulation and inflammation in chronic infection• Ludovic Desvignes, Carl Weidinger, Patrick Shaw, Martin Vaeth, Theo Ribierre, Menghan Liu, T

awania Fergus, Lina Kozhaya, Lauren McVoy, Derya Unutmaz, Joel D. Ernst, Stefan Feske • Published May 4, 2015

Citation Information: J Clin Invest. 2015. doi:10.1172/JCI80273.
















http://medicalresearch.com/infections/tuberculosis_moxifloxacin_likely_to_be_cornerstone_of_new_treatment_regimen/7408/

http://www.jci.org/articles/view/80273












Hospitals Vary In Treatment Of 22-24 Week Preterm InfantsMedicalResearch.com Interview with:Mr. Matthew A. Rysavy, B.S and Edward Bell, MDDepartment of Pediatrics, University of IowaIowa City, IA

• Medical Research: What is the background for this study? What are the main findings?• Response: We were interested in understanding reasons for differences in outcomes among

extremely preterm infants among hospitals. This has been shown in many studies. We found that differences among hospitals in whether treatment was initiated for infants born at very early gestations (22, 23, 24 weeks’ gestation) accounted for a lot of the variation in hospital-level outcomes at these gestational ages


http://medicalresearch.com/pediatrics/hospitals-vary-in-treatment-of-22-24-week-preterm-infants/14016/















• Medical Research: What should clinicians and patients take away from your report?• Response: In the editorial accompanying our study, Professor Marlow writes: “Information on

survival, morbidity, and policies regarding active intervention should be available to assist parents in making an informed choice about transfer to a specialist hospital, if feasible, and the level of intervention provided after birth.” Ultimately, the care of individual infants must be decided by the parents and doctors based on the best available information. We hope that, by unpacking some of the differences in hospital outcomes, our study sheds some light on what this information is and how to better obtain it.


















• Response: There are still many important questions about differences in hospital outcomes that need further study. For example, in our study, among hospitals that initiated treatment for 100% of infants born at 24 weeks of gestation, rates of risk-adjusted survival still varied from 42 to 70%. It seems important to understand other reasons for the variation in outcomes among hospitals.

• Also, there are important questions about how to better make decisions about treatment. The prognosis of extremely preterm infants is often fairly uncertain, and physicians and families have to make decisions based on very limited information. Gestational age alone is not the best indicator of prognosis. Some infants born at 22 weeks survive and do well and many others do not; likewise, some but not all, infants born at 26 weeks or later do well. This is why it is important not to use gestational age as the sole criterion for making decisions about treatment. We need to understand better issues related to the prognosis of extremely preterm infants to improve their care.

• Citation:• Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants• Matthew A. Rysavy, B.S., Lei Li, Ph.D., Edward F. Bell, M.D., Abhik Das, Ph.D., Susan R. Hintz, M.D.

, Barbara J. Stoll, M.D., Betty R. Vohr, M.D., Waldemar A. Carlo, M.D., Seetha Shankaran, M.D., Michele C. Walsh, M.D., Jon E. Tyson, M.D., M.P.H., C. Michael Cotten, M.D., M.H.S., P. Brian Smith, M.D., M.P.H., M.H.S., Jeffrey C. Murray, M.D., Tarah T. Colaizy, M.D., M.P.H., Jane E. Brumbaugh, M.D., and Rosemary D. Higgins, M.D. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

• N Engl J Med 2015; 372:1801-1811 May 7, 2015• DOI: 10.1056/NEJMoa1410689











http://www.nejm.org/doi/full/10.1056/NEJMoa1410689














Orthopedic Patients and Their Families At Risk For Opioid AbuseMedicalResearch.com Interview with:Hassan R. Mir, MD, MBA andDr. Brent J. Morris, M.D.

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

Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world’s population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large.

• Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain.

• Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases.


http://medicalresearch.com/pain-research/orthopedic-patients-and-their-families-at-risk-for-opioid-abuse/14019/








http://medicalresearch.com/author-interviews/abuse-deterrent-opioids-inadvertently-led-to-increased-heroin-use/12645/







• Medical Research: What should patients and clinicians take away from your report?• Dr. Mir: • 3 tips for patients:• Ask your doctor about ways to control your pain with minimal use of opioids.• Do not seek opioids from multiple physicians as “doctor shopping” for pain medication is

dangerous.• Seek help if you or a family member are becoming dependent on opioids.• 3 tips for clinicians:

• Counsel patients and establish reasonable expectations for pain as a part of treatment plan discussions and follow-up visits.

• Establish a standard pain protocol for specific surgical and nonsurgical treatment plans with an opioid taper.

• Be aware of available objective risk-assessment tools and state prescription drug monitoring programs to use as adjuncts to clinical experience and judgment when dealing with challenging patient scenarios.










http://medicalresearch.com/addiction/orthopedic-trauma-patients-doctor_shopping_and_increased_narcotics_use/4118/








• Dr. Mir: There are several areas of potential research with regard to opioid medications and musculoskeletal pain, many of which are already underway looking at the potential detrimental effects of opioid medications on clinical outcomes. Other areas for potential research include alternative multi-modal pain control regimens, clinician education, patient education, electronic health records, clinical practice guidelines, and prescription drug monitoring programs all as means to decrease the widespread use of opioid medications for musculoskeletal pain in the United States.

• Citation:• J. Morris, H. R. Mir. The Opioid Epidemic: Impact on Orthopaedic Surgery. Journal of the

American Academy of Orthopaedic Surgeons, 2015; 23 (5): 267 DOI: 10.5435/JAAOS-D-14-00163










http://medicalresearch.com/author-interviews/us-opioid-death-rate-flattens-heroin-deaths-increase/11098/

http://dx.doi.org/10.5435/JAAOS-D-14-00163






Comprehensive Stroke Centers Save Lives In Patients With Hemorrhagic StrokeMedicalResearch.com Interview with:James S McKinney, MD, FAHAAssistant Professor of Neurology Rutgers-Robert Wood Johnson Medical School

Medical Director, RWJUH Comprehensive Stroke Center New Brunswick, NJ 08901


Dr. McKinney: The current study evaluated outcomes of patients admitted to New Jersey hospitals with hemorrhagic stroke, including intracerebral hemorrhage (bleeding into the brain) and subarachnoid hemorrhage (bleeding along the surface of the brain) between 1996 and 2012 using the Myocardial Infarction Data Acquisition System (MIDAS) administrative database. The New Jersey Department of Health and Senior Services designates certain hospitals as comprehensive stroke centers (CSCs). We found that patients admitted to comprehensive stroke centers with hemorrhagic stroke were less likely to die than those admitted to other hospital types. This was particularly true for those patients admitted with subarachnoid hemorrhage, which is usually caused by a ruptured aneurysm.


http://medicalresearch.com/stroke/comprehensive-stroke-centers-save-lives-in-patients-with-hemorrhagic-stroke/14030/











http://medicalresearch.com/stroke/intensive-medical-therapy-vs-stent-angioplasty-for-stoke-which-is-better/180/








• Medical Research: What should clinicians and patients take away from your report?• Dr. McKinney: The stroke center designation process works to identify hospitals that are

dedicated to providing the resources to quickly diagnose and treat stroke patients. Patients with complex or serious strokes, such as hemorrhagic stroke, should be treated at hospitals with an appropriate spectrum of resources to manage their condition. Our study indicates that CSC care may lower mortality for patients with hemorrhagic stroke.













http://medicalresearch.com/stroke/intensive-medical-therapy-vs-stent-angioplasty-for-stoke-which-is-better/180/









• Dr. McKinney: The current study used administrative data and was unable to adjust for all potential confounding variables, particularly stroke severity. Further, we only were able to study stroke care in New Jersey using statewide department of health stroke center designations. Further research should look at outcomes of hemorrhagic stroke patients admitted to stroke centers adjusting for stroke severity and in other geographic regions.

