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Medical Research News and Exclusive Interviews from major and specialty medical research journals and meetings.TRANSCRIPT
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]
April 20 2014
For Informational Purposes Only: Not for Specific Medical Advice.
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Obstructive Sleep Apnea Associated with Hypertension in Perimenopausal WomenMedicalResearch.com Interview with: Rodrigo Pinto Pedrosa, MD, PhDSleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco Pernambuclo, Brazil
• MedicalResearch.com: What are the main findings of the study?• Dr. Pedrosa: Perimenopause is associated with increased cardiovascular risk. This study
evaluated the association between obstructive sleep apnea (OSA) and arterial stiffness and hypertension in perimenopausal women. OSA (apnea-hypopnea index: ≥5 events/hour) and moderate/severe OSA (apnea-hypopnea index: ≥15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) of women, respectively. Women with moderate/severe obstructive sleep apnea had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake blood pressure, nocturnal blood pressure, diastolic blood pressure, as well as higher arterial stiffness (pulse wave velocity: 11.5 [10.1 to 12.3] vs 9.5 [8.6 to 10.8] m/s, p<0.001) than women without obstructive sleep apnea, respectively. Oxygen desaturation index during the night was independently associated with 24h arterial blood pressure and with arterial stiffness.
MedicalResearch.com: Were any of the findings unexpected?• Dr. Pedrosa: No. Previously, we had more evidence of the association between arterial
stiffness and obstructive sleep apnea among men. Now, our results extends this knowledge to the perimenomausal population.
Read the rest of the interview on MedicalResearch.com
Obstructive Sleep Apnea Associated with Hypertension in Perimenopausal WomenMedicalResearch.com Interview with: Rodrigo Pinto Pedrosa, MD, PhDSleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco Pernambuclo, Brazil
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Pedrosa: Obstructive sleep apnea is common, underdiagnosed and
independently associated with high blood pressure and increased arterial stiffness in the perimenopause.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Pedrosa: Future studies must address the role of OSA treatment in this population to evaluate blood pressure and arterial stiffness reductions.
• Citation:
• Obstructive sleep apnea is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women
Pedrosa RP, Barros IL, Drager LF, et al.• Published online April 17, 2014.
doi:10.1378/chest.14-0097.
Read the rest of the interview on MedicalResearch.com
Prostate Cancer: Cost Savings from Active SurveillanceMedicalResearch.com Interview with: Alice Dragomir, MSc, PhDAssistant Professor, Urology/Surgery, McGill UniversityScientist, RI-MUHC
• MedicalResearch.com: What are the main findings of the study?• Authors’ response: Our study demonstrates that for eligible patients, active surveillance
could offer not only the known clinical advantages from the patient’s perspective, but also economic benefits from the health care system’s perspective. At the national level, the cost savings of an annual cohort of incident prostate cancers managed with active surveillance over a first year and 5 years of follow-up could be substantial. These are estimated at $96 million.
• MedicalResearch.com: Were any of the findings unexpected?• Authors’ response: The difference between the cost per patient on active surveillance and
cost per patient receiving immediate treatment is impressive. Over the first year and 5 years of follow-up these costs are estimated at: $6200 for active surveillance and $13 735 for immediate treatment, corresponding to a relative reduction of 54.9% for active surveillance.
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Prostate Cancer: Cost Savings from Active SurveillanceMedicalResearch.com Interview with: Alice Dragomir, MSc, PhDAssistant Professor, Urology/Surgery, McGill UniversityScientist, RI-MUHC
• MedicalResearch.com: What should clinicians and patients take away from your report?• Authors’ response: When no additional clinical benefits are expected with an early initiation
of an active treatment, clinicians can be reassured that there is no economic reason for it. Our results confirm that delayed treatment is associated with additional costs in patients requiring treatment after active surveillance, but this cost is minimal.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Authors’ response: Our study was based on a modeling approach, with initial and follow-up costs of treatments and active surveillance derived from hospital protocols. Future research on observational studies could be performed to account for actual healthcare resources used, as well as for adverse events and complications related to treatments.Citation:Active surveillance for low-risk prostate cancer compared with immediate treatment: a Canadian cost comparisonAlice Dragomir PhD, Fabio L. Cury MD, Armen G. Aprikian MDCMAJ Open April 24, 2014
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Suicide and Self-Harm: Genetic and Environmental Influences OverlapMedicalResearch.com Interview InvitationKarin J. H. Verweij, PhDDepartment of Developmental Psychology and EMGO Institute for Health and Care Research, VU University
Amsterdam, the Netherlands
• MedicalResearch.com: What are the main findings of the study?• Dr. Verweij: We performed a twin study using over 10,000 adult Australian twins to determine the relative importance of genetic
and environmental influences on individual differences in non-suicidal self-injury (NSSI) and suicidal ideation and their covariation.• We found that individuals that report self-harm are approximately eight times more likely to also report suicidal ideation. Results
from the bivariate genetic model indicated that the substantial correlation between non-suicidal self-injury and suicidal ideation (r=0.49 for males and 0.61 for females) is largely explained by overlapping genetic factors: 62% and 76% for males and females, respectively. Overlapping residual influences, including nonshared environmental influences and measurement error, also explain part of the covariance between the two traits. These findings suggest that the two behaviors share similar biological underpinnings.
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Verweij: This study showed that there is a high comorbidity between non-suicidal self-injury and suicidal ideation, and this
comorbidity is for a substantial part due to overlapping genetic influences. An important implication for clinicians and patients is that individuals that engage in non-suicidal self-injury are at risk for also developing suicidal behaviors. Early intervention targeting non-suicidal self-injury should therefore also focus on preventing suicidal behaviors.MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Verweij: Future research should further investigate which genetic and environmental influences underlie the vulnerability in NSSI and suicidal ideation. Studies may focus on both the overlapping genetic and environmental influences as well as on the influences that are unique for each behavior. There are currently not many studies that directly compare non-suicidal self-injury and suicidal behaviors; identification of the overlapping and unique risk factors will be valuable for developing effective prevention and intervention strategies.
• Citation:Overlapping Genetic and Environmental Influences on Nonsuicidal Self-injury and Suicidal Ideation: Different Outcomes, Same Etiology?
