Author Interviews, BMJ, General Medicine, Heart Disease / 30.10.2014

MedicalResearch.com Interview with: Anne Bellemain-Appaix Service de Cardiologie-La Fontonne Hospital, Antibes, France and Gilles Montalescot Professor of  Cardiology Institut de CardiologiePitié-Salpêtrière Hospital Université Paris 6, France ACTION Study Group, Paris, France Medical Research: What is the background for this study? Response: Pretreatment with P2Y12 inhibitors for Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients, although advised in current guidelines, has been recently questioned in term of benefit/risk ratio (no ischemic benefit and increase in major bleeding). We wanted to answer this question by giving enough power to results in a complete meta-analysis of studies comparing P2Y12 inhibitors pretreatment (defined as its administration before the coronary angiogram) to no pretreatment in NSTE-ACS.
Author Interviews, BMJ, Orthopedics / 29.10.2014

MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute Medical Research: What are the main findings of the study? Prof. Michaëlsson: A high milk intake is recommended for the prevention of osteoporotic fractures but milk is also the major dietary source of galactose intake. The addition of galactose by injection or in the diet is an established animal model of aging by induction of oxidative stress and inflammation. Previous research results regarding the importance of milk intake for the prevention of fractures and the influence on mortality rates are conflicting. High milk intake was in our study associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).
Author Interviews, BMJ, Case Western / 29.10.2014

MedicalResearch.com Interview with: Dr. med. Rainer Erices Institut für Geschichte und Ethik der MedizinMedicalResearch.com Interview with: Dr. med. Rainer Erices Institut für Geschichte und Ethik der Medizin Medical Research: What are the main findings of the study? Dr. Erices: The study presents the results of a first systematic investigation of clinical drug trials carried out by Western pharmaceutical firms in Eastern Germany in the 1980s. The scientific investigation of the East German Health system has only just started. The study shows that in that period of time, around 220 clinical trials were carried out. We now know how many patients took part and what remuneration the GDR received. It continues to be difficult to evaluate these tests. Despite intensive research efforts in different archives, we have been unable to find documentation on how detailed (and systematically) patients were informed about the trial they were taking part in. The responsible institutions repeatedly advised testers to stick to the law during the clinical trials. The law required that these trials should only be carried out on patients which had given their informed consent and had decided to participate voluntarily. However, so far there is no convincing proof that these legal requests were met.
Author Interviews, BMJ, Environmental Risks, OBGYNE, Pulmonary Disease / 22.10.2014

Medical Research Interview with: Eva Morales, MD, PhD, MPH Centre for Research in Environmental Epidemiology (CREAL) Barcelona Biomedical Research Park Barcelona, Spain Medical Research: What are the main findings of the study? Dr. Morales: We aimed to assess the consequences of exposure to outdoor air pollution during specific trimesters of pregnancy and postnatal lifetime periods on lung function in preschool children. We conducted a longitudinal study by using data from 620 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project – a population-based cohort study set up in several geographic areas in Spain. We found that exposure to outdoor air pollution during the second trimester of pregnancy in particular raises the risk of harm to a child’s lung function at preschool age.
Author Interviews, BMJ, Occupational Health, Tobacco / 22.10.2014

Dr. John Cherrie PhD Honorary Professor in Occupational Hygiene Institute of Applied Health Sciences Aberdeen, UKMedicalResearch.com Interview with: Dr. John Cherrie PhD Honorary Professor in Occupational Hygiene Institute of Applied Health Sciences Aberdeen, UK Medical Research: What are the main findings of the study? Dr. Cherrie: We set out to bring together measurements of fine particle levels in homes where smoking takes place, to compare these with smoke-free homes and then to estimate how much of these fine particles are inhaled by people at different stages in their life. We also wanted to look at the exposure to particles of non-smokers living with smokers and compare this with the exposure of people living in heavily polluted major cities around the world.
Author Interviews, BMJ, Heart Disease, Kidney Disease / 13.10.2014

Dr Jelena Kornej Department of Electrophysiology Heart Center Leipzig Leipzig Germany;MedicalResearch.com Interview with: Dr Jelena Kornej Department of Electrophysiology Heart Center Leipzig Leipzig Germany; Medical Research: What are the main findings of the study? Dr. Komej: Both atrial fibrillation (AF) and renal impairment are known to coexist and associated with increased morbidity and mortality. However, there is only limited data on changes of renal function after AF catheter ablation and predictors thereof. This is the largest study analyzing the effects of atrial fibrillation catheter ablation on renal function and changes thereof in a contemporary population during mid-term follow-up. We found that lower baseline eGFR was associated with higher CHADS2 and CHA2DS2-VASc scores and that both scores were independently associated with eGFR changes after atrial fibrillation catheter ablation as were atrial fibrillation recurrences.
Alcohol, Author Interviews, BMJ / 04.10.2014