• Citation:• James S. McKinney, Jerry Q. Cheng, Igor Rybinnik, John B. Kostis, and the Myocardial

Infarction Data Acquisition System (MIDAS 22) Study Group. Comprehensive Stroke Centers May Be Associated With Improved Survival in Hemorrhagic Stroke. Journal of the American Heart Association, May 2015 DOI: 10.1161/JAHA.114.001448













http://medicalresearch.com/stroke/target-stroke-program-improved-stroke-treatment-time-and-outcomes/3805/

http://dx.doi.org/10.1161/JAHA.114.001448






Childhood Obesity Presents Opportunities and ChallengesMedicalResearch.com Interview with:Rebecca Jones, MSPHNutrition and Health Sciences ProgramGraduate Division of Biological and Biomedical Sciences Emory University

• Medical Research: What is the background for this study? What are the main findings?• Response: Obesity in children is associated with a wide range of conditions later in life

including heart disease, cancer, and diabetes. Even prior to adulthood, children can be affected by a host of non-communicable diseases which are affected by weight status of the child. With an increase in children who are overweight or obese globally, Dr. Chan, Director-General of the World Health Organization, announced a new initiative to combat childhood obesity at the 2014 World Health Assembly. Within childhood obesity the pre-school (under age 5) years are a critical period for prevention due the association of adiposity rebound and obesity in later years as well as the early establishment of taste preferences and attitudes around healthy eating habits. Recent evaluation of incident obesity in the United States has demonstrated a component of the course to obesity is already established by the age of five years.


http://medicalresearch.com/weight-research/childhood-obesity-presents-opportunities-and-challenges/13942/









http://medicalresearch.com/pediatrics/links-between-breastfeeding-duration-and-childhood-obesity/11905/

http://medicalresearch.com/weight-research/childhood-obesity-common-in-both-new-york-and-shanghai/13486/







Our main finding is the necessity for better surveillance and comparability of weight status, particularly overweight and obesity, in children under five across countries in the European region. 60% of countries within the region have some form of published data on this particular population however they vary based on level of national representation, cut-off criteria, age and gender. All these different factors can significantly change the prevalence estimates making it very difficult to ascertain the full nature of the problem. Based on the data which was available the European Region has reason for concern about overweight and obesity in young children.

















Medical Research: What should clinicians and patients take away from your report?

Response: Historically, a fat child meant a healthy child and the concept of bigger as better was widely accepted. This perception has begun to shift, however clinicians and patients need to continue to be made aware of the importance of a healthy weight even at such young ages. It is vital that clinicians discuss with patients the long-term problems which can result from an unhealthy weight in children under 5.











http://medicalresearch.com/weight-research/pre-pregnancy-bmi-and-gestational-weight-gain-linked-to-childhood-obesity/12594/








• Response: Future research needs to comprehensively evaluate the weight status of children under five, underweight and overweight, within countries with an aim towards having data which is comparable with other countries across the region. This research is pivotal to help in the future development of comparable core indicators for inclusion in national health surveillance systems. To begin to impact the weight status of children in the region, policy makers first need a knowledge base of prevalence estimates of nutritional status.

• Citation:• Abstract presented at the European Congress on Obesity May 2015

T7:PO.011Surveillance of Overweight including Obesity in Children Under 5: Opportunities and Challenges for the European RegionJones R.1,2, Breda J.21Department of Public Nutrition, Rollins School of Public Health, Emory University, Atlanta, Georgia, 2Department of Nutrition, Physical Activity and Obesity, Division Noncommunicable Diseases and Lifecourse, World Health Organization European Regional Office, Copenhagen, Denmark











http://medicalresearch.com/weight-research/childhood-obesity-common-in-both-new-york-and-shanghai/13486/






Obese Patients Face Stigma and DiscriminationMedicalResearch.com Interview with: Claudia SikorskiDr. rer. med. Claudia Sikorski, Dipl.-Psych.Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP)

Institute of Social Medicine, Occupational Health and Public HealthUniversität Leipzig, Medizinische FakultätLeipzig


Response: Obesity is a highly stigmatized condition. People with obesity are often regarded a lazy, slow and sloppy. One consequence of these negative attitudes may be discrimination, e.g. the unfair treatment of individuals with obesity. This study, conducted by Jenny Spahlholz, myself and colleagues reviews observational and experimental studies that investigated the occurrence and nature of discrimination in obesity.

• Medical Research: What should clinicians and patients take away from your report?• Response: We find that patients with obesity are indeed faced not only with negative

attitudes but also with unfair treatment in every-day life in numerous domains. Heavier individuals and women report more experiences of discrimination and may therefore be more prone to psychosocial effects such as low self-esteem.


http://medicalresearch.com/weight-research/obese-patients-face-stigma-and-discrimination/13944/


























http://medicalresearch.com/weight-research/obesity-paradox-overweight-heart-failure-patients-have-best-prognosis/12939/

http://medicalresearch.com/diabetes/obesity-inactivity-and-smoking-predict-disability-in-diabetes/13848/






Obese Patients Face Stigma and DiscriminationMedicalResearch.com Interview with: Claudia SikorskiDr. rer. med. Claudia Sikorski, Dipl.-Psych.Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP)

Institute of Social Medicine, Occupational Health and Public HealthUniversität Leipzig, Medizinische FakultätLeipzig


• Response: We would like to find out more about the mechanisms of stigmatization and discrimination. We also need to re-think legislative protection for individuals with obesity.

• Citation:• upcoming ECO abstract :• Obesity and Discrimination – A Systematic Review• Spahlholz J.1,2, Baer N.2, König H.H.3, Riedel-Heller S.G.2, Sikorski C.1,2• 1Leipzig University Medical Center, IFB AdiposityDiseases, Leipzig, Germany, 2Institute of

Social Medicine, Occupational Health and Public Healt (ISAP), Leipzig University, Leipzig, Germany, 3Department of Medical Sociology and Health Economics, University Medical Center

































Measures To Reduce Sugary Drinks Gains Public AcceptanceMedicalResearch.com Interview with:Dr. Dragos PetrescuDepartment of Public Health and Primary CareCambridge

• Medical Research: What is the background for this study? What are the main findings?• Response: Consumption of sugar-sweetened beverages is a major contributor to obesity,

particularly in children. Recent systematic reviews provide good evidence that reducing portion size reduces consumption. Similarly, evidence suggests that container shapes and product placement in supermarkets can influence consumption. The public acceptability of “nudging” — altering properties such as the size, the shape, and location of sugar-sweetened beverages — to improve public health is unknown. Here we compared the acceptability in UK and USA samples of government interventions to reduce consumption of sugar-sweetened beverages: three nudge interventions (limiting portion size, changing container shape, and changing shelf location) and two traditional interventions (increased taxation and an education campaign).

• We found that for the majority of UK and USA samples, the education campaign and the three nudge interventions were acceptable, with education attracting most support. By contrast, only a minority of participants supported taxation.


http://medicalresearch.com/weight-research/measures-to-reduce-sugary-drinks-gains-public-acceptance/13946/
















• Medical Research: What should clinicians and patients take away from your report?• Response: Nudge interventions to reduce consumption of sugary drinks appear to be

acceptable to the public. Policymakers can be reassured about the public acceptability of nudging to reduce sugar-sweetened beverages consumption; however our results suggest taxation to lower consumption would not be popular with the majority of both the UK and US populations.












http://medicalresearch.com/author-interviews/sugar-sweetened-beverage-taxess/4471/








• Response: Future research is needed to explore how best to communicate to the public in order to increase support for unpopular but likely effective policies, such as increased taxation.

• Citation: Abstract presented at the European Congress on Obesity• Public acceptability in the UK and USA of nudging to reduce obesity: The example of reducing

sugar-sweetened beverages consumption• Petrescu D.C.1, Hollands G.J.1, Ng Y.1, Marteau T.M.1• 1Behaviour and Health Research Unit, University of Cambridge












http://eco2015.easo.org/






Sleep Loss Impairs Decision MakingMedicalResearch.com Interview with:Hans P.A. Van Dongen, Ph.D.Director, Sleep and Performance Research Center Research Professor, College of Medical Sciences

Washington State University Spokane, Spokane, WA

• MedicalResearch: What is the background for this study? What are the main findings?• Research: Our main interest is in better understanding why people sometimes are able to

manage perfectly well with sleep loss, while at other times sleep loss can have profoundly negative effects. We found that sleep deprivation reduces the effectiveness of signals used to tell when you are right or wrong, an effect we labeled feedback blunting.