• Dominique F. Maciejewski, BSc; Hanneke E. Creemers, PhD; Michael T. Lynskey, PhD; Pamela A. F. Madden, PhD; Andrew C. Heath, PhD; Dixie J. Statham, DPsych; Nicholas G. Martin, PhD; Karin J. H. Verweij, PhD
• JAMA Psychiatry. Published online April 23, 2014. doi:10.1001/jamapsychiatry.2014.89•
Read the rest of the interview on MedicalResearch.com
Homeless Men: Association with High Rate of Prior Brain InjuryMedicalResearch.com Interview with:Jane Topolovec-Vranic, PhDClinical Researcher, Trauma and Neurosurgery Program
Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto
• MedicalResearch.com What are the main findings of the study?• Answer: In our study we found that almost half of the men interviewed in a homeless shelter
in Toronto had experienced a traumatic brain injury in their past, and that most of them had experienced their first brain injury prior to becoming homeless, usually in the early teenage years.
MedicalResearch.com Were any of the findings unexpected?• Answer: An unexpected finding was that although many of the men had experienced at least
one of their brain injuries as a result of an assault, high numbers of them indicated that they had experienced them as a result of sports and recreation, motor vehicle collisions, and or falls.
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Homeless Men: Association with High Rate of Prior Brain InjuryMedicalResearch.com Interview with:Jane Topolovec-Vranic, PhDClinical Researcher, Trauma and Neurosurgery Program
Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto
• MedicalResearch.com What should clinicians and patients take away from your report? • Answer: Given that many of the injuries occurred in youth, by events that could happen to
any of us, this strongly supports the need for injury prevention strategies and potential longer-term monitoring of youth after brain injuries. Clinicians and frontline workers should also keep in mind that the behaviors of these individuals may be influenced by a brain injury from their past.
• MedicalResearch.com What recommendations do you have for future research as a result of this study?
• Answer: Future research could assess the comfort and ability of workers with individuals who are homeless to assess for and manage symptoms of traumatic brain injury. Also, the effect of implementing strategies to reduce the symptoms related to past traumatic brain injury, or to prevent the occurrence of new injuries should be evaluated.
• Citation:• Traumatic brain injury among men in an urban homeless shelter: observational study of rates
and mechanisms of injury
Jane Topolovec-Vranic PhD, Naomi Ennis BA(Hons), Mackenzie Howatt BSc(Hons) and colleagues
CMAJ Open April 25, 2014Read the rest of the interview on MedicalResearch.com
Stroke: Prediction Tool Separates Risk For Ischemic vs Hemorrhagic EventMedicalResearch.com Interview with:M. Arfan Ikram, MD, PhDAssistant professor in Neuroepidemiology Erasmus Medical CenterRotterdam, the Netherlands
• MedicalResearch.com: What are the main findings of this study? • Dr. Ikram: We show that the risk of stroke might be increased due to an increased risk of
ischemic stroke or increased risk of hemorrhagic stroke. Because these subtypes of stroke require different -often opposite- clinical management, currently available prediction rules for any stroke are insufficient. We propose a novel prediction rule that provides separate risks for ischemic stroke and hemorrhagic stroke.
• MedicalResearch.com: Were any of the findings surprising?• Dr. Ikram: We show that an increased risk of ischemic stroke stroke does not parallel an
increased risk of hemorrhagic stroke. In other words, there is a subgroup of persons that specifically has an increased risk of hemorrhagic stroke and not ischemic stroke, and vice versa. These different subgroups may therefore require different clinical management. Ischemic strokes occur due to insufficient blood supply to parts of the brain; these strokes require opening the obstructed artery to re-establish blood flow. In contrast, hemorrhagic strokes occur due to leakage of blood through blood vessels into the brain; these strokes require stopping the bleeding.
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Stroke: Prediction Tool Separates Risk For Ischemic vs Hemorrhagic EventMedicalResearch.com Interview with:M. Arfan Ikram, MD, PhDAssistant professor in Neuroepidemiology Erasmus Medical CenterRotterdam, the Netherlands
• MedicalResearch.com: What should patients and clinicians take away from this report?• Dr. Ikram: An increased risk of stroke can be either due to ischemic stroke or hemorrhagic
stroke, and these two risks should be assessed differently.• MedicalResearch.com: What further research do you recommend as a result of this study?• Dr. Ikram: Future studies can focus on several points.• First, they can investigate whether this prediction rule can be further refined by using
additional clinical information, e.g. APOE-genotype, medication use etc.• Second, studies should investigate to what extent the clinical management between the
subgroups should indeed differ. Finally, a further refinement of subgroups can be made, for instance studying subtypes of ischemic stroke (small vessel, large vessel, cardioembolic) or hemorrhagic stroke (lobar versus deep).
• Citation:Separate prediction of intracerebral hemorrhage and ischemic strokeBart S. Ferket, Bob J.H. van Kempen, Renske G. Wieberdink, Ewout W. Steyerberg, Peter J. Koudstaal, Albert Hofman, Eyal Shahar, Rebecca F. Gottesman, Wayne Rosamond, Jorge R. Kizer, Richard A. Kronmal, Bruce M. Psaty, W.T. Longstreth, Jr, Thomas Mosley, Aaron R. Folsom, M.G. Myriam Hunink, and M. Arfan Ikram
Neurology 10.1212/WNL.0000000000000427; published ahead of print April 23, 2014
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Diuretic Acetazolamide Improved Visual Outcomes in Intracranial HypertensionMedicalResearch.com Interview with: Michael Wall, MDDepartment of Neurology,University of Iowa Hospitals and Clinics, 200 Hawkins DIowa City, IA 52242-1091
• MedicalResearch.com: What are the main findings of the study?• Dr. Wall: We studied patients with idiopathic intracranial hypertension (formerly called
pseudotumor cerebri) with mild visual loss. We found that subjects taking acetazolamide, a type of diuretic, along with a low sodium weight loss program had significantly better visual outcomes than those taking placebo along with the diet.
• MedicalResearch.com: Were any of the findings unexpected?• Dr. Wall:• 1. Acetazolamide improved vision and symptoms independent of the amount of weight loss.• 2. Acetazolamide prevented severe visual field worsening (treatment failures).• 3. Patients with higher grades of optic disc swelling regained much more vision than those
with lower grades.• 4. Acetazolamide, in spite of having side effects, improves patients’ quality of life scores.