Professor Tina Kold Jensen MD Professor, Department of Environmental Medicine Research leader, Odense Child CohortMedicalResearch.com: Interview with: Professor Tina Kold Jensen MD Professor, Department of Environmental Medicine Research leader, Odense Child Cohort Medical Research: What are the main findings of the study? Prof. Jensen: Our study suggests that even modest habitual alcohol consumption of more than 5 units per week had adverse effects on semen quality although most pronounced effects were seen in men who consumed more than 25 units per week. Alcohol consumption was also linked to changes in testosterone and SHBG levels.
Alcohol, Author Interviews, BMJ, HPV, Sexual Health / 03.10.2014

Matthew B. Schabath, Ph.D Assistant Member, Department of Cancer Epidemiology Moffitt Cancer Center Tampa, Florida MedicalResearch.com: Interview with: Matthew B. Schabath, Ph.D Assistant Member, Department of Cancer Epidemiology Moffitt Cancer Center Tampa, Florida   Medical Research: What are the main findings of the study? Dr. Schabath: Overall, the results from these analyses demonstrated that men who consumed the highest amounts of alcohol were associated with an increased risk for genital human papillomavirus (HPV) infections.
Author Interviews, BMJ, Breast Cancer, Weight Research / 29.09.2014

MedicalResearch.com Interview with: Professor Usha Menon,  Evangelia-Ourania Fourkala PhD and Matthew Burrell PhD Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, University College London, UK Medical Research: What are the main findings of the study? Response: Our study has shown that skirt size is a good proxy for central obesity. Each unit increase in UK skirt size every ten years between the age of 20 and 60 was associated with a 33% increase in postmenopausal breast cancer in our cohort.
Accidents & Violence, Author Interviews, BMJ / 20.09.2014

MedicalResearch.com Interview with: Bindu Kalesan PhD MPH Department of Epidemiology Mailman School of Public Health Columbia University Medical Research: What are the main findings of the study? Dr. Kalesan: There were on average 84 gun deaths per day in the US between 2000 and 2010. The main message of the study is that the 11-year stable national firearm fatality rates mask the wide variation between states, racial and ethnic subgroups and intent of injury. Across 11 years, African-Americans had firearm fatality rates twice greater than Caucasians and 6-times greater than other minority races; the rates showing a decline only among other races. We found that the lowest rates are in HI while very high rates are observed in AK, LA and DC. Seven states (NY, IL, MD, NC, CA, AZ, NV) and DC showed declining rates while FL and MA had rising rates. The widely varying inter-state differences were driven by race specific differences within states.
Author Interviews, BMJ, HPV / 17.09.2014

Dr Neha Pathak, MBBS MA(Cantab) Academic Clinical Fellow in Obstetrics and Gynaecology Queen Mary University London.MedicalResearch.com Interview with: Dr Neha Pathak, MBBS MA(Cantab) Academic Clinical Fellow in Obstetrics and Gynaecology Queen Mary University London. Medical Research: What are the main findings of the study? Dr. Pathak: Cervical testing for human papillomavirus (HPV) is being piloted as a more accurate method for cervical cancer screening than current cytology-based ("Pap smears"). However, cervical testing still requires gynaecological examination and a doctor or nurse to take the sample. This could be a deterrent to attending screening as it is invasive and time-consuming. Urine-based HPV testing would be a less invasive and more convenient alternative. Our study was completed at the Queen Mary University London Women's Health Research Unit. We pooled the results of 14 studies from around the world which tested 1443 women for HPV in urine and cervical samples. We found that detection of HPV in urine seems to have good accuracy for the detection of HPV present in the cervix. We also found that using first void samples (the first part of the stream of urine) was twenty-two times more accurate than random or midstream urine samples.
Author Interviews, BMJ, Orthopedics / 17.09.2014