• Subjects in the study performed a decision making task that was simple but required feedback, i.e., a signal indicating the response was correct or incorrect, to perform correctly. We found that people who were sleep deprived were no longer able to use the feedback information to make correct responses. And when people had to adapt to unexpected changes in when to respond, sleep deprived people were completely unable to adapt to these changing circumstances.

• The finding of feedback blunting in this study indicates that people who are sleep deprived not only have trouble sustaining attention to details in the environment (a well established effect of sleep loss), they also have trouble changing the focus of attention to deal with changing circumstances.


http://medicalresearch.com/sleep-disorders/sleep-loss-impairs-decision-making/14066/












http://medicalresearch.com/sleep-disorders/sleep_deprivation_specific_molecular_changes_lead_to_memory_impairments/9188/








• An interesting paradox in the research literature has been that people have been shown in many circumstances to perform complex tasks at a very high level while sleep deprived. Yet, we know from real-world experience that sleep deprived people can make catastrophic, life-threatening decisions that they would never have made if they were well rested. The current study is the first to shed light on this issue. It showed that sleep deprived people who get feedback, telling them that their actions are not effective, are less capable of changing their behavior.

• The study is part of a line of research in which we are trying to identify how sleep loss changes specific components of cognition, and how these changes may lead to serious problems in everyday life activities. Being able to study and understand these effects of sleep deprivation under controlled conditions is an important step toward preventing human error under real world conditions.














http://medicalresearch.com/diabetes/sleep-loss-associated-obesity-diabetes/4386/








• MedicalResearch: What should clinicians and patients take away from your report?

• Research: One important lesson is not to ignore the effect of sleep loss just because it hasn’t had much impact in the past. The study findings imply that when circumstances change from the everyday routine is when sleep deprivation will cause the biggest problems. Thus, getting adequate sleep is as important as any other measure taken to promote health and safety.

• Sleep loss is inescapably linked with shift work, extended work hours, and emergency situations, as well as with sleep disorders and many other medical conditions. In today’s fast-paced society, people are often called upon to make critical decisions under dynamically changing circumstances and with potentially major consequences. Our study indicates that the circumstances that cause people to be sleep deprived are often precisely the circumstances when the effects of sleep deprivation can be the most dramatic.














http://medicalresearch.com/sleep-disorders/poor-sleep-quality-increases-mood-disturbances/13852/








• There are two specific things to note.• First, sustaining attention, even for brief periods of time, is very difficult for people who are

sleep deprived. Any task that requires sustained attention is likely to lead to problems under conditions of sleep loss. If you are doing something that is well practiced and there is no novelty or ambiguity to deal with, you can keep doing that task while sleep deprived, but occasional errors will pop up.

• Second, any task that requires evaluating changes in the environment, e.g., new events, or changing or ambiguous circumstances, is going to be particularly difficult when people are sleep deprived. That means you may not recognize signals that would ordinarily allow you to avoid errors or prompt you to change your course of action. Serious problems arise even in well practiced activities when you must continually evaluate the environment and adapt to changing circumstances.






















• Research: Most conventional test used to measure the impact of sleep loss rely on either subjective measures of sleepiness or objective measures of inability to sustain attention. While useful, these approaches miss the importance of situations that demand attending to signals to change our current pattern of behavior. Future research focusing on people’s processing of feedback information can lead to improved assessment and prediction of failures that can arise from sleep loss.

• In addition, we know that there are individual differences in susceptibility to sleep loss, and better understanding the mechanisms of sleep loss effects on performance is a key step in understanding these individual differences.

• Citation:Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

• Journal Sleep: VOLUME 38, ISSUE 05http://dx.doi.org/10.5665/sleep.4668• Paul Whitney, PhD; John M. Hinson, PhD; Melinda L. Jackson, PhD; Hans P.A. Van Dongen, Ph

D














http://www.journalsleep.org/ViewAbstract.aspx?pid=30003











Viagra Derivatives May Block Malaria TransmissionMedicalResearch.com Interview with:Dr. Gordon LangsleyLaboratoire de Biologie Cellulaire Comparative des Apicomplexes,Institut Cochin, INSERM U1016, CNRS UMR 8104, Faculté de Medecine

Université Paris Descartes, Paris


Response: We have been studying the role of cAMP-dependent PKA signaling in Plasmodium falciparum-infected red blood cells for some time; see just a few examples: PMID: 25522250; PMID: 22626931; PMID: 18248092; PMID: 11559352 and we came to the conclusion that intra cellular cAMP levels regulate infected red blood cell deformability and adhesion to for example, brain endothelial cells.

• Medical Research: What should clinicians and patients take away from your report?• Response: Drugs that manipulate (alter) cAMP levels in Plasmodium-infected erythrocytes

have the potential to become one day new anti-malaria drugs and the proof of principal is the demonstration we provide for inhibitors of phosphodiesterases (PDEs) and deformability of transmissable (step V) gametocytes and their potential to block transmission of malaria.


http://medicalresearch.com/infections/viagra-derivatives-may-block-malaria-transmission/14077/























http://medicalresearch.com/infections/malaria-vaccine-has-potential-to-contribute-to-disease-control/13738/






Viagra Derivatives May Block Malaria TransmissionMedicalResearch.com Interview with:Dr. Gordon LangsleyLaboratoire de Biologie Cellulaire Comparative des Apicomplexes,Institut Cochin, INSERM U1016, CNRS UMR 8104, Faculté de Medecine

Université Paris Descartes, Paris


• Response: First, we do not propose that Viagra should be used as a transmission blocking anti-malaria drug, but rather derivatives, lacking its erectile function, could become malaria transmission blocking drugs.

• We envisage in the next couple of years performing clinical trials to test the efficacy of PDE inhibitors to reduce transmission of malaria

• Citation:• Ghania Ramdani, Bernina Naissant, Eloise Thompson, Florence Breil, Audrey Lorthiois, Florian

Dupuy, Ross Cummings, Yoann Duffier, Yolanda Corbett, Odile Mercereau-Puijalon, Kenneth Vernick, Donatella Taramelli, David A. Baker, Gordon Langsley, Catherine Lavazec. cAMP-Signalling Regulates Gametocyte-Infected Erythrocyte Deformability Required for Malaria Parasite Transmission. PLOS Pathogens, 2015; 11 (5): e1004815 DOI: 10.1371/journal.ppat.1004815

























http://medicalresearch.com/infections/biomarkers-may-lead-to-breath-test-for-malaria/13240/

http://dx.doi.org/10.1371/journal.ppat.1004815






Frequent Emergency Department Users More Likely To Die Or Be AdmittedMedicalResearch.com Interview with:Dr. Brian Rowe, MD, MSc, CCFP(EM), FCCPProfessor, Department of Emergency Medicine

University of Alberta, Edmonton, Alberta, Canada

• MedicalResearch: What is the background for this study? • Dr. Rowe: Frequent users are also called “familiar faces” or “heavy users” and they represent

an important sub-group of patients in the emergency setting, with often complex needs that contribute to overcrowding and excess health care costs. The evidence suggests that frequent users account for up to one in 12 patients seeking emergency care, and for around one in four of all visits.


http://medicalresearch.com/author-interviews/frequent-emergency-department-users-more-likely-to-die-or-be-admitted/14002/














• MedicalResearch: What are the main findings?• Dr. Rowe: Frequent users of emergency department care are more than twice as likely to die,

be admitted to hospital, or require other outpatient treatment as infrequent users, concludes an analysis of the available evidence, published in Emergency Medicine Journal.

• These conclusions are based on a thorough search of seven electronic databases of relevant research relating to the frequency and outcomes of emergency department use by adults. Out of a total of more than 4000 potential studies, 31 relevant research reports published between 1990 and 2013 were included in the final analysis. Frequent users were variably defined as visiting emergency care departments from four or more times up to 20 times a year.

• Among the seven studies looking at deaths, the analysis showed that frequent attenders at emergency care departments were more than twice as likely to die as those who rarely sought emergency care. Most of the studies included hospital admission as an outcome, and these showed that frequent users were around 2.5 times as likely to be admitted as infrequent users. Ten studies looked at use of other hospital outpatient care, and these showed that frequent users were more than 2.5 times as likely to require at least one outpatient clinic after their visit to the emergency care department.









http://medicalresearch.com/author-interviews/aca_may_result_in_more_patients_using_emergency_rooms_for_primary_care/9084/








MedicalResearch: What should clinicians and patients take away from your report?