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Diuretic Acetazolamide Improved Visual Outcomes in Intracranial HypertensionMedicalResearch.com Interview with: Michael Wall, MDDepartment of Neurology,University of Iowa Hospitals and Clinics, 200 Hawkins DIowa City, IA 52242-1091
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Wall: The main message is that there for the first time, data from a properly controlled
clinical trial to guide therapy in idiopathic intracranial hypertension patients. In IIH patients with mild visual loss, acetazolamide when combined with a low sodium weight reduction program improves vision, reduces optic disc swelling and improves quality of life. The medication was well tolerated with no known permanent untoward side effects.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Wall: Future research should be aimed at finding the cause of idiopathic intracranial hypertension. Secondly, we need another clinical trial to develop protocols for treating more severe visual loss.
• Citation:• The NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee. Effect of A
cetazolamide on Visual Function in Patients With Idiopathic Intracranial Hypertension and Mild Visual Loss: The Idiopathic Intracranial Hypertension Treatment Trial. JAMA. 2014;311(16):1641-1651. doi:10.1001/jama.2014.3312.
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Predicting Alzheimer’s Disease in Patients With Mild Cognitive ImpairmentMedicalResearch.com Interview with:Ziad Nasreddine MD FRCP© Professeur adjointUniversité de Sherbrooke et McGill UniversityNeuro Rive-Sud/CEDRA: Centre
Diagnostique et Recherche sur la Maladie d’Alzheimer Québec, Canada
• MedicalResearch.com: What are the main findings of this study?• Dr. Nasreddine: The Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) and Memory Index Score (MoCA-
MIS) are useful in predicting conversion to Alzheimer’s disease (AD) in individuals with mild cognitive impairment (MCI). Identifying individuals with MCI at high of conversion to Alzheimer’s disease is important clinically and for selecting appropriate subjects for therapeutic trials.
MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Nasreddine: The MoCA and it’s Memory index sub-score is a short and simple test that may be very useful in
determining which mild cognitive impairment patients would require close follow-up and attention because of their risk of conversion to dementia.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Nasreddine: The MoCA usefulness to predict MCI to AD conversion should be compared to Alzheimer’s disease
Biomarkers, and possibly associated with them, to improve biomarkers‘ performance, or help determine when biomarkers should be used in mild cognitive impairment subjects in order to improve sensitivity and specificity of these expensive measures.
• Citation:Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) as a Predictor of Conversion from Mild Cognitive Impairment to Alzheimer’s Disease
J Am Geriatr Soc 62:679–684, 2014.• Parunyou Julayanont MD,
• Mélanie Brousseau SWT,• Howard Chertkow MD,
• Natalie Phillips PhD3,6 and• Ziad S. Nasreddine MD
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Stroke: More Patients Getting Faster Treatment, Fewer ComplicationsMedicalResearch.com Interview with:Dr. Gregg C. Fonarow MDDirector, Ahmanson-UCLA Cardiomyopathy CenterProfessor, Department of Medicine Associate Chief, Cardiology
• MedicalResearch.com: What are the main findings of the study?• Dr. Fonarow: This study examined data from hospitals that have adopted the American Heart
Association/ American Stroke Association’s national quality initiative, Target: Stroke, which aims to increase the number of stroke patients treated with clot-busting drugs for ischemic stroke within 60 minutes or less after hospital arrival. Initiated nationwide in 2010, Target: Stroke provided 10 key strategies as well as tools to facilitate timely tPA administration, as well as additional approaches to improve stroke care and outcome.
• Data from 71,169 tPA-treated stroke patients at 1,030 hospitals participating in Target: Stroke were analyzed to compared the time to treatment and incidence of complications before implementation, from 2003 to 2009, to the post-implementation years, from 2010 to 2013.
• This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. In addition, the average time to treatment dropped by 15 minutes, from 74 to 59 minutes.
• Faster treatment was associated with lower rates of complications, including death. Before Target: Stroke, 9.9% of stroke patients died in the hospital, compared to 8.3% of patients treated after the initiative started, a difference which was statistically significant. In addition, patients treated by Target: Stroke strategies were less likely to develop the complication of symptomatic intracranial hemorrhage.
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Stroke: More Patients Getting Faster Treatment, Fewer ComplicationsMedicalResearch.com Interview with:Dr. Gregg C. Fonarow MDDirector, Ahmanson-UCLA Cardiomyopathy CenterProfessor, Department of Medicine Associate Chief, Cardiology
• MedicalResearch.com: Were any of the findings unexpected?• Dr. Fonarow: While there have been concerns that attempting to achieve shorter DTN times
may lead to rushed assessments, inappropriate patient selection, dosing errors, and greater likelihood of complications, our findings suggest that more rapid reperfusion therapy in acute ischemic stroke is feasible and, importantly, can be achieved not only without increasing rates of symptomatic intracranial hemorrhage, but with actual reductions in complications and improvements in overall tPA treatment rates.
• While the clinical outcome improvements observed in this study and their magnitude are consistent with those expected with more timely tPA treatment based prior studies in acute ischemic stroke, these findings stand in contradistinction to an analysis involving 515 hospitals and 96,738 admissions in which reductions in door-to-balloon times in ST-segment elevation myocardial infarction were not accompanied by any changes in short-term mortality rates. This difference potentially reflects greater sensitivity of the brain versus the heart to functionally relevant ischemia progression over time spans of several minutes.
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Stroke: More Patients Getting Faster Treatment, Fewer ComplicationsMedicalResearch.com Interview with:Dr. Gregg C. Fonarow MDDirector, Ahmanson-UCLA Cardiomyopathy CenterProfessor, Department of Medicine Associate Chief, Cardiology
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Fonarow: The Target: Stroke quality improvement initiative was highly successful in
improve stroke care and clinical outcomes at the national level. These findings also further reinforce the importance and clinical benefits of faster administration of intravenous tPA. By showing that the timeliness of tPA administration can be improved at the national level, these findings also support further expansion of the Target: Stroke initiative.
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Stroke: More Patients Getting Faster Treatment, Fewer ComplicationsMedicalResearch.com Interview with:Dr. Gregg C. Fonarow MDDirector, Ahmanson-UCLA Cardiomyopathy CenterProfessor, Department of Medicine Associate Chief, Cardiology
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Fonarow: The American Heart Association/American Stroke Association will be launching Target: Stroke Phase II to further improve the timeliness of tPA administration and clinical outcomes for acute ischemic stroke. The Phase II Program goal is to increase the proportion of patients with door-to-needle times within 60 minutes to 75% and to achieve door-to-needle times of 45 minutes or less in at least 50% of patients.
