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Tom Arild Torstensen Department of Neurobiology, Care Sciences and Society Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden and Holten Institute, Stockholm, Sweden MedicalResearch.com: What is the background for this study? Response: People suffering from pain due to knee osteoarthritis (OA) is a major and increasing problem. There there is today good scientific evidence for different forms of exercise therapy, but there is no agreement regarding what type of exercises and what dose of exercise therapy is best. Thus, we wanted to investigate if high dose medical exercise therapy is superior to low dose. MedicalResearch.com: What are the main findings? Response:  The main findings from this superiority study do not support our hypothesis that high-dose exercise is superior to low-dose exercise. The only differences favoring high-dose exercise were in the domain of knee function during sports and recreation at the end of treatment and 6 months after the intervention and in the QoL domain at 6 months. Notably, most variables numerically favored the high-dose group, albeit not in a statistically or clinically meaningful way. Adherence was nearly perfect in the low-dose exercise group but was lower in the high-dose exercise group. No adverse events were reported. MedicalResearch.com: What should readers take away from your report? Response: Our study was designed as a superior trial, meaning that even though we failed to show that high-dose treatment is better than low-dose treatment, our results do not imply that a low-dose exercise regimen is as beneficial as a high-dose regimen. Interestingly, it seems that high-dose treatment could be preferable to low-dose treatment in the long run for people who lead active lives. This should be the subject of future studies. In the discussion we refer to positive and negative expectations (placebo/nocebo) in relation to pain as a homeostatic feeling (1 and 2) and that those mechanisms might have overrided the physiological effects of the difference in exercise dose during the 12 week intervention period. These mechanisms are surely present in our study because all patients in both high-dose and low-dose were supervised during the treatment by experienced physiotherapists. The basis for medical exercise therapy is close supervision using graded exercise therapy as a form of cognitive behavioral therapy applying methods like exposure and acceptance. It might be that the feeling state of pain is the game changer and when a person is experiencing pain and seeking help from a health professional the most important factor for a decrease in symptoms are the positive experience of being helped by the physiotherapist. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: I believe we have to update our understanding of pain as a homeostatic emotion (1 and 2). That anxiety and pain are similar entities and the importance of health professionals being present with the patient supporting - communicating - with the patient during the treatment phase is fundamental for achieving a positive outcome. I also think we need to take a step back and do more RCTs having a comparison group with a minimal type of treatment but still getting the attention from the therapist exploring how important positive expectations (placebo) and negative expectations (nocebo) really are. As human beings we are social animals depending on each other, seeking help when we are not able to solve the problem ourselves. Thus we should stop looking at placebo as something negative. Instead we should look at positive expectations (placebo) and negative expectations (nocebo) as thoughts and feelings that makes us human. All the time we are thinking this is good or that is bad. And finally, when I treat a patient and designing an exercise program I am the exercises. The exercises are an extension of me, my personality, my thoughts and feeling, that I through the exercise give to the patient to help the patient. Citations: 1) Tom Arild Torstensen, Håvard Østerås, Riccardo LoMartire, et al. High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis: A Randomized Controlled Multicenter Trial. Ann Intern Med. . doi:10.7326/M22-2348 2) Larkin H. Both High- and Low-Dose Exercise Therapy Help Knee Osteoarthritis. JAMA. Published online February 01, 2023. doi:10.1001/jama.2023.0746 https://jamanetwork.com/journals/jama/fullarticle/2801204 3)     Craig AD. A new view of pain as a homeostatic emotion. Trends Neurosci 2003;26:303–7. 4)     Ingvar M. Learning mechanisms in pain chronification - teachings from placebo research. Pain 2015;156:S18–S23 “The seminal article of Craig with the description of pain as a homoeostatic emotion  moved the field away from the concept of a “searching for pain center” in the brain to a systems-oriented understanding. The experience of pain was put in a behavioural perspective and the dynamics of the preprogrammed complex emotional reactions to acute pain were explained in terms of a dynamic regulatory system. Just as in all other expressions of emotion, the homoeostasis model for understanding pain provides both a basis for a prolongation of the feeling state but also, at the same time, an effective measure of social communication to alert others of, eg, danger. In addition, such a mechanism also serves to raise empathic responses in the group. The understanding of pain as a homoeostatic emotion has also contributed to the understanding of affective comorbidity in different pain syndromes because the mechanisms of both lowered mood and anxiety are based on similar regulatory mechanisms. However, the mentioned mechanisms are mostly represented in the phylogenetically old components of the central nervous system. The role of the cerebral cortical regulation in chronic pain remains a challenge to fully explain”, Ingvar M (2015) pp:S18, line 13-31 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