Dr. Rowe: Our results suggest that, despite heterogeneity, frequent users are a distinct and high risk group. Clinicians should be aware of the important risks associated with this group of patients. Frequent users should not be discouraged from attending emergency departments; however, an organized care plan should be developed.









http://medicalresearch.com/author-interviews/reducing-emergency-department-costs-by-improving-ambulatory-care/13434/









Dr. Rowe: The lack of any consensus as to what constitutes a frequent user is striking, they emphasize, and this makes it difficult to permit comparison and come up with potentially generalizable recommendations. Proactive, targeted treatment may help patients and clinicians. Further research on these remaining issues is urgently required.

• Citation:• Mortality, admission rates and outpatient use among frequent users of emergency departme

nts: a systematic review• Jessica Moe, Scott Kirkland, Maria B Ospina, Sandy Campbell, Rebecca Long, Alan Davidson, P

atrick Duke, Tomo Tamura, Lisa Trahan, Brian H Rowe• Emerg Med J emermed-2014-204496Published Online First: 7 May 2015 doi:10.1136/emerme

d-2014-204496









http://emj.bmj.com/citmgr?gca=emermed;emermed-2014-204496v1











Breast Cancer Risk Reduction of Prophylactic Salpingo-Oophorectomy May Be Overestimated For Some BRCA1 CarriersMedicalResearch.com Interview with:Bernadette A.M. Heemskerk-Gerritsen, Ph.D.Department of Medical Oncology

Erasmus MC Cancer Institute Roterdam, the Netherlands


• Dr. Heemskerk-Gerritsen: Women with a BRCA1 or BRCA2 mutation have substantially higher risks of developing both primary and contralateral breast cancer (BC) and ovarian cancer than women from the general population. Options to reduce these increased cancer risks include risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). The latter intervention obviously reduces the risk of developing ovarian cancer, but has been reported also to reduce the risk of developing a subsequent breast cancer with approximately 50%. However, studies on the efficacy of risk-reducing surgery in BRCA1/2 mutation carriers are confined to observational studies, thus challenging several methodological issues. Consequently, previous studies on breast cancer risk-reduction after RRSO may have been influenced by bias associated with selection of study subjects, bias associated with start of follow-up, or by confounding, and breast cancer risk-reduction may have been overestimated.

• In the current study, we revisited the association between risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1/2 mutation carriers, focusing on the impact of different analytical methods and potential types of bias.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-risk-reduction-of-prophylactic-salpingo-oophorectomy-may-be-overestimated-for-some-brca1-carriers/14081/





















• First, we replicated the analyses of four previously performed studies, to examine if our Dutch cohort was comparable with the cohorts used in the previous studies. We replicated the approximately 50% breast cancer risk reduction after RRSO in the Dutch cohort.

• Second, we estimated the effect of RRSO on breast cancer risk in the Dutch cohort using a revised analytical approach for observational studies in BRCA1/2 mutation carriers in order to minimize bias as much as possible. Using this method of analysis, we found no evidence of first BC risk-reduction after RRSO in BRCA1/2 mutation carriers.























• Medical Research: What should clinicians and patients take away from your report?

• Dr. Heemskerk-Gerritsen: From the results, we concluded that in previous studies, breast cancer risk reduction after RRSO in BRCA1/2 mutation carriers may have been overestimated because of bias. We suggest that counselors, clinicians, and researchers should consider the potential impact of bias in previous and future observational studies on this topic. For the present, we advise caution in the message regarding breast cancer risk reduction after RRSO, at least for BRCA1 mutation carriers.
















http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-brca1-negative-and-brca1-positive-and-ten-year-survival/1468/









• Dr. Heemskerk-Gerritsen: We are very interested in the risk estimates in the previous study cohorts when using our proposed design and analytical method, and in validation of our findings. Additionally, further research with longer follow-up and larger numbers of especially BRCA2 mutation carriers is warranted to explore differential effects on BC risks after RRSO for BRCA1 and BRCA2 mutation carriers.

• Citation:• Breast Cancer Risk After Salpingo-Oophorectomy in Healthy BRCA1/2 Mutation Carriers: Re

visiting the Evidence for Risk Reduction• J Natl Cancer Inst. 2015 Mar 18;107(5). pii: djv033. doi: 10.1093/jnci/djv033
















http://medicalresearch.com/cancer-_-oncology/key-function-of-mutation-in-brca1-gene-discovered/163/

http://jnci.oxfordjournals.org/content/107/5/djv033








Electronic Medical Records Did Not Improve Stroke Outcomes Or Quality Of CareMedicalResearch.com Interview with:Karen E. Joynt, MD MPH Cardiovascular Division,Brigham and Women’s Hospital and VA Boston Healthcare System

Department of Health Policy and Management Harvard T.H. Chan School of Public Health

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Joynt: While there is a great deal of optimism about the potential of Electronic Health

Records (EHRs) to improve health care, there is little national data examining whether hospitals that have implemented EHRs have higher-quality care or better patient outcomes. We used national data on 626,473 patients with ischemic stroke to compare quality and outcomes between hospitals with versus without EHRs. We found no difference in quality of care, discharge home (a marker of good functional status), or in-hospital mortality between hospital with versus without EHRs. We did find that the chances of having a long length of stay were slightly lower in hospitals with EHRs than those without them.


http://medicalresearch.com/stroke/electronic-medical-records-did-not-improve-stroke-outcomes-or-quality-of-care/13993/














http://medicalresearch.com/author-interviews/electronic-records-facilitating-hospital-reporting-of-public-health-measures/12946/








• MedicalResearch: What should patients and providers take away from this report?• Dr. Joynt: In our sample, EHRs were not associated with overall higher-quality care or better

outcomes. Though Electronic Health Records may be necessary for an increasingly high-tech, transparent health care system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
















http://medicalresearch.com/author-interviews/electronic_records_and_withholding_information_from_doctors/6768/








• MedicalResearch: What future research do you recommend as a result of this study?• Dr. Joynt: Future research should find ways of leveraging EHRs to improve care and

outcomes – electronic tools have the potential to improve care, but in order to do so, need to be integrated into clinical workflow and provide meaningful information to the clinician. We don’t yet know enough about how best to use Electronic Health Records to improve care, or what type of innovations in electronic tools might really improve outcomes, and that is an important area of research.

• Citation:• Joynt KE, Bhatt DL, Schwamm LH, et al. Lack of Impact of Electronic Health Records on Quality

of Care and Outcomes for Ischemic Stroke. J Am Coll Cardiol. 2015;65(18):1964-1972. doi:10.1016/j.jacc.2015.02.059.
















http://medicalresearch.com/author-interviews/exchanging_medical_data_between_providers_leaves_room_for_improvemement/6128/

http://content.onlinejacc.org/article.aspx?articleID=2288979









Red Blood Cell Surface Molecule May Be Target For New Malaria Vaccine and TreatmentMedicalResearch.com Interview with:Manoj Duraisingh Ph.D.John LaPorte Given Professor of Immunology and Infectious Diseases Harvard

T.H. Chan School of Public HealthDepartment of Immunology and Infectious Diseases Boston, Massachusetts

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Duraisingh: The malaria parasite P. falciparum is one of the most important pathogens of

humans, with enormous mortality resulting from blood-stage infections, when parasites replicate exponentially in red blood cells. Although anti-Plasmodial drugs are in clinical use, widespread and increasing parasite drug-resistance has contributed to an ongoing public health crisis, and we urgently need to find novel approaches to prevent and treat disease.

• Targeting host red blood cell molecules presents an unexploited alternative. However, the highly differentiated and enucleated red blood cell poses a significant technical hurdle for genetic experimentation, due to the lack of a nucleus.

• Here we have developed a novel, forward genetic screen to identify critical factors of malaria infection of red blood cells in an unbiased fashion. Our screen takes advantage of recent advances in human stem cell biology that enable the ex vivo culture of red blood cells from nucleated hematopoietic precursors which are amenable to in vitro genetics.