• Citation: • Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes
in Acute Ischemic Stroke Before and After a Quality Improvement Initiative• Gregg C. Fonarow MD, Xin Zhao MS, Eric E. Smith MD, MPH, Jeffrey L. Saver MD, Mathew J.
Reeves PhD, Deepak L. Bhatt MD, MPH, Ying Xian MD, PhD, Adrian F. Hernandez MD, MHS, Eric D. Peterson MD, MPH, Lee H. Schwamm MD
• JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203
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Rare Childhood Disorder Enhances Understanding of Resistance to Viral InfectionsMedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhDDirector, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of
Health Bethesda, MD, 20892• MedicalResearch.com: What are the main findings of the study?• Dr. Rosenzweig: We diagnosed a disease called CDG-IIb in two siblings with severe
development issues and very low levels of immunoglobulins, which include infection-fighting antibodies. These children were referred to the NIAID Primary Immunodeficiency Clinic through the NIH Undiagnosed Diseases Program. CDG-IIb is an extremely rare congenital disorder of glycosylation (CDG), with only one other case reported. The genetic defect of the disease disrupts glycosylation, the process for attaching and trimming sugars from proteins. Almost 50% of our proteins have sugars attached, and these are called glycoproteins. They include immunoglobulins and also some viral glycoproteins that are made when cells are infected by a virus. The spread of some viruses, including HIV and influenza, depend on viral glycoproteins in order to infect additional cells and form viral protective shields. We found that this type of virus was less able to replicate, infect other cells, or create adequate protective shields in CDG-IIb patient cells because of the glycosylation defect. In comparison, adenovirus, poliovirus, and vaccinia virus, which either do not rely on glycosylation or do not form protective glycoprotein shields, replicated normally when added to both CDG-IIb and healthy cells.
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Rare Childhood Disorder Enhances Understanding of Resistance to Viral InfectionsMedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhDDirector, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of
Health Bethesda, MD, 20892• MedicalResearch.com: Were any of the findings unexpected?• Dr. Rosenzweig: While most of our patients’ clinical manifestation fit into what would be
expected in patients with CDGs, the fact that they also presented with severe hypogammaglobulinemia (low levels of immunoglobulins) but did not have increased rates of infections was paradoxical, because patients with severe hypogammaglobulinemia typically have recurrent and severe bacterial and viral infections.
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Rare Childhood Disorder Enhances Understanding of Resistance to Viral InfectionsMedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhDDirector, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of
Health Bethesda, MD, 20892• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Rosenzweig: There are 3 major lessons we learned from these patients:• First, they taught us that hypogammaglobulinemia not only could arise from production
defects (T and B cell disorders), or loss of immunoglobulins through stools and urine, but also due to intrinsic immunoglobulin defects related to the glycosylation pattern, which in turn determines the half life, or stability, of these molecules.
• Second, and perhaps the most important lesson we learned, is that we may potentially treat individuals with molecules that modify glycosylation, and this may afford protection against infection from glycosylation-dependent viruses.
• Last, but not least, these children reinforce the concept that by taking care of patients with very rare diseases, we can learn about basic mechanisms that not only help us to understand their uncommon diseases but can be generalized and extended for the benefit of the rest of the population.
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Rare Childhood Disorder Enhances Understanding of Resistance to Viral InfectionsMedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhDDirector, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of
Health Bethesda, MD, 20892• MedicalResearch.com: What recommendations do you have for future research as a result
of this study?• Dr. Rosenzweig: We are exploring the possibility of using drugs that modify glycosylation to
prevent and treat certain viral infections that depend on glycoproteins for the infection to spread. Besides HIV and influenza, which we already show in our work, other candidates may be dengue, respiratory syncytial virus (RSV) or even ebola virus, all microorganisms with very important clinical and epidemiological impacts.
• • Citation:
Brief Report: Glycosylation, Hypogammaglobulinemia, and Resistance to Viral Infections• M.A. Sadat and Others
NEJM Published Online: April 9, 2014
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Diabetes: Nocturnal Hypoglycemia and Risk of Cardiac ArrhythmiasMedicalResearch.com Interview with:Prof. Simon R. Heller Professor of Clinical DiabetesDepartment of Human MetabolismUniversity of Sheffield, Sheffield, U.K.
• MedicalResearch.com: What are the main findings of the study?• Prof. Heller: We explored the potential to hypoglycaemia to cause cardiac arrhythmias since we
have previously shown that a low glucose can alter the electrocardiogram. We had a hypothesis that alterations in heart rhythm or ectopic beats might contribute to cardiac mortality and in part explain the association between intensive diabetic therapy and increased mortality. We therefore undertook continuous glucose monitoring and 12 lead EKG monitoring for a period of 5 days in individuals with Type 2 diabetes at increased CV risk. We found that hypoglycaemia was fairly common and that nocturnal episodes in particular, were generally marked by a pattern whereby glucose levels dropped to low levels for some hours during which patients slept. These periods of hypoglycemia were associated with a high risk of marked slow heart rates (bradycardia) accompanied by ectopic beats. Our data suggest that this was due to overactivity of the vagus nerve. We have therefore identified a mechanism which might contribute to increased mortality in individuals with Type 2 diabetes and high CV risk during intensive insulin therapy.
• MedicalResearch.com: Were any of the findings unexpected?• Prof. Heller: We were surprised to see how common, prolonged episodes of hypoglycaemia were
in these patients with type 2 diabetes and that these were symptomatic (i.e. patients slept through them) although such a pattern has been described in people with type 1 diabetes, particularly children. We also didn’t expect to see these very slow heart rates during nocturnal hypoglycaemic episodes.
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Diabetes: Nocturnal Hypoglycemia and Risk of Cardiac ArrhythmiasMedicalResearch.com Interview with:Prof. Simon R. Heller Professor of Clinical DiabetesDepartment of Human MetabolismUniversity of Sheffield, Sheffield, U.K.
• MedicalResearch.com: What should clinicians and patients take away from your report?• Prof. Heller: There should be no undue cause of alarm among patients. These slow heart rates while a
cause for concern, were not in this study associated with any very serious heart rhythms. However it does suggest that even those with standard insulin therapy and who are not aiming for intensive glucose targets should be aware of the risk of running low overnight (particularly if they have known cardiovascular disease), perhaps check their blood glucose in the middle of the night every now and then and work with their doctor to either change insulin dose timing or type to minimize the risk of prolonged episodes of hypoglycemia overnight.