Dr. Ristić Igor Ristić, Ph.D. (he/him) Public Affairs Specialist, Media Relations Branch National Cancer Institute National Institutes of Health MedicalResearch.com: What is the background for this study? Response: Tea is rich in bioactive compounds that can possibly protect against health conditions such as cancer and heart disease. A lower risk of death was seen among tea drinkers than non-drinkers in previous studies, but these were largely in populations where green tea drinking is common. In contrast, the studies in populations where black tea drinking is more common have been limited and the findings from these studies have been inconsistent. MedicalResearch.com: What are the main findings? Any particular type of tea? Response:  We found that people who drank 2 or more cups of tea every day had a lower risk of death than people who didn’t drink tea during 14-years of follow up in a very large study of nearly half a million people in the United Kingdom, where more than 4 out of 5 people reported drinking tea every day. Similar findings were seen among people who added milk or sugar to their tea. These findings were also seen regardless of tea temperature or whether people had genetic variants that affect caffeine metabolism. While we did not analyze by tea type, almost 90% of tea drinkers in this study drank black tea. MedicalResearch.com: What should readers take away from your report? Response: Our findings indicate that black tea can be part of a healthy diet and may offer reassurance to tea drinkers. Nevertheless, people should not make decisions about whether or not to start drinking tea or how much tea they drink based on findings from a single study. These findings need to be replicated and extended to other populations with different lifestyles. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Although we carefully assessed the associations of tea drinking and a risk of death, this study is observational in nature, and we cannot be certain that other poorly measured or unmeasured factors may have impacted our results. Also, this study was performed in a predominantly White population with a relatively high socioeconomic status. Future studies are needed to extend these findings to other populations with different lifestyles and more diverse populations. MedicalResearch.com: Is there anything else you would like to add? Any disclosures? Response: We saw a similarly lower risk of death among people who added milk or sugar to their tea, but the added amount of sugar and milk was relatively small. We caution that dietary guidelines recommend avoiding large amounts of sugar and saturated fat, like fat in milk. None of the authors of this study have anything to disclose. Citation: Maki Inoue-Choi, Yesenia Ramirez, Marilyn C. Cornelis, et al; Tea Consumption and All-Cause and Cause-Specific Mortality in the UK Biobank: A Prospective Cohort Study. Ann Intern Med. . doi:10.7326/M22-0041 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

MedicalResearch.com Interview with: Leonardo Mattos, PhD Head of Biomedical Robotics Lab Advanced Robotics Department Istituto Italiano di Tecnologia Genova, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have been working on robotic microsurgery for several years, and have developed robotic technology for it that is getting ready for use on humans. Then, 5G started to become a reality here in Italy, and we wanted to test if it could be used to enable remote telesurgery. So we joined forces with Vodafone Italia to realize this study and proof of concept demonstration. Telesurgery has been a dream for over 20 years, and has been demonstrated already back in 2001. However, the wide scale adoption of the technology has been limited by many factors, including the limited availability of surgical robots and the lack of a telecommunication network that is fast and reliable enough for such operation. Recent technological progress is changing this scenario, with surgical robots being used in hospitals around the world and high-performance telecommunications system becoming widely available. This study shows that telesurgery is now feasible using the newest 5G telecommunication networks, enabling us to consider a large scale adoption of the technology.  MedicalResearch.com: Read the full article