• We have now identified a surface molecule CD55 (alias Decay-Accelerating Factor, DAF) as an essential host factor required for the invasion of red blood cells by P. falciparum. We demonstrate that this protein is required by all P. falciparum strains tested (laboratory and field) for invasion. Furthermore, we demonstrate that CD55 acts at the initial stage of invasion when the P. falciparum parasite attaches to the surface of the red blood cell.

• Collectively, our findings indicate that CD55 is an ideal target for the development of new host-directed and vaccine therapeutics for malaria.


http://medicalresearch.com/infections/red-blood-cell-surface-molecule-may-be-target-for-new-malaria-vaccine-and-treatment/13969/























• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Duraisingh: Parasites have evolved to use multiple surface protein receptors to enter red

blood cells. Targeting specific receptors was previously thought to be problematic as the notion was that the parasite would simply invade using alternative receptors. Here we have identified an essential surface protein, CD55, required by all P. falciparum parasites for entry into the cell.

• Blocking this interaction between CD55 and the parasite should be a very powerful approach in the development of blood-stage therapeutics. This could be either through the development of a drug-like molecule in the form of a CD55-mimetic, or through the identification of the parasite molecule that binds to the CD55 protein, which would immediately become a top vaccine candidate.

• Our unbiased screening approach can also be used to identify novel host molecules that the parasite needs for growth in the red blood cell. Targeting host molecules by drugs instead of the parasite would have the advantage that host molecules in the fully differentiated and enucleated red blood cell cannot change to become resistant to drugs. The evolution of drug-resistance in parasitic targets remains one of the greatest challenges of malaria control.


















http://medicalresearch.com/infections/detecting_infectious_diseases_without_needles_through_skin_patch/8577/

http://medicalresearch.com/infections/detecting_infectious_diseases_without_needles_through_skin_patch/8577/









• Dr. Duraisingh: In the future, we would very much like to explore the exploitation of CD55 for the development of host-targeted therapeutics, as is used in HIV. In addition, CD55 provides a starting point for the search of a parasite ligand that binds to it. As the interaction is essential, the putative CD55-binding protein could be pursued for vaccine development. Finally, CD55 is a blood group protein, and there are a few polymorphisms in this molecule that are at high prevalence in African populations that bear the brunt of malaria, and may confer protection against malaria. It would of great interest to study the effect of these CD55 polymorphisms on human selection by the malaria parasite.

• Citation:• A forward genetic screen identifies erythrocyte CD55 as essential for Plasmodium falciparum

invasion• Elizabeth S. Egan, Rays H. Y. Jiang, Mischka A. Moechtar, Natasha S. Barteneva, Michael P. We

ekes, Luis V. Nobre, Steven P. Gygi, Joao A. Paulo, Charles Frantzreb, Yoshihiko Tani, Junko Takahashi, Seishi Watanabe, Jonathan Goldberg, Aditya S. Paul, Carlo Brugnara, David E. Root, Roger C. Wiegand, John G. Doench, and Manoj T. DuraisinghScience 8 May 2015: 711–714. [DOI:10.1126/science.aaa3526]


















http://www.sciencemag.org/content/348/6235/711.abstract?sid=6d30d750-9e28-4129-b8b7-aba3a40d223a













Nondisclosure Agreements in Medical Malpractice Settlements May Limit TransparencyMedicalResearch.com Interview with:William M. Sage MD JDJames R. Dougherty Chair for Faculty ExcellenceSchool of Law The University of Texas


Response: We reviewed settlement agreements in malpractice claims closed by The University of Texas System as part of a larger study on incorporating patient perspectives into safety improvement funded by the Agency for Health Care Research and Quality. Over the five years studied, we found that 88.7% of the 124 settlement agreements that met our study criteria contained non-disclosure provisions, but with little standardization or consistency. Restrictions on disclosure, which selectively burdened patients and their families, seemed broader than needed to protect health care providers from disparagement or to avoid attracting additional litigation.

• Nearly half of the agreements (46.4%) prohibited disclosure of the underlying facts, which may be inconsistent with emerging principles of patient safety and compassionate care, and 26.4% prohibited reporting to regulatory bodies, a restriction that the health system subsequently eliminated in response to our findings. Settlements reached after tort reform took full effect in Texas had stricter non-disclosure provisions than earlier settlements, suggesting greater leverage by defendants notwithstanding the reduced risk of additional litigation.


http://medicalresearch.com/author-interviews/nondisclosure-agreements-in-medical-malpractice-settlements-may-limit-transparency/14063/
















• Medical Research: What should clinicians and patients take away from your report?• Response: Silence and secrecy around medical error can persist even in a well-intentioned

academic health system that faces little litigation risk and generally attempts to treat patients fairly and transparently. The findings are important because they remind us how concerned professionals can be about reputation and how uncomfortable publicity can make them, even when science and ethics have advanced to favor greater information exchange.



















• Response: Many health care organizations are implementing “communication and resolution” programs involving medical injuries. These programs include vigilant detection of errors, full disclosure to patients and families, timely redress of injuries, and detailed feedback to improve patient safety. Based on our study, biases and habits involving settlement need to be re-examined in these and other settings, and best practices developed and disseminated.

• Citation:• Sage WM, Jablonski JS, Thomas EJ. Use of Nondisclosure Agreements in Medical Malpractice

Settlements by a Large Academic Health Care System. JAMA Intern Med. Published online May 11, 2015. doi:10.1001/jamainternmed.2015.1035.












http://archinte.jamanetwork.com/article.aspx?articleid=2293079









Wide US Regional Variation In Organ Donation RatesMedicalResearch.com Interview with:Dr. David Goldberg MD, MSCEAssistant Professor of Medicine LDI Fellow, Leonard Davis Institute, University of Pennsylvania

Medical Director for Living Donor Liver Transplantation, Hospital of the University of Pennsylvania

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Goldberg: While there are data that demonstrate differences in authorization (consent)

rates for deceased donation among racial and ethnic minorities, it is unknown how these differences contribute to geographic differences in the number of deceased organ donors. It has been postulated that geographic differences in the distribution of racial and ethnic minorities may contribute to differences in the deceased organ supply, yet there have been no empiric data to support this. Using data on “eligible deaths,” defined as potential brain-dead organ donors <=70 years of age, we demonstrated that even after accounting for differences in the racial/ethnic demographics of the potential donor population, there are dramatic differences in authorization (consent) rates across geographic areas that are not explained by demographics alone. If the source of these differences could be identified, then there could be large increases in the number of organ donors, and lifesaving transplants, in areas with lower authorization rates.


http://medicalresearch.com/author-interviews/wide-us-regional-variation-in-organ-donation-rates/13895/









http://medicalresearch.com/author-interviews/active_critical_care_can_increase_number_of_transplantable_organs_per_donor/7645/






Wide US Regional Variation In Organ Donation RatesMedicalResearch.com Interview with:Dr. David Goldberg MD, MSCEAssistant Professor of Medicine LDI Fellow, Leonard Davis Institute, University of Pennsylvania

Medical Director for Living Donor Liver Transplantation, Hospital of the University of Pennsylvania

• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Goldberg: The rates of authorization for donation among potential brain-dead organ

donors varies dramatically across the United States, and these differences are not explained solely by donor demographics, including race/ethnicity.


• Dr. Goldberg: It is necessary to identify what the root causes of the geographic differences in authorization rates are so that interventions can be applied to increase authorization rates, thus increasing the number of lifesaving transplants, in those areas that with lower rates.

• Citation:• Increasing the Number of Organ Transplants in the United States by Optimizing Donor Auth

orization RatesGoldberg,1 B. French,2 P. Abt,3 R. Gilroy.4

• 1Department of Medicine, University of Pennsylvania, Philadelphia, PA2Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA3Department of Surgery, University of Pennsylvania, Philadelphia, PA4Department of Medicine, University of Kansas Medical Center, Kansas City, KS.

• 2015 American Transplant Congress











http://www.atcmeetingabstracts.com/abstract/increasing-the-number-of-organ-transplants-in-the-united-states-by-optimizing-donor-authorization-rates/


















http://www.atcmeetingabstracts.com/meetings/2015-american-transplant-congress/?alpha=I






Genetic Variants Explain Differences in Age Of Onset Of Huntington’s Disease SymptomsMedicalResearch.com Interview with:Kristina Bečanovič Ph.D.Department of Clinical NeuroscienceKarolinska Institutet, Stockholm, Sweden.