• Clinicians responsible for the care of insulin treated patients with type 2 diabetes need to be more aware of the potential for prolonged nocturnal episodes of hypoglycemia at night to check for it and alter therapy to reduce the risk especially for those who have known CV disease.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Prof. Heller: More research of this type needs to be undertaken, with larger numbers, perhaps with Holter monitoring to see how common these abnormal heart rates and rhythms are occurring in people with type 2 diabetes at CV risk. More studies of the effect of hypoglycaemia on nerve function affecting the heart (autonomic nervous system) should also be undertaken, particularly in patients with diabetes.
• Citation:• Elaine Chow, Alan Bernjak, Scott Williams, Robert A. Fawdry, Steve Hibbert, Jenny Freeman, Paul J. Sherid
an, and Simon R. Heller• Risk of Cardiac Arrhythmias During Hypoglycemia in Patients With Type 2 Diabetes and Cardiovascular Ris
k Diabetes May 2014 63:5 1738-1747; doi:10.2337/db13-0468 1939-327X
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Vitamin D Did Not Alter Risk of FallsMedicalResearch.com Interview with:Dr Mark Bolland, PhDBone and Joint Research Group, Department of MedicineUniversity of Auckland, Auckland, New Zealand
• MedicalResearch.com: What are the main findings of the study?• Prof. Bolland: In a meta-analysis of 20 randomized clinical trials, there was no effect of vitamin D with or without calcium on
falls. In a trial sequential analysis of these trials, the effect estimate for vitamin D with or without calcium on falls lay within the futility boundary, providing reliable evidence that vitamin D supplementation does not alter the relative risk of falls by ≥15% and suggesting that future trials that are similar in design to current trials are unlikely to change that conclusion.
•MedicalResearch.com: Were any of the findings unexpected?
• Prof. Bolland: Previously meta-analyses have reported conflicting results on the effect of vitamin D on falls, but a number of large, fairly recent randomised clinical trials have reported either harm or no effect of vitamin D on falls. The most recent meta-analyses that include these trials, generally report similar findings to ours. The results are in broad agreement with a number of recent meta-analyses and systematic reviews that report no effect of vitamin D supplements in community dwelling individuals on a very broad range of health outcomes including fracture, bone density, cancer, and cardiovascular events.
• MedicalResearch.com: What should clinicians and patients take away from your report?• Prof. Bolland: There is little justification currently for prescribing vitamin D to prevent falls. People who are at risk of
osteomalacia because of very low vitamin D levels (frail elderly people living in residential care, people who actively avoid the sun, and people with deeply pigmented skin) should consider taking vitamin D supplements. For others, vitamin D supplements are not necessary.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Prof. Bolland: Research should focus on better defining what vitamin D level is adequate for health, rather than carrying out
more trials of vitamin D supplements that are similar to the existing ones.• Citation:
The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysisDr Mark J Bolland PhD,Andrew Grey MD,Greg D Gamble MSc,Prof Ian R Reid MDThe Lancet Diabetes & Endocrinology – 1 April 2014 ( Vol. 2, Issue 4, Pages 307-320 ) DOI: 10.1016/S2213-8587(13)70212-2
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Cannabis Associated Cardiovascular Complications IncreaseMedicalResearch.com Interview with:Emilie Jouanjus, PharmD, PhDRisques, maladies chroniques et handicaps Facult_e de M_edecine,Guesde, Toulouse 31073, France.
• MedicalResearch.com: What are the main findings of the study?• Dr. Jouanjus: Our study emphasizes that cardiovascular complications make up 1.8 percent of
cannabis-related health complications reported in France. These were cases of peripheral arteriopathies, and cardiac and cerebrovascular disorders, some of which resulted in the death. These findings conducted us to conclude that marijuana is a possible risk factor for cardiovascular disease in young adults.
• MedicalResearch.com: Were any of the results unexpected?• Dr. Jouanjus: In a previous study, we had been stunned to observe several very serious cases
of cardiovascular complications in young cannabis users (Jouanjus et al. British Journal of Clinical Pharmacology, 2011: 71; 758-65). With the present work, we were willing to explore at the national level whether such cases were described, and to survey their evolution across time. Cardiovascular or cerebrovascular disorders and peripheral arteriopathies arisen in 34 years old (on average) cannabis users confirmed our fears. Cases were remarkably serious, or even lethal. Moreover, their report has constantly increased, especially during the last three observed years. This result is surprising considering that cardiovascular complications, when toxic cause is suspected, are more commonly attributed by doctors to cocaine or amphetamine use. These results raise concern about the harmful potential of marijuana and its impact on public health, notably because its medicinal use has become more prevalent in particular since some governments are legalizing its use.
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Cannabis Associated Cardiovascular Complications IncreaseMedicalResearch.com Interview with:Emilie Jouanjus, PharmD, PhDRisques, maladies chroniques et handicaps Facult_e de M_edecine,Guesde, Toulouse 31073, France.
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Jouanjus: Cannabis use is commonly thought to be harmless, however, there is now compelling
evidence on the growing risk of cannabis-associated adverse cardiovascular effects, especially in the Young. It is therefore important that users as well as clinicians be aware of this. Doctors, including cardiologists, must consider cannabis use as one of the potential causes of cardiovascular disorders. Indeed, exposure to cannabis should be systematically investigated in patients presenting with cardiovascular problems. This should contribute to improve the clinical management of cannabis using patients, as well as prognosis of the pathologies their suffer from.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Jouanjus: The surveillance of cannabis-related reports of cardiovascular disorders needs to be
maintained. Furthermore, fundamental experiments would be of interest to ascertain the mechanisms through which cannabis may trigger such cardiovascular disorders, especially since its medicinal use is increasing. Actually, the precise pathways involved are still debated and remain somehow controversial. Their elucidation would help in understanding how harmful cannabis may be, in particular in young people. The return expected concerns prevention and therapeutics, with meaningful impact towards public health.