Dr. Rochon Dr. Paula Rochon, MD, MPH Geriatrician and Vice-president of Research Women’s College Hospital Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? Response: As some health care systems approach collapse, a pressing need exists for tools modeling the capacity of acute and critical care systems during the COVID-19 pandemic. We developed an online tool to estimate the maximum number of COVID-19 cases that could be managed per day within the catchment area served by a health care system, given acute and critical care resource availability. The COVID-19 Acute and Intensive Care Resource Tool (CAIC-RT) is open access and available at https://caic-rt.shinyapps.io/CAIC-RT. MedicalResearch.com: What should readers take away from your report? Response:  By using an online tool, health care systems can estimate the maximum number of COVID-19 cases per day that could be managed on the basis of age-based case distribution and severity and the number of maximally available acute and critical care resources. Unlike forecasting instruments, our tool determines a sustainable threshold for resource use during the pandemic rather than forecasting when resources might become depleted on the basis of assumptions about reporting, epidemic growth, and reproduction numbers. Outputs from the tool allow planners to examine how increases in acute and critical resources available for patients with COVID-19 can affect health care system sustainability. Finally, the tool allows customization of age-based case distribution and severity, which is essential for countries with differing population demographics and health care systems. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research should consider modelling other factors limiting the containment and mitigation of the COVID-19 pandemic including access to personal protective equipment, diagnostic testing, medications and health human resources. No disclosures. Citation:  Estimating the Maximum Capacity of COVID-19 Cases Manageable per Day Given a Health Care System's Constrained Resources Vasily Giannakeas, MPH; Deepit Bhatia, MPH; Matthew T. Warkentin, MSc; Isaac I. Bogoch, MD; Nathan M. Stall, MD Published:Ann Intern Med. 2020. DOI:10.7326/M20-1169 https://annals.org/aim/fullarticle/2764818/estimating-maximum-capacity-covid-19-cases-manageable-per-day-given The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Wallach Joshua D. Wallach, MS, PhD Assistant Professor of Epidemiology (Environmental Health Sciences) Yale School of Public Health New Haven, CT MedicalResearch.com: What is the background for this study? Response: Over the past few years, there has been growing interest in the potential health benefits of cannabidiol (CBD), a chemical compound in cannabis. Although only one CBD-derived prescription drug has been approved by the US Food and Drug Administration (FDA) for the treatment of epilepsy, I recently started seeing products containing CBD advertised and sold across the US (e.g. CBD in foods, beverages, dietary supplements, and cosmetics). I noticed that many of these products were being marketed with unproven claims to prevent, cure, and treat various conditions, and became interested in learning more about the research supporting the use of CBD, the potential for misleading claims, and impact that the CBD-industry may be having on research that is being generated and disseminated to the public. Research funding sources and other author conflicts of interests (e.g. consulting fees, honoraria, travel expenses) can influence the way that research is designed, conducted, and reported. Previous studies have consistently demonstrated associations between authors' conflicts of interest and proindustry conclusions in clinical research. Given the growing number of companies invested in CBD's commercial success, we decided to analyze the disclosed funding sources, conflicts of interest statements, author employment details, and CBD-related conclusions in a large sample of published articles on the characteristics, use, and therapeutic effects of cannabidiol. MedicalResearch.com: What are the main findings? Response: Among 417 articles discussing CBD (published between 2014 and 2019), we found that fewer than one-quarter were for human studies. While one-third of all 417 articles had any CBD-related funding, disclosed any CBD-related conflicts of interest, or included an author employed by the CBD industry, the rate was much higher among studies containing human subjects (approximately two-thirds). Overall, we found that more articles with CBD-related funding, conflicts, or author employment had conclusions that were supportive of CBD than those without. MedicalResearch.com: What should readers take away from your report? Response: Given the impact that the cannabidiol-industry may be having on cannabidiol-related research, our findings suggest the importance of critically evaluating funding sources, potential conflicts, and health-related claims reported in cannabidiol studies. There is only one CBD-derived prescription drug approved by the FDA (for epilepsy), and that little is known about the efficacy for other conditions and the long-term safety of cannabidiol.  