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The gut microbiome plays an important role in immune function and has been implicated in several autoimmune disorders. Here we use 16S rRNA sequencing to investigate the gut microbiome in subjects with multiple sclerosis (MS, n =60) and healthy controls ( n =43). Microbiome alterations in MS include increases in Methanobrevibacter and Akkermansia and decreases in Butyricimonas , and correlate with variations in the expression of genes involved in dendritic cell maturation, interferon signalling and NF-kB signalling pathways in circulating T cells and monocytes. Patients on disease-modifying treatment show increased abundances of Prevotella and Sutterella , and decreased Sarcina , compared with untreated patients. MS patients of a second cohort show elevated breath methane compared with controls, consistent with our observation of increased gut Methanobrevibacter in MS in the first cohort. Further study is required to assess whether the observed alterations in the gut microbiome play a role in, or are a consequence of, MS pathogenesis. The gut microbiome has been implicated in several autoimmune disorders. Here, the authors study the gut microbiome of patients with multiple sclerosis, and find correlations between altered abundance of certain gut microorganisms and changes in expression of immune defence genes.

Introduction: CHO9 North Dublin has a large cohort of women over the age of 65. An estimated 33% of Irish adults are incontinent of urine. Treatment mainly consists of containment in the form of incontinence wear with minimal use of re-training methods and medication, both of which are proven effective. McCarthy.G et al (2007).It was decided to make real and positive changes to this culture in the form of the continence promotion clinics as there was no formal health promotion available in the community. A service was envisaged that could lead to a better quality of life for women and enable them to age with confidence in their own community.Methods: The initiative will deliver a quality service for women empowering them to make positive changes to their bladder health. Initially patients will be offered a holistic assessment and a treatment plan will be devised according to their individual needs. Patients will be reviewed regularly to monitor progress.The focus of first line treatments will be support, retraining methods and medication management . When necessary patients will be referred via GP to Urology specialists for further investigation. Incontinence wear will be provided as a form of containment when all other avenues have been exhausted.To maximize the clinics success and staff involvement we enlisted the help of enthusiastic staff members to support this change in practice, our Champions of Change. Frameworks for clinics and staff training were developed along with a procedure to ensure consistency in practice. The clinics were started in one test area and will remain there until well established.Results: When implementing change to add value to people’s lives the results are not always quantifiable, although resources are available to measure the outcomes in the form of clinical compstats.The main focus of outcome measure will be patient satisfaction surveys which will emphasize quality of life changes such as increased self-esteem and dignity.Early feedback from patients in this regard is highly positive and also suggests notable improvements in continence.Reviews will be undertaken to ensure clinics are meeting objectives and changes made were necessary. At this point the resources will be in place to branch out to the wider community and the model will be available to replicate.Conclusion: The change project is bringing bladder health promotion to the forefront of the public health nursing service. With the addition of education sessions for nurses it will ensure best practice is promoted and the highest service will be provided to patients.Clinic staff nurses are currently working closely with Tertiary services to reduce unnecessary Urodynamic investigations. Our method of first line treatment plans in conjunction with Gp's for medication management where necessary is a viable way of achieving this.Our ultimate goal is to create a system of Direct referral pathways between hospital and community alike and amongst multidisciplinary team members for continence care.This has the potential to change the face of continence care so that every woman can deservedly receive the same level of care in the community.

Breast cancer prognostic assays are emerging as tools used by physicians in the cancer treatment decision-making process. This technology is new, and we must interrogate the integration of these assays into clinical practice and their effect on prognosis and treatment for both providers and patients. The objective of this study was to explore perspectives on the use and integration of breast cancer prognostic assays in clinical care. 15 international researcher-physician/scientist key opinion leaders who had conducted studies on breast cancer prognostic assays were interviewed. Participants had conducted studies using five different assays. The interview guide was developed through a literature review and leveraged extensive data collected on key clinical utility outcomes for the assays. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis. Three novel themes emerged from participant's perspectives on the use and value of these assays. The emerging role of prognostic assays to identify overtreatment and unnecessary care was highlighted by the majority of participants. The primary value of these tools is to identify patients who will not benefit from adjuvant chemotherapy. Participants reported that current standard practice is to overtreat and portrayed the binary or definitive results of these assays as an important tool to reduce overtreatment. Participants also provided insights into deliberate efforts to integrate the assays into clinical practice and how improved quality of life and reduction in overtreatment was positioned to justify high cost of the assay. Finally, participants reported how the perspectives and uses of these assays vary significantly in different countries and cultures. This jurisdictional variation in cancer prognosis and treatment was observed as producing uneven and sometimes problematic interpretations of value for the assays. The results of this study provide insights into the integration of prognostic assays into healthcare services. The assays are seeking to extend the boundaries of their clinical utility through identifying overtreatment and low value care. Efforts to integrate these assays and justify their high prices are unpacked and reveal complex and contradictory factors. Finally, these results illuminate that the varied approaches to cancer treatment, and varied use of chemotherapy create disparate perceptions of value for the assays.

Background Little is known about risk attitudes and risk perceptions in multiple sclerosis (MS). Objectives The objectives of this paper are to investigate the range of risk attitudes and risk perceptions and examine associations between risk attitudes and risk perceptions and demographic and clinical features of the disease. Methods A total of 223 individuals completed a risk questionnaire. Risk attitude was measured using two rating scales and a standard gamble scenario. Risk perception was measured by asking participants to estimate the likelihood of disease progression and the likelihood of minor and serious side effects associated with common MS therapies. Results Participants were risk neutral overall and risk averse on issues related to health and safety. There was a significant association between disease duration and risk attitude, with patients with longer disease duration showing greater tolerance for risk. On the standard gamble scenario, males were significantly more likely to take treatments with a likelihood of death of 1:10,000 or 1:100,000 than females. Individuals with higher disability or a progressive disease course were significantly more likely to expect progression at two, five and 10 years. Conclusion Individuals with MS demonstrate low tolerance for risk. Risk attitudes and perceptions are influenced by some demographic and clinical features of the disease.

Some time ago, several of the bodies corporate were approached by the BDJ and asked if they would be prepared to field a director to be interviewed for the journal. The only stipulation was that the director should be one of the dentists on the board. The next few issues of the BDJ will feature interviews with those dentist-directors of bodies corporate who accepted the invitation. Of those approached, ADP Dental Company Ltd, Boots Dentalcare Ltd, Integrated Dental Holdings Plc, Oasis Dental Care Ltd, Ora Dental Group Ltd, OrthoWorld 2000 Ltd, accepted. Only two declined the opportunity: Dr J. D. Hull & Associates Ltd and Dencare Management Ltd. The first interview follows this introduction to the series by Fiona Stuart-Wilson.