• Citation:• Cannabis Use: Signal of Increasing Risk of Serious Cardiovascular Disorders• Emilie Jouanjus, PharmD, PhD; Maryse Lapeyre-Mestre, MD, PhD; Joelle Micallef, MD, PhD; The French Ass
ociation of the Regional Abuse• and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications*• Journal of the American Heart Association Journal Report: April 23 2014
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Bone Mineral Density: What is Impact of Change in Physician Reimbursement?MedicalResearch.com Interview with:Susan Jaglal, PhDSenior Scientist Toronto Rehabilitation Institute University of Toronto,Toronto, Ontario
• MedicalResearch.com: What are the main findings of the study?• Dr. Jaglal: Bone Mineral Density (BMD) tests are used to both diagnose osteoporosis and assess and individual’s risk of fracture. While the tests play an
important role in bone health, they are sometimes ordered inappropriately. For example, while women age 40-44 are typically not at risk of fragility fracture or in need of Bone Mineral Density testing, these individuals received almost half the Bone Mineral Density tests performed in Ontario in 2007/2008.
• Policy changes have been made in recent years in an effort to curb unnecessary testing of low risk individuals in both the United States and Canada. Policy efforts in Ontario included a 2008 fee schedule change that limited repeated testing among low-risk patients and included a new fee code for a “baseline” tests. Patients were limited to 1 baseline test in their lifetime.
• The goal of the present study was to determine the impact of this fee schedule change on Bone Mineral Density testing rates. The study was based on an analysis of provincial administrative data including physician billings, hospital discharges, and emergency department visits.
• Results demonstrated that while fee schedule changes were associated with a decrease in BMD testing rates, the decreases affected both low and high-risk patients. Most decreases were seen in testing rates of low-risk women. However, the associated decrease in testing among high-risk patients (e.g., those over 65 or with a recent fracture) is concerning, as high-risk patients benefit from screening and monitoring of Bone Mineral Density.
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Jaglal: Current clinical guidelines for Bone Mineral Density testing need to be better communicated to both clinicians and patients. Osteoporosis
Canada currently suggests baseline Bone Mineral Density testing for all men and women who are over age 65. Men and women who are over 50 and have clinical risk factors for fracture, like low body weight or history of fragility fracture, should also be tested. Clinicians should be aware that men and women under age 50 typically should not be tested unless major risk factors for bone loss exist.
• While it is important to curb testing rates among low risk women (i.e., those under age 50), this cannot be done at the expense of testing individuals who are genuinely at risk. Testing rates for individuals following a recent fragility fracture were low before fee schedule changes and are now lower. Similarly, testing rates in Ontario for eligible seniors remain below 50% and have been declining among women since fee schedule changes. These two groups of at-risk patients need to be better identified in practice and screened.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Jaglal: Why the change in the Ontario fee schedule reimbursement was associated with such a dramatic decrease in the rate of testing among patients
with recent fracture is of particular concern. Additional research to understand the failure to enforce guidelines in this patient population is required. What is not known from this study is the appropriateness of testing. Future research needs to determine if those who were not tested more likely to have normal Bone Mineral Density. This would require information on BMD test result.
• Citation:• Susan Jaglal, Gillian Hawker, Ruth Croxford, Cathy Cameron, Anne-Marie Schott, Sarah Munce, and Sonya Allin• Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study
cmajo 2:E45-E50; published online March 31, 2014, doi:10.9778/cmajo.2013-0052
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Dementia Symptoms Management in Clinical Settings: Panel RecommendationsMedicalResearch.com Interview with Helen C. Kales MDProfessor of Psychiatry Director
, Section of Geriatric Psychiatry and The Program for Positive Aging, University of MichiganResearch Scientist, VA Center for Clinical Management Research and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System• Please note that this paper is the result of the deliberations of a multi-disciplinary national expert
panel, not a specific study.• MedicalResearch.com: What were the main findings of the expert panel?• Dr. Kales: Often more than memory loss, behavioral symptoms of dementia are among the most
difficult aspects of caring for people with dementia. These symptoms are experienced almost universally, across dementia stages and causes, and are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment. Doctors often prescribe these patients psychiatric medications like antipsychotics, despite little hard evidence that they work well in this population and despite the risks they pose including hastening death. Meanwhile, studies show promise for non-medication behavioral and environmental approaches (such as providing caregiver education/support, creating meaningful activities and simplifying/enhancing the environment), but too few health providers are trained in their use. The method created by the national multidisciplinary group of experts (DICE which stands for Describe, Investigate, Create and Evaluate) represents a comprehensive approach to assessment and management of behavioral symptoms in dementia. For example, a new report of “agitation” from a caregiver, should be fully understood and described (e.g. who/what/when/where/risk/safety); underlying causes should be investigated (e.g. pain, changes in medications, medical conditions, poor sleep, fear); a treatment plan should be created (e.g. responding to physical problems, working collaboratively with the caregiver and other team members to institute non-pharmacologic interventions); and evaluating whether the interventions tried were effective.
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Dementia Symptoms Management in Clinical Settings: Panel RecommendationsMedicalResearch.com Interview with Helen C. Kales MDProfessor of Psychiatry Director
, Section of Geriatric Psychiatry and The Program for Positive Aging, University of MichiganResearch Scientist, VA Center for Clinical Management Research and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System• MedicalResearch.com: Were any of the findings unexpected?• Dr. Kales: Given the mixed evidence-base for most psychotropics used for behavioral
symptoms of dementia, several of the expert panelists were hesitant recommend first-line treatment with medications under any circumstances. Others noted that lack of homogeneity of behavioral symptoms in prior trials may have been problematic. Given the limitations of the current evidence base, the panel consensus was that psychotropic drugs should only be used after significant efforts have been made to mitigate behavioral symptoms using behavioral and environmental modifications and medical interventions (e.g. treatment of a urinary tract infection that could underlie behavioral changes), with three exceptions. In each of the three “exceptions”, medication use would follow a concern for significant and imminent risk:
• · Major depression with or without suicidal ideation• · Psychosis causing harm or great potential of harm• · Aggression causing risk to self or others• If medications are used, close followup is needed to monitor for adverse effects and use
should be time-limited as behaviors and symptoms may resolve over time with or without drug intervention.
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Dementia Symptoms Management in Clinical Settings: Panel RecommendationsMedicalResearch.com Interview with Helen C. Kales MDProfessor of Psychiatry Director
, Section of Geriatric Psychiatry and The Program for Positive Aging, University of MichiganResearch Scientist, VA Center for Clinical Management Research and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System• MedicalResearch.com: What should clinicians and patients take away from this report?• Dr. Kales: The DICE approach offers clinicians an evidence-informed structured approach that can be
integrated into diverse practice settings. The approach is inherently patient- and caregiver- centered because the concerns of individuals with dementia and their caregivers are integral to each step of the process. DICE enables clinicians to consider conjointly the role of nonpharmacological, medical and pharmacologic treatments.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Kales: Ultimately, developing technology applications of DICE (e.g. in the form of an “app”) may simplify its use, save time, standardize its application and facilitate evaluation of its effectiveness. Drs. Kales and Gitlin are Co-PIs on a grant from the National Institute of Nursing Research (R01NR014200) creating and testing the approach using technology with the benefit of key stakeholder (patient, caregiver and provider) input.