Marc Nieuwenhuijse MD Research fellow ICOR and FDA Weill Cornell Medical College New York CityMedicalResearch.com Interview with: Marc Nieuwenhuijse MD Research fellow ICOR and FDA Weill Cornell Medical College New York City   Medical Research: Why did you decide to study this topic? Dr. Nieuwenhuijse : The introduction of new orthopaedic implants and related technologies has been the focus of major scientific and policy discussions since the failures of articular surface replacement and large head size metal-on-metal articulations in total hip replacement were brought to light. However, scientists and policy makers seem to “run out of steam,” and the momentum for change generated by these recent high profile failures is waning. The consequences of uncontrolled device introduction worldwide may not be fully recognised by the scientific community and there is a high likelihood that current practice regarding device innovations will not change much. As such, there is a need to investigate whether the problems associated with the articular surface replacement and large head size metal-on-metal articulation are isolated events or if there is a systemic problem affecting the introduction of a much wider range of implantable devices. In this study, we systematically evaluate the evidence concerning the introduction of five substantial, innovative, relatively recent, and already widely implemented device technologies used in major total joint replacement to determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.
AHRQ, Author Interviews, BMJ, Outcomes & Safety / 11.09.2014

Yves A. Lussier, MD, Fellow ACMI Professor of Medicine Associate Vice President for Health Sciences (Chief Knowledge Officer) The University of ArizonaMedicalResearch.com Interview with: Yves A. Lussier, MD, Fellow ACMI Professor of Medicine Associate Vice President for Health Sciences (Chief Knowledge Officer) The University of Arizona Medical Research: What are the main findings of the study? Dr. Lussier:  The main finding is that reporting patient safety using ICD-10-CM coding schema rather than ICD-9-CM will change the reported percentage of adverse events reported for half the specific "patient safety indicators" (PSIs), even with a true unaltered frequency of reported events in the medical center. For some patient safety indicators, the reported frequency will appear to increase substantially and for others, it will appear to decrease.  The latter is particularly  worrisome as it may erroneously appease administrators and prospective clients (patients) as their apparent trend is improving, while their institution may inadvertently be under-reporting adverse events.
Alzheimer's - Dementia, Author Interviews, BMJ / 10.09.2014

Sophie Billioti de Gage PharmD University of Bordeaux Segalen FranceMedicalResearch.com Interview with: Sophie Billioti de Gage PharmD University of Bordeaux Segalen France   Medical Research: What are the main findings of the study? Answer: The risk of Alzheimer’s disease was found increased by 43-51% in persons (>65) having initiated a treatment with benzodiazepines in the past (>5 years before). Risk increased with the length of exposure and when long acting benzodiazepines were used.
BMJ, General Medicine, Pediatrics / 05.09.2014

Dr. Steve Turner Child Health, Royal Aberdeen Children's Hospital Aberdeen,UKMedicalResearch.com: Interview with: Dr. Steve Turner Child Health, Royal Aberdeen Children's Hospital Aberdeen,UK   Medical Research: What are the main findings of the study? Dr. Turner: There is evidence that being small for a given gestational age is associated with a broad range of what could be loosely considered “disadvantageous” outcomes in early childhood, eg increased risk for wheeze, increased blood fat levels, increased blood pressure and low bone mineral density.  Many of these outcomes are subclinical – ie unless they were measured no-one would be any the wiser – and what remains to be determined is whether as these individuals grow up these subclinical measurements become important.  Follow up may take many years, decades for outcomes such as coronary artery disease and type II diabetes.
Author Interviews, BMJ, Heart Disease, Metabolic Syndrome / 04.09.2014

Dr Weiguo Zhang, MD PhD Cardiovascular and Neurological Institute 6771 San Fernando, Irving, TX 75039, USAMedicalResearch.com Interview with: Dr Weiguo Zhang, MD PhD Cardiovascular and Neurological Institute 6771 San Fernando, Irving, TX 75039, USA

Medical Research: What are the main findings of the study?

Prof. Zhang: Higher heart rate has emerged as a cardiovascular risk factor and is associated with higher mortality rate. However the mechanistic link between heart rate and mortality outcome in population has been missing. The main findings of the present study in a relatively large population are two-fold: Firstly, there is a strong and positive association between resting heart rate and metabolic syndrome, which is defined when an adult has 3 of the following: obesity (waist circumference ≥90 cm for men or ≥80 for women); hypertriglyceridemia (triglycerides ≥1.7 mmol/L); low plasma level of high-density lipoprotein <1.03 mmol/L for men or <1.30 mmol/L for women); hypertension (systolic blood pressure/ diastolic blood pressure≥130/85 mmHg or current use of antihypertensive medications); hyperglycemia (fast blood glucose ≥5.6 mmol/L or previously diagnosed type 2 diabetes or current use of hypoglycaemic agents or insulin). Secondly and more importantly, those without metabolic syndrome but with higher resting heart rate will have greater risk in developing metabolic syndrome in the near future. As such, the findings from both cross-sectional and longitudinal studies provide evidence that resting heart rate is an independent risk factor for existing metabolic syndrome and a powerful predictor for its future incidence.