MedicalResearch.com: Is there anything else you would like to add? Response: Ms. Emma Deary, the first author of this manuscript, received funding from the National-Institute of Health-funded Summer Research Experience in Environmental Health (SREEH) Program at the Yale School of Public Health. In the past 36 months, I have received support, outside of the scope of this research, from the Collaboration for Research Integrity and Transparency from the Laura and John Arnold Foundation and through the Center for Excellence in Regulatory Science and Innovation (CERSI) at Yale University and the Mayo Clinic (U01FD005938). In the past 36 months, Dr. Joseph Ross received research support, outside of the scope of this research, through Yale from Johnson and Johnson to develop methods of clinical trial data sharing, from Medtronic, Inc. and the Food and Drug Administration (FDA) to develop methods for postmarket surveillance of medical devices (U01FD004585), from the Centers of Medicare and Medicaid Services (CMS) to develop and maintain performance measures that are used for public reporting, from the FDA to establish a Center for Excellence in Regulatory Science and Innovation (CERSI) at Yale University and the Mayo Clinic (U01FD005938), from the Blue Cross Blue Shield Association to better understand medical technology evaluation, from the Agency for Healthcare Research and Quality (R01HS022882), and from the Laura and John Arnold Foundation. V.V. received research support through the National Institutes of Health. Ms. Kate Nyhan has no disclosures.  Citation: Conflicts of Interest Among Authors of Published Cannabidiol Articles, 2014–2019 Emma C. Deary; Joseph S. Ross, MD, MHS; Kate Nyhan, MLS; Joshua D. Wallach, MS, PhD Published: Ann Intern Med. 2020. DOI: 10.7326/M19-3650   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

MedicalResearch.com Interview with: Dr. Devereaux Dr. PJ Devereaux MD, PhD, FRCP(C) Director of the Division of Cardiology Scientific Leader Anesthesiology, Perioperative Medicine, and Surgical Research Group Population Health Research Institute McMaster University  MedicalResearch.com: What is the background for this study? Response: There is an ethical obligation to provide patients with an accurate estimation of the potential benefits of surgery and the potential risks, to facilitate informed decision making about the appropriateness of surgery.  There are two common approaches to risk estimation. First, physicians commonly use clinical risk indices.  Based upon a patient’s clinical history (e.g., history of prior heart attack or stroke) an estimate of perioperative risk is determined.  Research demonstrates that these clinical risk indices have suboptimal risk discrimination capabilities, and they will underestimate risk in many patients. The second approach that has commonly been used is to have patients undergo an expensive and time consuming non-invasive cardiac test (e.g., stress nuclear cardiac study).  Although these non-invasive cardiac tests can enhance risk estimation in some patients who will have a perioperative cardiac event, these tests more commonly exaggerate risk in patients who will not have a complication. MedicalResearch.com: What are the main findings? Response: Preliminary data suggested that a much cheaper test (i.e., the biomarker NT-proBNP) that can be obtained in minutes is more accurate than the clinical risk indices and non-invasive cardiac tests.  Because of the limitations of the current approaches to perioperative risk estimation and the encouraging preliminary data that a simple blood test may accurately predict perioperative risk, we undertook this 10,402 patient international prospective cohort study to evaluate the prognostic capabilities of NT-proBNP in patients undergoing non-cardiac surgery. Our study demonstrated that NT-proBNP strongly differentiates who will and will not experience a perioperative cardiovascular complication.  Beyond this, we also demonstrated that NT-proBNP is able to differentiate the risk of mortality in patients undergoing surgery. MedicalResearch.com: What should readers take away from your report? Response: We demonstrate that NT-proBNP is able to improve risk prediction in patients who will and will not suffer a major perioperative cardiac event.  This is a major advance compared to our two prior approaches to risk estimation.  Moreover, the tests is faster and cheaper than non-invasive cardiac tests and even medical consults. Although our study demonstrates that NT-proBNP can be used to improve perioperative risk prediction and therefore facilitate more informed decision making about the appropriateness of surgery, surgical and anesthestic approaches, and identification of patients who require enhanced monitoring after surgery, there is a need for more research.   MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response:  We are using NT-proBNP to identify patients who are eligible for a large international randomized controlled trial that we are currently conducting.  Moreover, we plan to undertake trials informed by patients preoperative NT-proBNP level that will target interventions that we believe can influence the NT-proBNP level and potentially improve patient outcomes. Disclosures: I a member of a research group with a policy of not accepting honorariums or other payments from industry for our own personal financial gain. We do accept honorariums/payments from industry to support research endeavours and costs to participate in meetings. Based on study questions I have originated and grants I have written, I have received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics and Stryker. I have also participated in an advisory board meeting for GlaxoSmithKline and an expert panel meeting with AstraZeneca, Boehringer Ingelheim, and Roche. Citation: Duceppe E, Patel A, Chan MT, et al. Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study. Ann Intern Med. 2019; . doi: https://doi.org/10.7326/M19-2501 Last Modified: The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Akhter Murtaza Akhter, MD Assistant Professor Department of Emergency Medicine University of Arizona College of Medicine Phoenix MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent years have brought a significant increase in emergency department visits, and therefore also a boon in openings of freestanding emergency departments (FrEDs). However, it is has been unclear whether the opening of FrEDs reduces healthcare costs. Our study showed that in increase in FrEDs was associated with an increase in spending per Blue Cross Blue Shield enrollee. MedicalResearch.com: What should readers take away from your report? Response: Opening up freestanding emergency departments can have various effects, and that often times it can lead to increased healthcare costs. This is often due to increased utilization, thereby making freestanding emergency departments supplements to hospital-based EDs rather than substitutes.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: One important aspect to look at would be how regulations in various states affect FrEDs, and in particular healthcare costs. It is very possible that the rules stipulated by each state on where freestanding emergency departments can be opened affect how effective they are. Another topic needing more research is how much of the costs related to opening of FrEDs are related to in-network vs. out-of-network physicians. Thirdly, a closer look at how a patient is directly affected by the opening of freestanding emergency departments would be a useful analysis; our study found that out-of-pocket payments were even reduced in one of the four states, as one example. MedicalResearch.com: Is there anything else you would like to add? Response: No conflicts of interest. Dr. Ho has received financial support from The Sid W. Richardson Foundation at Rice University's Baker Institute and Dr. Xu received financial support from the Karen Davis Endowment in Rice University's Economics Department. Citation: Vivian Ho, Yingying Xu, Murtaza Akhter. Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care. Academic Emergency Medicine, 2019; DOI: 10.1111/acem.13848  The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Wee Christina C. Wee, MD, MPH Associate Professor of Medicine Harvard Medical School Director , Obesity Research Program Division of General Medicine Beth Israel Deaconess Medical Center (BIDMC) Associate Program Director, Internal Medicine Program, BIDMC Deputy Editor of the Annals of Internal Medicine MedicalResearch.com: What is the background for this study? Response: New research is showing that for many people without diagnosed heart disease, the risk of bleeding may outweigh the benefits of taking a daily aspirin particularly in adults over 70 years of age.  The American Heart Association and the American College of Cardiology recently updated their guidelines and now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke. Our study found that in 2017,  a quarter of adults aged 40 years or older without cardiovascular disease – approximately 29 million people – reported taking daily aspirin for prevention of heart disease. Of these, some 6.6. million people did so without a physician's recommendation. MedicalResearch.com: What are the main findings? Response: Concerningly, nearly half of adults 70 years and older (over 9 million adults) without a history of heart disease or stroke reported taking aspirin daily. Moreover, adults who had a history of peptic ulcer disease – another contraindication for the routine use of aspirin – were not significantly less likely to use aspirin as we would have expected. MedicalResearch.com: What should readers take away from your report? Response: Readers should be aware that our understanding of the benefits and risks of aspirin use for preventing new heart disease has changed  and that they should talk to their doctor about whether aspirin use in this context is appropriate for their particular health situation. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: This study looked at aspirin use in 2017 before the recent release of the new guidelines. It would be important to see whether aspirin use to prevent heart disease among patients without pre-existing heart disease or stroke changes in response to these new recommendations. MedicalResearch.com: Is there anything else you would like to add? Response: I want to emphasize that this study did not look at adults who had a history of heart disease or stroke. Every person’s health situation is unique, we recommend that people talk to their doctors before making any changes.  Citation: Colin W. O'Brien, Stephen P. Juraschek, Christina C. Wee. Prevalence of Aspirin Use for Primary Prevention of Cardiovascular Disease in the United States: Results From the 2017 National Health Interview Survey. Annals of Internal Medicine, 2019; DOI: 10.7326/M19-0953 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article