• Citation:• Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from
a Multidisciplinary Expert Panel
Kales HC1
, Gitlin LN, Lyketsos CG; Detroit Expert Panel on the Assessment and Management of the Neuropsychiatric Symptoms of Dementia.
J Am Geriatr Soc. 2014 Apr;62(4):762-9. doi: 10.1111/jgs.12730. Epub 2014 Mar• Read the rest of the interview on MedicalResearch.com
Autism and Prenatal Exposure to SSRIsMedicalResearch.com Interview with Li-Ching Lee, PhD, ScMAssociate Scientist, Departments of Epidemiology and Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimore MD 21205
• MedicalResearch.com: What are the main findings of the study?• Dr. Li-Ching Lee: This population-based case-control study in young children provides evidence that
prenatal selective serotonin reuptake inhibitor (SSRI) use may be a risk factor for autism and other developmental delays (DD). Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with autism spectrum disorder (ASD) relative to children with typical development; the strongest association occurred with first-trimester exposure. Exposure was also elevated among boys with DD and was strongest in the third trimester.
• MedicalResearch.com: Were any of the findings different from previous studies?• Dr. Li-Ching Lee: Recent ASD studies using electronic medical records and registries included large
samples of pregnant women with prospectively collected medication use. However, ASD diagnoses were not validated. Furthermore, studies by Croen et al (2011) using Kaiser patients and by Hviid et al (2013) using Danish registries were unable to confirm whether dispensed SSRIs were actually taken by mothers, whereas the Rai et al (2013) study from Stockholm, Sweden, only included self-reported use at the first antenatal visit. The Kaiser and Swedish studies reported modestly increased autism spectrum disorder risk among children prenatally exposed to SSRIs, independent of maternal mental health, whereas no significant differences were observed in the Danish cohort. Similar to our results, the Kaiser study found the highest risk with first-trimester use. The Swedish study could not assess timing of use. Neither assessed differences in SSRI effects by child gender. Similar to the Danish cohort results, we found no association when boys and girls were combined. Hviid et al reported no data on gender, nor gender-stratified analyses.
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Autism and Prenatal Exposure to SSRIsMedicalResearch.com Interview with Li-Ching Lee, PhD, ScMAssociate Scientist, Departments of Epidemiology and Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimore MD 21205
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Li-Ching Lee: Because of low exposure prevalence and possible cofactors influencing susceptibility to
autism spectrum disorder from SSRI exposure, any contribution of these medications to the increase in autism diagnoses over time is likely minimal. The reported results must be viewed in the context of the disorder SSRIs are used to treat and, particularly, with the risks associated with failure to treat the condition. Maternal depression during pregnancy has itself been linked to preterm birth, fetal growth restriction, and preeclampsia, as well as increased irritability in newborns and reduced activity and attentiveness compared with infants of nondepressed women. Given these negative consequences, depression during pregnancy and the positive aspects of pharmacologic management present pregnant women and their doctors with complex treatment decisions. The benefits of treating depression with SSRIs during pregnancy should continue to be carefully weighed against any potential risk of harm.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Li-Ching Lee: Whether the risk of DDs other than autism spectrum disorder is also elevated in association
with prenatal SSRI exposure requires confirmation with a larger sample size; research might usefully address how maternal SSRI use is affected by the knowledge of predisposing genetic conditions. Also needed are studies in more girls, sufficient sample sizes to address possible differential effects from specific SSRIs, and attention to mechanisms by which SSRIs might influence autism spectrum disorder and other developmental outcomes. The field would benefit from a deeper understanding of the contribution of maternal and fetal genetics in regulating serotonin.
• Citation:Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay
• Rebecca A. Harrington, Li-Ching Lee, Rosa M. Crum, Andrew W. Zimmerman, and Irva Hertz-Picciotto• Pediatrics peds.2013-3406; published ahead of print April 14, 2014, doi:10.1542/peds.2013-3406
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Stroke: Specialized Ambulances Improved Treatment Time, Costs May Be ProhibitiveMedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin EbingerOberarzt der Klinik und Hochschulambulanz für Neurologie am Campus Charité Mitte
Center for Stroke Research Berlin (CSB) Charitéplatz 1 | 10117 Berlin | Germany
• MedicalResearch.com: What are the main findings of the study?• Dr. Ebinger: The main findings of our study was a significant time reduction during
randomized weeks with prehospital thrombolysis compared to control weeks with regular care.
MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Ebinger: Prehospital thrombolysis increased thrombolysis rate to 33%, reduced time from
alarm-to-treatment and was not associated with increased risks.• MedicalResearch.com: What recommendations do you have for future research as a result
of this study?• Dr. Ebinger: Researchers in emergency medicine may rethink the opportunities to place
certain time critical interventions into the prehospital phase.Citation:
• Effect of the Use of Ambulance-Based Thrombolysis on Time to Thrombolysis in Acute Ischemic Stroke: A Randomized Clinical Trial
Martin Ebinger MD, Benjamin Winter MD, Matthias Wendt MD, Joachim E. Weber MD, Carolin Waldschmidt MD, Michal Rozanski MD, Alexander Kunz MD, Peter Koch MD, Philipp A. Kellner MD, Daniel Gierhake MD, Kersten Villringer MD, Jochen B. Fiebach MD, Ulrike Grittner PhD, Andreas Hartmann MD, Bruno-Marcel Mackert MD, Matthias Endres MD, Heinrich J. Audebert MD
• JAMA. 2014;311(16):1622-1631. doi:10.1001/jama.2014.2Read the rest of the interview on MedicalResearch.com
Brain AV Malformations: Conservative Treatment May Be Best For Stable LesionsMedicalResearch.com Interview with: Rustam Al-Shahi SalmanProfessor of clinical neurology and MRC senior clinical fellowUniversity of Edinburgh
Honorary consultant neurologist, NHS Lothian
• MedicalResearch.com: What are the main findings of the study?• Prof. Al-Shahi Salman: Patients with arteriovenous malformations (abnormal connection between arteries and
veins) in the brain that have not ruptured had a lower risk of stroke or death for up to 12 years if they received conservative management of the condition compared to an interventional treatment.