Dr. Becanovic: While the symptoms normally debut in middle-age, there is wide individual variation in how Huntington disease manifests itself, and even though two people carry the exact same genetic mutation that codes for the huntingtin protein, there can be up to a 20-year difference in onset of motor symptoms. This suggests that genetic variants, transcription factors and environmental factors could contribute to the observed differences in disease expressivity. As the identification of regulatory factors of the huntingtin gene would be targets for therapeutic intervention, we set out to study the regulation of the huntingtin gene as it has not been well-known which factors regulate the expression levels. We were interested in identifying both genetic variants and transcription factors that are of importance for gene regulation. We therefore used DNA from Huntington disease patients to study the regulation of the huntingtin gene promoter in cells.


http://medicalresearch.com/genetic-research/genetic-variants-explain-differences-in-age-of-onset-of-huntingtons-disease-symptoms/14071/



















Dr. Becanovic: This study presents multiple findings that are of potential interest for clinicians, patients and other researchers.

• Most people who develop Huntington’s disease have a normal and a mutated huntingtin gene. In the present study, we found that when the genetic variant was on the gene copy that codes for the normal Huntington protein, the patients developed motor symptoms on average four years earlier than expected; on the other hand, the genetic variant had a protective effect when sitting on the gene copy that codes for the mutated protein, which is toxic for the brain. These patients developed their motor symptoms on average ten years later than expected. We showed that NF-ĸB which is known to be a central player in the inflammatory response, acts as a transcription factor regulating huntingtin gene expression, but that the genetic variant hindered the binding of NF-ĸB which led to lower levels of the huntingtin protein.This study suggests that the genetic variant therefore leads to lower levels of the normal or the mutated protein depending on which gene copy it sits on, and that this explains the differences in disease onset. Our results emphasize the importance of “allelic imbalance”, where the yin-yang relationship of the normal and the mutant Huntington protein is of significance, and when altered, affects the Huntington disease age of onset in patients.














http://medicalresearch.com/neurological-disorders/huntingtons-disease/8643/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Becanovic: Our findings are important for the development of disease-modifying

treatments, which not only reduce the symptoms but also protect the brain. Much research has gone into silencing the expression of the huntingtin protein, something that will be tested in patients within the near future. Our work is the first to support the claim that this type of therapy could help people with Huntington’s disease by slowing the progression of the disease. This work further supports continued efforts on allele-specific silencing approaches in Huntington disease. This work also suggests the identified genetic variant to be used as a prognostic marker in Huntington disease patients.





















• Dr. Becanovic: In this study we went from identifying molecular mechanisms, to showing that this specific genetic variant affects the disease onset in Huntington disease patients. Our study therefore supports continued efforts in the identification of genetic variants, and transcription- and environmental factors that affect gene expression. Differential gene expression contributes to differential disease expressivity. We need to increase our knowledge about these factors to enable the development of disease-modifying therapeutics, not only for Huntington disease, but also for other neurodegenerative diseases.

• Citation:• A SNP in the HTT promoter alters NF-κB binding and is a bidirectional genetic modifier of H

untington disease.Kristina Bečanović , Anne Nørremølle, Scott J Neal, Chris Kay, Jennifer A Collins, David Arenillas,Tobias Lilja,Giulia Gaudenzi,Shiana Manoharan,Crystal N Doty,Jessalyn Beck,Nayana Lahiri,Elodie Portales-Casamar,Simon C Warby, Colúm Connolly, Rebecca A G De Souza, REGISTRY Investigators of the European Huntington’s Disease Network,

Sarah J Tabrizi, Ola Hermanson, Douglas R Langbehn, Michael R Hayden, Wyeth W Wasserman & Blair R Leavitt

• Nature Neuroscienc (2015) doi:10.1038/nn.40Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.













http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFjAA&url=http://www.nature.com/articles/nn.4014&ei=QwlRVdniHcvfsATu0IGgDw&usg=AFQjCNFXMoiXnSgWLGogoqBktShelL1VEw&sig2=kVZfwmTJQj8KZuu2VWm0mw&bvm=bv.92885102,d.cWc
















Dexamethasone May Limit Kidney Failure After Heart SurgeryMedicalResearch.com Interview with:Kirolos A. Jacob, MD, MSc PhD CandidateDivision Vital Functions, Cardiothoracic Surgery and Intensive Care MedicineUniversity Medical Center Utrecht


Dr. Jacob: Heart surgery carries many risks for a patient undergoing such a procedure. One of the most devastating complications following open heart surgery is kidney failure requiring dialysis. Most of these patients who develop kidney failure requiring dialysis after surgery have some form of chronic kidney disease before the operation, which placed them at especially high risk. Approximately one out of every 100 patients undergoing open heart surgery develops severe kidney failure. When such kidney failure occurs, the patient has more than 40% chance of dying. 1% sounds like a small percentage, however given the fact that each year, over half a million people undergo heart surgery in the USA alone, this means that an estimated 5,000 patients develop renal failure and of those about 2,500 die as a result of this complication. This figure is rising yearly as more and more patients are being operated due to the aging population. Also, this elderly population has often significant pre-existing kidney disease, further increasing the incidence of kidney failure after a heart operation.


http://medicalresearch.com/heart-disease/dexamethasone-may-limit-kidney-failure-after-heart-surgery/14106/















• Thus, treatment strategies are needed for this relatively small yet very important and expanding group of patients. Heart surgery initiates an inflammatory reaction across the human body due to the surgical trauma and the heart-lung machine. This systemic immune system reaction is thought to play a vital role in the development of kidney injury after heart surgery.

• Our study investigated the effects of dexamethasone, a strong anti-inflammatory drug, on severe kidney injury after heart surgery. Severe kidney injury was defined as the use of dialysis during the hospital stay after surgery. We discovered that patients who receive the drug used 56% less frequently kidney dialysis, when compared to those receiving a placebo. Thus patients who did not receive the drug had about 2.5x higher risk for developing kidney failure when compared to those receiving dexamethasone. The beneficial effects of dexamethasone were particularly present in those who already had pre-existing kidney disease before heart surgery. This reinforces the fact that this drug could be of major importance for the increasing elderly population with pre-existing kidney disease undergoing a heart operation.











http://medicalresearch.com/heart-disease/infections-heart-surgery-differ-type-surgery/10902/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Jacob: Patients undergoing heart surgery are of high risk of developing severe kidney

failure, especially if they have underlying chronic kidney disease. Dexamethasone is an anti-inflammatory drug that may prevent against severe kidney failure after heart surgery. It is shown by our trial that especially those patients with previous chronic kidney disease benefit from dexamethasone.

• Our study is the largest randomized, placebo-controlled trial showing a potential benefit of any therapeutic drug for the prevention of severe kidney injury following heart surgery. Dexamethasone is long-existing and very affordable drug. Such a single dose of the drug during a heart operation is also straightforward and painless for patients. Furthermore a single dose of the drug does not carry many important side-effects. All in all, these advantages make the intervention very accessible and cost-effective, especially since the costs for dialysis are very high.


















• Dr. Jacob: The total number of dialysis events was relatively low despite the large sample size of our study. Furthermore, this was a post-hoc analysis of a trial, which means that the study did not originally set out to test the effect of dexamethasone on kidney failure requiring dialysis. Because of that, these very promising results need to be confirmed by other large trials.

• Citation:• Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery • Kirolos A. Jacob, David E. Leaf, Jan M. Dieleman, Diederik van Dijk, Arno P. Nierich, Peter M. R

osseel, Joost M. van der Maaten, Jan Hofland, Jan C. Diephuis, Fellery de Lange, Christine Boer, Jolanda Kluin, Sushrut S. Waikar, and for the Dexamethasone for Cardiac Surgery (DECS) Study Group

• JASN ASN.2014080840; published ahead of print May 7, 2015, doi:10.1681/ASN.2014080840











http://jasn.asnjournals.org/content/early/2015/05/07/ASN.2014080840.abstract











Many Overweight and Obese Children Will Become Obese AdultsMedicalResearch.com Interview with:Matthew PearceNHS Gloucestershire Clinical Commissioning GroupUK


Response: Despite evidence to suggest that the prevalence of childhood obesity in the UK has stabilized in recent years, we know that approximately one in five children start their school life either overweight or obese, increasing to one in three children by the last year in primary school. Our research was the first to undertake an in-depth analysis on the UK’s National Child Measurement Programme (NCMP) and retrospectively track the weights of individual children over a 7-year period. Our study included a sample of 1863 children in South Gloucestershire, Bristol in the UK.