Author Interviews, BMJ, Tobacco Research / 30.08.2014

MedicalResearch.com Interview with:  Michelle Scollo Senior policy adviser, Tobacco Centre for Behavioural Research in Cancer Medical Research: What are the main findings of the study? Answer:  Each November the Cancer Council Victoria conducts a survey asking smokers about their tobacco purchasing habits and smoking attitudes, intentions and behaviours. This study compared what smokers said about where and what they purchased in:
  • November 2011, a year before the introduction of world-first legislation mandating standardized packaging of tobacco products throughout Australia
  • In November 2012, while the new plain packs were being rolled out onto the market and
  • In November 2013 one year later.
The tobacco industry had strenuously opposed the legislation, but—contrary to the industry predictions and continuing claims in other countries contemplating similar legislation—we found: 1.       No evidence of smokers shifting from purchasing in small independent outlets to purchasing in larger supermarkets 2.       No evidence of an increase in use of very cheap brands of cigarettes manufactured by companies based in Asia and 3.       No evidence of an increase in use of illicit unbranded tobacco.
Aging, Author Interviews, BMJ, Heart Disease / 28.08.2014

MedicalResearch.com Interview with: Philip Haycock, PhD Post-Doctoral Research Assistant MRC Integrative Epidemiology Unit University of Bristol Bristol, BS8 2BN, UK Medical Research: What are the main findings of the study? Dr. Haycock: We found that shorter telomeres were significantly associated with risk of coronary heart disease and that the association was independent of conventional vascular risk factors, including age, sex, body mass index, smoking, history of diabetes, blood pressure and lipid markers.
Author Interviews, BMJ, End of Life Care / 21.08.2014

MedicalResearch.com Interview with: Dr. Julian Mausbach RA Geschäftsführer Kompetenzzentrum Medizin - Ethik - Recht Helvetiae Zürich, Switzerland Medical Research: What are the main findings of the study? Answer: 611 cases of suicide tourism were found in the canton of Zurich between 2008 and 2012. More than half of the suicide tourists were women with a median age of 69 years. After an initial decrease in 2009, cases of suicide tourism increased from then on onwards and doubled in 2012. The underlying diseases varied considerably. Main reasons for the assisted suicide were neurological diseases, followed by cancer, rheumatic diseases. Approximately one third of the study population had more than one disease.
Author Interviews, BMJ, Exercise - Fitness, Weight Research / 20.08.2014

MedicalResearch.com Interview with: Dr Ellen Flint, BA MSc PhD, Research Fellow Department of Social & Environmental Health Research London School of Hygiene & Tropical Medicine Tavistock Place, LondonMedicalResearch.com Interview with: Dr Ellen Flint, BA MSc PhD, Research Fellow Department of Social & Environmental Health Research London School of Hygiene & Tropical Medicine Tavistock Place, London Medical Research: What are the main findings of the study? Dr. Flint: Men and women who commuted to work by cycling, walking or public transport had significantly lower BMI and percentage body fat than their car-using counterparts. This was the case despite adjustment for a range of factors which may affect both body weight and commuting mode preference (e.g. limiting illness, age, socioeconomic position, sports participation and diet). The differences were of a clinically meaningful magnitude. For example, compared to car users, men who commuted via active or public transportation modes were on average 1 BMI point lighter. For the average man in the sample this would equate to a difference in weight of almost half a stone (3kg).
Author Interviews, BMJ, Clots - Coagulation, Surgical Research / 13.08.2014

MedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special SurgeryMedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special Surgery Medical Research: What are the main findings of the study? Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events.
Author Interviews, BMJ, Nutrition / 11.08.2014