• Interventional treatment for brain arteriovenous malformations (bAVMs)with procedures such as neurosurgical excision, endovascularembolization, or stereotactic radiosurgery can be used alone or incombination to attempt to obliterate bAVMs. Because interventions mayhave complications and the untreated clinical course of unrupturedbAVMs can be benign, some patients choose conservative management (nointervention). Guidelines have endorsed both intervention andconservative management for unruptured brain arteriovenous malformations. Whether conservative management is superior to interventional treatment for unrupturedbAVMs is uncertain because of the lack of long-term experience,according to background information in the article.
• Rustam Al-Shahi Salman, Ph.D., of the University of Edinburgh,Scotland, and colleagues with the Scottish Audit of IntracranialVascular Malformations Collaborators, studied 204 residents ofScotland (16 years of age or older) who were first diagnosed as havingan unruptured bAVM during 1999-2003 or 2006-2010 and followed overtime. The researchers analyzed the outcomes for patients who receivedconservative management (no intervention; medications for seizures) oran intervention (any endovascular embolization, neurosurgicalexcision, or stereotactic radiosurgery alone or in combination).
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Brain AV Malformations: Conservative Treatment May Be Best For Stable LesionsMedicalResearch.com Interview with: Rustam Al-Shahi SalmanProfessor of clinical neurology and MRC senior clinical fellowUniversity of Edinburgh
Honorary consultant neurologist, NHS Lothian
• Of the 204 patients, 103 underwent some type of intervention. Thosewho underwent intervention were younger, more likely to have presentedwith seizure, and less likely to have large bAVMs than patientsmanaged conservatively. During a median (midpoint) follow-up of 6.9years, the rate of progression to sustained disability or death waslower with conservative management during the first 4 years offollow-up, but rates were similar thereafter. The rate of nonfatalstroke or death (due to the brain arteriovenous malformation or intervention) was lower with conservative management during 12 years of follow-up (14 vs 38 events).
• MedicalResearch.com: Were any of the findings unexpected?• Prof. Al-Shahi Salman: These findings are very similar to the results of the ARUBA trial,
recently published in The Lancet. Comparing this population-basedobservational study and the ARUBA trial, treated participants weresimilar in age and sex, and in the frequencies of incidentalpresentation, bAVM location, superficial venous drainagepattern, and Spetzler-Martin grades. The frequency of multimodalityintervention was similar in ARUBA and this observational study. In theconservative management group, the event rate was similar in ARUBA andthis observational study. Finally, the association betweenconservative management and stroke or death related to bAVM or itsintervention during 12 years in the observational study (adjustedhazard ratio [HR] 0·37, 95% CI 0·19–0·72) was similar to the effect ofconservative management on stroke or death of any cause during 6 yearsin the ARUBA randomised analysis (0·27, 0·14–0·54).
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Brain AV Malformations: Conservative Treatment May Be Best For Stable LesionsMedicalResearch.com Interview with: Rustam Al-Shahi SalmanProfessor of clinical neurology and MRC senior clinical fellowUniversity of Edinburgh
Honorary consultant neurologist, NHS Lothian
• MedicalResearch.com: What should clinicians and patients take away from your report?• Prof. Al-Shahi Salman: The similarity of the results of this observational study and ARUBA
and the persistent difference between the outcome of conservativemanagement and intervention during 12-year follow-up in our studysupport the superiority of conservative management to intervention forunruptured bAVMs, which may deter some patients and physicians fromintervention.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Prof. Al-Shahi Salman: Long-term follow-up in both this study and the ARUBA trial is needed to establish whether the superiority of conservative management willpersist or change.
• Citation:• Outcome After Conservative Management or Intervention for Unruptured Brain Arteriovenou
s Malformations• Rustam Al-Shahi Salman PhD, Philip M. White FRCR, Carl E. Counsell MD, Johann du Plessis FR
CR, Janneke van Beijnum MD, Colin B. Josephson MD, Tim Wilkinson MRCP, Catherine J. Wedderburn MBChB, Zoe Chandy MB, ChB, E. Jerome St. George FRCS, SN, Robin J. Sellar FRCR, Charles P. Warlow FRCP
• JAMA. 2014;311(16):1661-1669. doi:10.1001/jama.2014.3200Read the rest of the interview on MedicalResearch.com
Cancer Survivors: Discussions of Survivorship Have Room For ImprovementMedicalResearch.com Interview with:Danielle Blanch Hartigan, PhD, MPHCancer Prevention FellowNational Cancer Institute
• MedicalResearch.com: What are the main findings of the study?• Dr. Blanch-Hartigan: Results from this nationally-representative survey of oncologists and
PCPs suggest that discussion of survivorship care planning with cancer survivors does not always occur. Training and knowledge specific to survivorship care and coordinated care between PCPs and oncologists were associated with increased survivorship discussions with survivors.
•MedicalResearch.com: Were any of the findings unexpected?
• Dr. Blanch-Hartigan: Less than 5% of oncologists nationwide reported consistently giving survivors a written survivorship care plan and having discussions of follow-up care with survivors.
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Cancer Survivors: Discussions of Survivorship Have Room For ImprovementMedicalResearch.com Interview with:Danielle Blanch Hartigan, PhD, MPHCancer Prevention FellowNational Cancer Institute
• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Blanch-Hartigan: Creating a written survivorship care plan may not be enough;
oncologists and PCPs should involve survivors in the survivorship care planning process through discussions of recommendations for follow-up care.
• MedicalResearch.com: What recommendations do you have for future research as a result of this study?
• Dr. Blanch-Hartigan: In addition to providing a benchmark to assess implementation of new survivorship care mandates, future research should develop intervention studies to test the hypothesis that improved care coordination and enhanced physician survivorship training will increase the frequency of survivorship care discussions and downstream positive health outcomes for the survivor.
• • Citation:• Provision and Discussion of Survivorship Care Plans Among Cancer Survivors: Results of a Nati
onally Representative Survey of Oncologists and Primary Care Physicians• Danielle Blanch-Hartigan, Laura P. Forsythe, Catherine M. Alfano, Tenbroeck Smith, Larissa Ne
khlyudov, Patricia A. Ganz, and Julia H. Rowland• JCO JCO.2013.51.7540; published online on April 21, 2014;
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