• Our results were found to be similar to cross sectional data with obesity prevalence approximately doubling between the first (4/5yrs old) and last year (10/11yrs old) of primary school. Our findings provide little reassurance that those children who are obese in early childhood ‘grow out of ’ excess adiposity. Including overweight, we found that 84% of obese children at Reception year went on to be either overweight or obese by Year 6. Although previous studies have failed to identify any significant differences in BMI change between boys and girls during mid-childhood, our research found that more boys than girls dropped a weight category (from overweight or obese) by the time they reached Year 6. We found that the odds ratios of being overweight (BMI ≥85th percentile) or obese (≥95th percentile) based on BMI at Reception were similar to published literature. Our data found children who are within the upper range of the healthy weight category (75th–85th percentile) at Reception had an increased risk of being overweight or obese by the time they reach year 6.


http://medicalresearch.com/pediatrics/many-overweight-and-obese-children-will-become-obese-adults/14102/







http://medicalresearch.com/pediatrics/mediterranean_diet_in_children_found_protective_against_obesity/5530/

http://medicalresearch.com/pediatrics/breastfeeding-linked-to-modest-reduction-in-childhood-obesity/13447/







• Medical Research: What should clinicians and patients take away from your report?• Response: Previous research has shown that weight status tracks from childhood to

adulthood; therefore, many of the overweight and obese children in our sample will become obese adults, and this will have a significant impact on their future health. Our findings suggest that parents and health professionals should be more vigilant in recognizing children at risk of becoming obese. It is therefore important that preventative efforts are focused towards children who are likely to be on the path to obesity. Raising the potential risks with parents in terms of healthy growth is crucial to prevent future health problems, particularly as evidence suggests many parents and health professionals underestimate obesity in children and its importance.
















• Response: Current NCMP guidance recommends feedback to all parents around the four different weight categories (underweight, healthy weight, overweight and obesity).Our study indicates that health providers should place more emphasis on tailoring feedback based on a child’s percentile rather than weight category, in particular highlighting that those children at the upper end of the healthy weight range are likely to increase their BMI if a healthy lifestyle is not adhered to. Further research should be undertaken to understand what strategies were undertaken by children and their families for those who achieved a positive shift in weight status. Further research should also be undertaken to explore the gender differences found in our study.

• Citation:• Changes in objectively measured BMI in children aged 4–11 years: data from the National Chil

d Measurement ProgrammeMatthew Pearce, Sarah Webb-Phillips, and Isabelle Bray

• J Public Health first published online May 6, 2015 doi:10.1093/pubmed/fdv058









http://medicalresearch.com/pediatrics/weight-gain-in-2-to-5-year-old-children-role-of-sugar-sweetened-drinks/1329/

http://jpubhealth.oxfordjournals.org/citmgr?gca=jphm;fdv058v1











To Stay Healthy: “Keep your waist to less than half your height”MedicalResearch.com Interview with:Dr Margaret Ashwell OBE, FAfN, RNutr (Public Health)Ashwell AssociatesAshwell, Hertfordshire, United Kingdom.

Visiting Research Fellow, Oxford Brookes University

• MedicalResearch: What are the main findings from this study?• Dr. Ashwell: In this study, the authors explore the differences in CVD risk factors between

overweight and non-overweight people (by BMI) according to their shape (waist-to-height ratio -WHtR) Data for their analysis was taken from the Health Survey for England 2009 (HSE). They found significant differences in levels of total cholesterol (TC) and glycat ed haemoglobin (HbA1c—a measure of blood sugar control used to diagnose diabetes).

• Out of 2917 people aged 16 years and over, 346 classified as ‘normal’ by BMI, have WHtR exceeding 0.5 (12% of the total,sample, or 34% of normal weight people). These could be called non-overweight ‘apples’, who have a lot of fat around the waist but not a high BMI.

• The researchers classified the HSE population into four groups (2×2) using standard boundary values of BMI (above or below 25kg/m2) and WHtR (above or below 0.5). The group with ‘low/normal BMI but high WHtR (non-overweight ‘ap ples’) had significantly higher mean TC than the group with high BMI but low WHtR (overweight ‘pears’—people with a higher than normal BMI but less fat around the waist): 5.73mmol/L vs. 4.98mmol/L. Similarly, HbA1c levels were higher among non-over weight ‘apples’ than among overweight ‘pears’ (5.62% vs. 5.33%). These differences were similar and also significant in both sexes.


http://medicalresearch.com/weight-research/to-stay-healthy-keep-your-waist-to-less-than-half-your-height/14117/


















http://medicalresearch.com/weight-research/pre-pregnancy-bmi-and-gestational-weight-gain-linked-to-childhood-obesity/12594/








• MedicalResearch: Why do you say that piece so string can be used for primary screening?• Dr. Ashwell: Since a good boundary value for waist-to-height ratio is 0.5, you don’t even need

a tape measure to screen those at risk. It can be done with a piece of string. Measure the height of child with string, fold it in half and see if it fits around his/her waist. If it doesn’t, that child should proceed to the next stage of screening.

• MedicalResearch: Were you surprised by your study’s findings?• Dr. Ashwell: No because the science about the limitations of BMI and the superiority of

WHtR has been growing in leaps and bounds recently.



























• MedicalResearch: Why do you think BMI is flawed?• Dr. Ashwell: It does not measure central obesity which is the type of obesity associated with

the main health risks. And of course it measures muscle as well as fatWhy do you think your method using string is so effective?It is simple and great for prevention especially in children and especially in developing countries where resources are scarce. Yet it is based on good science.

• MedicalResearch: What is the background for this study? You have campaigned for more recognition of Waist to Height ratio (WHtR) for determination of cardiovascular risk. What first got you onto this theory?

• Dr. Ashwell: Knowing that all the scientific evidence pointed to central obesity, not total obesity, being the main problem associated with health risks, I first suggested in 1994 that we needed a shape index to replace BMI. In 1996 we suggested that waist-to-height ratio could be such an index and all our work since then, and that of many others, has confirmed this suggestion to be sensible. Many other Shape Indices have been suggested but invariably waist-to-height ratio outperforms them as a risk indicator. It is certainly the simplest index.



























• MedicalResearch: What dangers is society facing if it continues to stick rigidly to BMI as its default method for screening risks related to obesity?

• Dr. Ashwell: The ‘non- overweight weight’ apples (normal BMI but with waist-to-height ratio 0.5 or more) will not realise they are at risk and will not be recognised as needing care from health professionals.

• MedicalResearch: Tell us how much developing countries can benefit from using something as basic as WHtR?

• Dr. Ashwell: We have already been invited to India to help the academics produce a memorandum to their government to introduce our simple measure for screening Indian children. Since a good boundary value for waist-to-height ratio is 0.5, you don’t even need a tape measure to screen those at risk. It can be done with a piece of string. Measure the height of child with string, fold it in half and see if it fits around his/her waist. If it doesn’t, that child should proceed to the next stage of screening.



























• MedicalResearch: What are the next steps for your research in this area? What recommendations do you have for future research as a result of this study?

• Dr. Ashwell: We would like to perform a systematic review on the comparisons of BMI and waist-to-height ratio as indicators of risk in children. There are sufficient individual studies published now to make this possible. Alternatively, we would like to hear that some other group have published this. We would also like to promulgate the message that WHtR is not only superior to BMI in first stage screening for the health risks of obesity but is also more efficient in practice and can be done by personnel with minimal training and resources.

• MedicalResearch: What do you think is the biggest challenge the UK, and the rest of Europe, faces in terms of the obesity epidemic?

• Dr. Ashwell: It must be prevention in children.



