Professor Clodagh O'Gorman MB BCh BAO MSc MD FRCPI FPAEDS Foundation Chair & Professor of Paediatrics, Graduate Entry Medical School, University of Limerick, Ireland.MedicalResearch.com Interview with: Professor Clodagh O'Gorman MB BCh BAO MSc MD FRCPI FPAEDS Foundation Chair & Professor of Paediatrics, Graduate Entry Medical School, University of Limerick, Ireland. Medical Research: What are the main findings of the study? Professor O'Gorman: 1155 cues for food and beverages (BBC=450; RTE=705), were recorded over 82.5 hours; thus, on average one cue was recorded every 4.2 minutes. The total recorded time for food and beverage cues was 3.94 hours, equating to 4.8% of the total recording time, and averaging 13.2 seconds per cue. If these results are representative of all children’s television broadcast on RTE and BBC, then if your child watches 82.5 hours of television, your child will see 3.94 hours of food and beverages during this time. Unhealthy foods account for 47.5% of specified food cues, and sugar-sweetened beverages for 25% of specified beverage cues, with an average time of 13.8 s for healthy cues and 11.4 s for unhealthy cues (p=0.17). 88.2% of all food and beverage cues involved a major character and 95.3% involved a character ‘goodie’. Male characters were more common than female (45.3% vs 14.0%), adults more common than teens or children (46.3% vs 23.8% and 14.2%). Overweight characters were depicted in 4.7%. The most common ethnic group was white Caucasian (88.5%). The commonest motivating factor for consuming/depiction of food and beverage was celebratory/social (25.2%), followed by hunger/thirst (25.0%), reward (4.5%), health-related (2.2%) and punishment (1.2%). Motivating factors were positive (30.5%), negative (1.5%) and health-related (25.8%). Cue outcomes were positive (32.6%), negative (19.8%) and neutral (47.5%).
Author Interviews, BMJ, OBGYNE / 08.08.2014

MedicalResearch.com Interview with: Steven Ball Telethon Kids Institute University of Western Australia West Perth, WA 6872, Australia Medical Research: What are the main findings of the study? Answer: Our study suggests that the amount of time between pregnancies has less of an effect on birth outcomes than previously thought. Relative to pregnancies that started 18-23 months after a previous birth, pregnancies that followed shorter spacing had very little increased risk of preterm birth, low birth weight or small-for-gestational-age.  Longer pregnancy spacing showed increased risk of low birth weight and small-for-gestational-age, but not of preterm birth.
Author Interviews, BMJ, Nutrition / 08.08.2014

Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor University of South Carolina Arnold School of Public Health Department of Health Promotion, Education, and Behavior Discovery Columbia, SC 29208MedicalResearch.com Interview with: Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor, University of South Carolina Arnold School of Public Health Department of Health Promotion, Education, and Behavior Discovery Columbia, SC 29208  Medical Research: What are the main findings of the study? Dr. Turner-McGrievy: This study assessed how closely crowdsourced ratings of foods and beverages contained in 450 pictures from the Eatery mobile app as rated by peer users using a simple “healthiness” scale were related to the ratings of the same pictures by trained observers. Our trained observers used a rating scale based on the U.S. Dietary Guidelines to assess the healthiness of the foods and beverages in each picture. Crowdsourcing uses the input of several users to provide feedback and information. We found that all three trained raters’ scores was highly correlated with the peer healthiness score for all the photos. In addition, we found that peer ratings were in the expected direction for both foods/beverages the Dietary Guidelines say to increase and ones to limit. Photos with fruit, vegetables, whole grains, and legumes, nuts, and seeds were all associated with higher peer healthiness scores and processed, food from fast food restaurants, refined grains, red meat, cheese, savory snacks, sweets/desserts, and sugar sweetened beverages were associated with lower peer healthiness scores.
Author Interviews, BMJ, Heart Disease, Nutrition / 31.07.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalResearch.com Interview Invitation Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public Health Medical Research: What are the main findings of the study? Prof. Hu: We found that increasing consumption of fruits and vegetables is associated with reduced risk of mortality, especially cardiovascular mortality. The largest reduction in mortality can be achieved at 5 servings per day of fruits and vegetables.
Author Interviews, BMJ, Mediterranean Diet, Nutrition / 30.07.2014

Dr Michelle Morris Research Fellow Nutritional Epidemiology Group School of Food Science & Nutrition University of LeedsMedicalResearch.com Interview with: Dr Michelle Morris Research Fellow Nutritional Epidemiology Group School of Food Science & Nutrition University of Leeds Medical Research: What are the main findings of the study? Dr. Morris: The healthiest diets consumed by UK Women are the most expensive. This study is UK centric, using dietary patterns consumed by UK women and scored for healthiness according to the UK Department of Health Eatwell Plate. Cost of diet was estimated using average prices taken from an evaluated UK food cost database.
Author Interviews, BMJ, Circadian Rhythm, Diabetes, Occupational Health / 28.07.2014

