Multimorbidity in the older population: CARDI research brief

New research funded by the Centre for Ageing Research and Development in Ireland (CARDI) finds that people suffering from two or more chronic conditions are 20 times more likely to report disability than those with none. The study examines the prevalence of two or more chronic conditions, known as multimorbidity, and its impact on quality of life and disability in older people. The research Multimorbidity and Disability in the Older Population of Ireland, studied eight chronic conditions: cancer; heart attack; angina; stroke; diabetes; asthma; chronic obstructive pulmonary disease (COPD) and musculoskeletal pain (including rheumatism, arthritis and back pain). Musculoskeletal pain was the most widely reported condition across the island with a prevalence of 40%, followed by diabetes (7%) and angina (6%). Asthma and COPD have the same levels of prevalence, 5%, while cancer and stroke were reported less frequently (1-2%). The study also revealed some clear differences in the prevalence of chronic diseases between ROI and NI. Angina was reported far more frequently in NI, 10% compared to 4% in ROI. So too was musculoskeletal pain, 55% compared to 35% in ROI while asthma was reported more frequently in ROI, 6% compared to 3% in NI.

CARDI Research Brief: Medication use in patients with dementia at the end of life

��Palliative care and medication use are important issues in dealing with end-of-life stage dementia. As research into palliative care for patients with advanced dementia has been limited to date, CARDI funded a project, led by Dr. Carole Parsons of Queen’s University Belfast, as part of its grants programme. This project aimed to evaluate the extent to which patient-related factors influenced clinical decision-making with regard to medication use in patients with endstagedementia. This research brief presents a summary of the findings from the full report, Assessment of factors which influence physician decisionmaking regarding medication use in patients with dementia at the end of life (Parsons, et al., 2012).Read the research brief here: Medication use in patients with dementia at the end of lifeRead the press release here

CARDI Research Brief: Future demand for long-term care in Ireland

With the population across the island of Ireland growing older, the issue of how to provide and pay for care in the home and in residential settings is becoming more urgent. It is important that a strategy for providing long-term care for an ageing population is put in place, and understanding what the demand for care will be is a major part of this. As a result, CARDI funded a research project led by Professor Charles Normand at Trinity College Dublin which aimed to develop a predictive model of future long-term care demand in NI and ROI.This research brief contains information collated by CARDI and a summary of the findings in the full report, Towards the Development of a Predictive Model of Long-Term Care Demand for Northern Ireland and the Republic of Ireland (Wren et al., 2012).

Dementia Research Impact Report (1990-2012)

Impact of Alzheimer's Society's dementia research programme 1990-2012. Full details and the publication can be accessed here.

A Picture of Ageing Research in Ireland, North and South

This publication provides a snapshot of the ageing research landscape across the island of Ireland.�� By 2030 one in five people on the island of Ireland will be 65 years or older. As the population ages research into ageing and older people is vital to help plan for healthier and more active later lives for everyone. Academic institutions across the island are engaged in a wide range of research programmes and projects relating to ageing. ��Ageing is increasingly viewed as a research priority for these institutions and the island of Ireland is gaining recognition as a place of excellence for ageing research. This publication provides an overview of research relating to ageing being carried out in their various third level institutions in Ireland, North and South. ��It combined these profiles with information about a selection of major collaborative research projects and CARDI’s research funding activities to produce an update of a previous directory published in 2010. A Picture of Ageing Research 2014 illustrates the continued growth and quality of research being carried out in a wide range of disciplines by a growing community of researcher in Ireland, North and South. CARDI Director Dr Roger O’Sullivan says, “We are delighted to present this publication which captures the innovative and high quality nature of ageing research being carried out by researchers in Ireland, North and South. ��Ageing research is vital to providing a valuable evidence base for building a better future for our ageing populations”.

Measuring deprivation in health services research, with particular reference to analysis of cancer incidence, mortalilty and survival

This report reviews various measures of deprivation in order to be able to monitor socio-economic inequalities in cancer incidence, survival and service provision in the future.

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.

BACKGROUND: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. METHODS: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. FINDINGS: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. INTERPRETATION: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. FUNDING: UK Medical Research Council, US National Institutes of Health.

Comparative effectiveness research across two spine registries.