• MedicalResearch: How would you frame the take-home message of the study?• Dr. Ashwell: “Keep your waist to less than half your height” if you want to stay healthy. This

message is suitable for people ( children and adults) all over the world.• MedicalResearch: What should clinicians and patients take away from your report? What

are the clinical implications of the findings?• Dr. Ashwell: Waist-to-height ratio should be measured and recorded as well as BMI. Valuable

resources can then be focussed on those with the higher waist-to-height ratios• MedicalResearch: Does the risk increase at WHtR above 0.5?• Dr. Ashwell: Yes almost certainly it does as we know from other research . Above 0.6 and

especially above 0.7,Mortality or years of life lost increases as well. We have not analysed subgroups yet in this dataset (need more data)



























• MedicalResearch: Is everyone with a WHtR > 0,5 at more risk of cardio-disease and diabetes?

• Dr. Ashwell: This a population sample and is a statistical result, but it does mean that everyone with a WHtR of say 0.55 is at higher risk. Age is the most powerful predictor of all and dwarfs all other measures.

• MedicalResearch: Does exercise help, even if you`re an “apple”?• Dr. Ashwell: Exercise always helps- especially if you are an apple! It can improve your

metabolic profile and preserve your muscle mass• MedicalResearch: Do you have any financial disclosures?• Dr. Ashwell: Both authors are independent scientific consultants( see www.ashwell.uk.com

and www.sig-nurture.com).• This piece of research was self funded. Dr Margaret Ashwell has devised the Ashwell (R) Shape

Chart which is distributed to health professional on a non profit making basis• • Citation:• Non-overweight ‚apples‘ have higher cardiometabolic risk factors than overweight ‚pears‘: Wai

st-to-height ratio is a better screening tool than BMI for plasma cholesterol and glycated haemoglobin

• Gibson S.1, Ashwell M.2,3• 1Sig-Nurture Ltd, Surrey GU1 2TF, UK, 2Ashwell Associates, Ashwell, Herts SG7 5PZ, UK,

3Oxford Brookes University, Oxford OX3 0BP, UKRead the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.



















http://www.ashwell.uk.com/

http://www.sig-nurture.com/









Rising Number Of Heart Infections Due To Staphylococcus BacteriaMedicalResearch.com Interview with:J L Mehta, MD, PhDProfessor of Medicine and Physiology and Biophysics Stebbins Chair in CardiologyUniversity of Arkansas for Medical

Sciences Little Rock, AR 72205


Dr. Mehta: In 2007, ACC/AHA published new guidelines regarding infective endocarditis (IE) prevention. This guideline drastically differed from the way we practiced and prescribed antibiotics to our patients when they undergo surgery or any other procedure like dental procedure, endoscopy, etc. to prevent infective endocarditis. As a result of these guideline, antibiotic use is now being restricted to only a small number of patients who have cardiac conditions that puts them at very high risk for adverse outcomes from IE. However, there is paucity of data on IE trends in the community following such a major change in practice. Therefore evaluated the trend in incidence of infective endocarditis and their outcomes before and after the advent of new guideline.


http://medicalresearch.com/infections/rising-number-of-heart-infections-due-to-staphylococcus-bacteria/14041/


















• Our study has several important findings.• First, there has been a steady increase in the incidence of infective endocarditis

hospitalizations over the last decade in the US. However, the incidence of IE pre- and post-inception of new antibiotic prophylaxis guidelines is not significantly different. In parallel to these findings, the rate of valve replacement for infective endocarditis did not change after the release of new guidelines in 2007.

• Secondly, the increase in IE incidence was seen across all types of pathogens- Staphylococcus, Streptococcus, gram negative bacteria and fungi. The major offender involved in IE in the United States is Staphylococcus.

• Finally, the rate of Streptococcus infective endocarditis related hospitalization increased significantly following the release of new guideline in the US, while Staphylococcus IE hospitalizations although on rise, did not increase significantly following the 2007 ACC/AHA guideline update.




















• Medical Research: What should clinicians and patients take away from your report?• Dr. Mehta: The take home messages from our study is that the incidence of infective

endocarditis in the country is steadily rising causing more hospitalization, healthcare expenditure and morbidity. The reason behind this seems multifactorial including factors pertaining to healthcare providers (increasing device implants, surgical procedures), patients (increasing proportion of intravenous drug users, patient with cardiac problem, immunosuppresed, hemodialysis patient) and the flora (increasing prevalence of MRSA in the community/hospitals). While the new guideline has advocated more rational use of antibiotic, this doesn’t seem to have decreased the rising burden of the disease. We have seen in our study that Staphylococcus has remained the major microbe responsible. We believe this data will help develop more targeted prevention strategy to prevent the rising incidence of this disease.













http://medicalresearch.com/infections/targeted-program-reduced-superbug-infections-in-nursing-home-residents/12749/









• Dr. Mehta: Some of the areas worth exploring in this field include use of hospital microbiological data specific antibiotic usage in IE prevention, use of alternate strategy like antiplatelet agent for IE prevention, impact of controlled substance monitoring and its impact on infective endocarditis, ongoing monitoring of impact of prevention guideline and finally cost effectiveness analysis of the prevention strategy.

• Citation:• Pant S, Patel NJ, Deshmukh A, et al. Trends in Infective Endocarditis Incidence, Microbiology, a

nd Valve Replacement in the United States From 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070-2076. doi:10.1016/j.jacc.2015.03.518.













http://medicalresearch.com/infections/drop_in_antibiotic_prophylaxis_in_uk_linked_to_increased_number_of_heart_infections/9232/

http://content.onlinejacc.org/article.aspx?articleid=2290815









UK Primary Care Reforms Resulted In More Unplanned Hospital Admissions For ChildrenMedicalResearch.com Interview with:Elizabeth Cecil, MScDepartment of Primary Care and Public,Health, Imperial College London London, United Kingdom


Response: Unplanned hospital admissions in children have been rising for more than a decade placing strain on health care resources in the UK. Unnecessary hospital admission exposes children to hospital acquired infections and an over invasive approach, and is inconvenient for their families as well as adding to pressures on staff dealing with sicker children.

• Our team from Imperial College London were interested in assessing the impact of primary care policy reforms on short stay admissions, in England. The reforms were nationally implemented in April 2004 and reduced the availability of primary care physicians for children. Our study, found that reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions and with fewer children’s admissions being referred by a primary care physician.

• Over the study period from April 2000 to March 2012, we found that more than half of the 7.8 million unplanned hospital admissions for children younger than 15 years were short-stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness.


http://medicalresearch.com/pediatrics/uk-primary-care-reforms-resulted-in-more-unplanned-hospital-admissions/14074/









http://medicalresearch.com/infections/hospital_acquired_infections_still_room_for_improvement/4436/







• Medical Research: What should clinicians and patients take away from your report?• Response: The UK primary care reforms, which focused heavily on improving chronic disease

management in adults, may have had negative unintended consequences on children with primary care-sensitive conditions. Chronic conditions in children require good quality management in primary care and are sensitive to changes in primary care physicians’ working patterns. Clinicians must be aware of possible knock on effects when quality improvements are implemented to a targeted population.











http://medicalresearch.com/author-interviews/canadian-universal-health-insurance-reduces-racial-disparities-primary-care-access/8356/








• Response: The expansion in primary care based activity as a result of reforms has meant that primary care physicians in the UK are struggling to maintain their workload. Amid concerns about rising emergency department visits and short-stay admissions, controversial pilot schemes, increasing primary care access to 7 days, have been introduced. However their effectiveness remains unproven. National implementation of 7 day access would have huge implications for the primary care physician workforce and UK health system budgets. We recommend further research to model clinical and cost effectiveness and survey parental attitudes to weigh best options for avoiding admissions in children.

• Citation:• Elizabeth Cecil, Alex Bottle, Mike Sharland, and Sonia Saxena• Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for C

hildren With Primary Care–Sensitive Conditions Ann Fam Med May/June 2015 13:214–220; doi:10.1370/afm.1786











http://medicalresearch.com/author-interviews/early-primary-care-follow-may-reduce-readmissions-high-risk-surgery-patients/6054/

http://www.annfammed.org/citmgr?gca=annalsfm;13/3/214










medicalresearch.com: medical research exclusive interviews may 12 2015

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