Professor Zuxun Lu School of Public Health Tongii Medical College Huazhong University of Science and Technology Wuhun, Hubei, China.MedicalResearch.com Interview with: Professor  Zuxun Lu School of Public Health Tongii Medical College Huazhong University of Science and Technology Wuhun, Hubei, China. Medical Research: What are the main findings of the study? Prof. Lu: The main finding of this systematic review and meta-analysis was that shift work is associated with an increased risk of diabetes mellitus (DM). The association between shift work and DM appeared to be independent of physical activity, family of history of DM and body mass index. We found that the increased risk of diabetes mellitus was more pronounced in rotating shift group and male shift workers than in other shift group and female shift workers, respectively.
Author Interviews, BMJ, End of Life Care / 15.07.2014

Dr. Kirsty Boyd Programme theme head (Clinical Communication) Honorary Clinical Senior Lecturer Primary Palliative Care Research Group Division of Community Health Sciences: General Practice University of EdinburghMedicalResearch.com Interview with: Dr. Kirsty Boyd Programme theme head (Clinical Communication) Honorary Clinical Senior Lecturer Primary Palliative Care Research Group Division of Community Health Sciences: General Practice University of Edinburgh Medical Research: What do we know already about people with ‘multimorbidity’? Dr. Boyd: We know that an increasing number of patients have multiple life-limiting illnesses or progressively deteriorating health due to several long term conditions or general frailty. Caring for them well poses major challenges and they are often hospitalised in the last year of life. They do not fit well into illness and healthcare models that focus on single conditions. Understanding the experiences of patients and their family caregivers is vital to inform improvements in best supportive care and palliative care. We wanted to build on care models for integrated care of people with long term conditions and consider the needs of those at risk of dying with multiple conditions in more detail.
Author Interviews, BMJ, Emergency Care / 15.07.2014

MedicalResearch.com Interview with: Jeffrey Allen Kline Vice Chair of Research Department of Emergency Medicine MedicalResearch.com Interview with: Jeffrey Allen Kline Vice Chair of Research Department of Emergency Medicine Indiana University Health Medical Research: What are the main findings of this study? Dr. Kline: We believe that clinicians use information from their patients’ faces to make decisions about diagnostic testing. This is particularly relevant in emergency medicine, where the clinicians make decisions rapidly with limited information. We videotaped patients’ faces who had chest pain and dyspnea and used the most well-known facial scoring system to assess their facial expression variability in response to seeing visual stimuli. We found that patients who ultimately had emergent problems tended to hold their faces in a neutral position and be less likely to show the expression of surprise. The investigators were not surprised at this, but we did find that patients with emergent problems also tended to have less negative affect as well as less positive affect. In other words, patients who were sickest even tended to frown less than patients with no medical problem.
Author Interviews, BMJ, Multiple Sclerosis / 14.07.2014

Dr Nils Muhlert Wellcome Trust ISSF Research Fellow School of Psychology Cardiff UniversityMedicalResearch.com Interview with: Dr Nils Muhlert Wellcome Trust ISSF Research Fellow School of Psychology Cardiff University Medical Research: What are the main findings of the study? Dr. Muhlert: Decision making impairments are known to occur in people with multiple sclerosis (MS), and are important, given they can contribute to employment status, treatment compliance and function in everyday life. Studies by Kleeberg, Simioni and others have demonstrated that decision-making impairments can occur early in the course of multiple sclerosis and get worse as the disease progresses. Questions however remain over whether these impairments are linked to more general cognitive difficulties, differences between multiple sclerosis subtypes, and their relationship with MRI changes. We assessed decision-making and examined MRI changes in a relatively large sample of people with multiple sclerosis (N = 105) and healthy controls (N = 43). All participants performed the Cambridge Gambling Task, which independently measures risk-taking, impulsivity, deliberation and risk adjustment, and underwent an MRI scan including T1-weighted and diffusion MRI sequences. We demonstrate that people with multiple sclerosis experience difficulties with risk adjustment (gauging risk and adapting accordingly) and in the speed of making decisions but not in impulsivity. These problems were seen in those classified as having cognitive impairment and those not (i.e. cognitively unimpaired). We found that decision-making impairments were twice as common in people with relapsing-remitting and primary progressive MS than healthy controls, and almost four times as common in people with secondary progressive multiple sclerosis. In addition, decision making impairments in multiple sclerosis were linked to MRI changes in regions previously linked to decision-making in other conditions, including fronto-striatal and hippocampal regions. These findings offer insight into the precise decision-making difficulties experienced by people with multiple sclerosis, the relative prevalences in different subtypes of the disease and the pathological processes that may underlie them.
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