BACKGROUND: Comparative effectiveness research in spine surgery is still a rarity. In this study, pain alleviation and quality of life (QoL) improvement after lumbar total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF) were anonymously compared by surgeon and implant. METHODS: A total of 534 monosegmental TDAs from the SWISSspine registry were analyzed. Mean age was 42 years (19-65 years), 59% were females. Fifty cases with ALIF were documented in the international Spine Tango registry and used as concurrent comparator group for the pain analysis. Mean age was 46 years (21-69 years), 78% were females. The average follow-up time in both samples was 1 year. Comparison of back/leg pain alleviation and QoL improvement was performed. Unadjusted and adjusted probabilities for achievement of minimum clinically relevant improvements of 18 VAS points or 0.25 EQ-5D points were calculated for each surgeon. RESULTS: Mean preoperative back pain decreased from 69 to 30 points at 1 year (ØΔ 39pts) after TDA, and from 66 to 27 points after ALIF (ØΔ 39pts). Mean preoperative QoL improved from 0.34 to 0.74 points at 1 year (ØΔ 0.40pts). There were surgeons with better patient selection, indicated by lower adjusted probabilities reflecting worsening of outcomes if they had treated an average patient sample. ALIF had similar pain alleviation than TDA. CONCLUSIONS: Pain alleviation after TDA and ALIF was similar. Differences in surgeon's patient selection based on pain and QoL were revealed. Some surgeons seem to miss the full therapeutic potential of TDA by selecting patients with lower symptom severity.

Need of reduced and harmonized bureaucracy in multi-centre clinical research - a case-report from a Swiss trial

Introduction We launched an investigator-initiated study(ISRCTN31181395) to evaluate the potential benefit of pharmacokinetic-guided dosage individualization of imatinib for leukaemia patients followed in public and private sectors. Following approval by the research ethics committee (REC) of the coordinating centre, recruitment throughout Switzerland necessitated to submit the protocol to 11 cantonal RECs.Materials and Methods We analysed requirements and evaluation procedures of the 12 RECs with associated costs.Results 1-18 copies of the dossier, in total 4300 printed pages, were required (printing/posting costs: ~300 CHF) to meet initial requirements. Meeting frequencies of RECs ranged between 2 weeks and 2 months, time from submission to first feedback took 2-75 days. Study approval was obtained from a chairman, a subor the full committee, the evaluation work being invoiced by 0-1000 CHF (median: 750 CHF, total: 9200 CHF). While 5 RECs gave immediate approval, the other 6 rose in total 38 queries before study release, mainly related to wording in the patient information, leading to 7 different final versions approved. Submission tasks employed an investigator half-time over about 6 months.Conclusion While the necessity of clinical research evaluation by independent RECs is undisputed, there is a need of further harmonization and cooperation in evaluation procedures. Current administrative burden is indeed complex, time-consuming and costly. A harmonized electronic application form, preferably compatible with other regulatory bodies and European countries, could increase transparency, improve communication, and encourage academic multi-centre clinical research in Switzerland.

Omics meets hypothesis-driven research. Partnership for innovative discoveries in vascular biology and angiogenesis.

The emergence of omics technologies allowing the global analysis of a given biological or molecular system, rather than the study of its individual components, has revolutionized biomedical research, including cardiovascular medicine research in the past decade. These developments raised the prospect that classical, hypothesis-driven, single gene-based approaches may soon become obsolete. The experience accumulated so far, however, indicates that omic technologies only represent tools similar to those classically used by scientists in the past and nowadays, to make hypothesis and build models, with the main difference that they generate large amounts of unbiased information. Thus, omics and classical hypothesis-driven research are rather complementary approaches with the potential to effectively synergize to boost research in many fields, including cardiovascular medicine. In this article we discuss some general aspects of omics approaches, and review contributions in three areas of vascular biology, thrombosis and haemostasis, atherosclerosis and angiogenesis, in which omics approaches have already been applied (vasculomics).

HSC R&D Commissioned Research Framework

Framework for commissioning needs-led and opportunity-led research

A Delphi study to identify research priorities for the therapy professions in Northern Ireland

A study by the University of Ulster, funded by Health and Social Care Research and Development Division of the Public Health Agency, enabled members of six Allied Health Professions (AHPs) to express opinions on research needs within their areas of expertise.The respondents to 'A Delphi Study to Identify Research Priorities for the Therapy Professions in Northern Ireland', were selected from professionals based in clinical and academic settings in the areas of physiotherapy, occupational therapy, speech and language therapy, podiatry, nutrition and dietetics and orthoptics. The views of a group of key stakeholders in health and social care and a separate panel of service users were also gathered. A copy of this report, and an Executive Summary,�can be downloaded below.

A new pathway for the regulation and governance of health research

The Academy's review, 'A new pathway for the regulation and governance of health research' was published in January 2011. The report was prepared by a working group, chaired by Professor Sir Michael Rawlins FMedSci, convened in response to an invitation from Government to review the regulation and governance of UK health research involving human participants, their tissue or their data.The report proposes four key principles that should underpin the regulation and governance framework around health research in the UK, and makes recommendations to:Create a new Health Research Agency (HRA) to rationalise the regulation and governance of all health research. Include within the HRA a new National Research Governance Service to facilitate timely approval of research studies by NHS Trusts. Improve the UK environment for clinical trials.Provide access to patient data that protects individual interests and allows approved research to proceed effectively. Embed a culture that values research within the NHS.