Conducting and reporting trials for older people

Randomised controlled trials provide the most rigorous test of efficacy and effectiveness for interventions used in healthcare. They underpin much of clinical practice, yet older people are often excluded from studies, resulting in uncertainty about risks and benefits of new treatments. Encouraging inclusion of older people in randomised controlled trials and reporting of trial results in a rigorous manner is a key function of clinical geriatrics journals such as Age and Ageing. This article provides practical advice on how to report randomised controlled trials that are targeted at older people. Some of these issues are generic, but there are specific requirements which apply to most studies of older people. Recording and reporting basic characteristics of recruits in terms of physical function, cognition, comorbidity and/or frailty is vital to allow proper interpretation of the external validity of the trial. Adverse effects should include consideration of common geriatric problems including falls. Authors should follow the CONSORT reporting guidelines (CONsolidated Standards Of Reporting Trials) to enhance the transparency and quality of their manuscript

Effect of multiple episodes of Acute Kidney Injury on mortality:an observational study

Background Patients who survive an episode of acute kidney injury (AKI) are more likely to have further episodes of AKI. AKI is associated with increased mortality, with a further increase with recurrent episodes. It is not clear whether this is due to AKI or as a result of other patient characteristics. The aim of this study was to establish whether recurrence of AKI is an independent risk factor for mortality or if excess mortality is explained by other factors. Methods This observational cohort study included adult people from the Tayside region of Scotland, with an episode of AKI between 1 January 2009 and 31 December 2009. AKI was defined using the creatinine-based Kidney Disease: Improving Global Outcomes definition. Associations between recurrent AKI and mortality were examined using a Cox proportional hazards model. Results Survival was worse in the group identified to have recurrent AKI compared with those with a single episode of AKI [hazard ratio = 1.49, 95% confidence interval (CI) 1.37–1.63; P

Oral Bicarbonate Therapy in Non-Haemodialysis Dependent Chronic Kidney Disease Patients : A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Supplementary Materials: The following are available online at www.mdpi.com/2077-0383/8/2/208/s1, Supplementary Figure S1. Forest plot comparing the effects of oral bicarbonate therapy and control on serum creatinine levels. Supplementary Figure S2. Forest plot comparing the effects of oral bicarbonate therapy and control on eGFR at one year. Supplementary Figure S3. Forest plot comparing the effects of oral bicarbonate therapy and control on serum bicarbonate levels at one year. . Funding: This work was supported by a National Institute of Health Research Health Technology Assessment (NIHR HTA) project grant (Ref: 10/71/10).Peer reviewedPublisher PD

Increasing physical activity levels in care homes for older people:a quantitative scoping review of intervention studies to guide future research

Physical activity (PA) levels in older care home residents are low. This has detrimental effects on health. Little is known about the nature of interventions to increase physical activity in this population. A scoping review to: (1) identify and describe interventions to increase PA in older care home residents, and (2) describe the extent to which interventions address care home context, systemised by social–ecological models. We systematically searched databases for peer-reviewed intervention studies to increase PA in older people resident in care homes. Data were extracted using the template for intervention description and replication (TIDieR) and mapped against a social–ecological framework to locate the intervention focus. The 19 included studies consisted of interventions tested in randomised or quasi-experimental trial designs. Interventions consisted of single or multiple components and predominantly addressed individual resident level factors (such as muscle strength) rather than broader social and environmental aspects of context. Interventions were not all fully described. For most interventions a distinct theoretical foundation was not identified. Interventions were mostly delivered by health professionals and research staff external to care homes. Future interventions should address contextual care home factors and should be clearly described according to intervention description guidance.Implications for rehabilitationPhysical activity holds promise as an effective means of improving health and function in older care home residents, but physical activity levels in this population are low.Several reasons beyond the individual resident but related to care home contextual factors may explain low PA in care homesTo date, contextual factors influencing PA in care homes have been poorly addressed in interventions.Wider care home context (social, cultural, and environmental factors) must be considered in future interventions. Physical activity holds promise as an effective means of improving health and function in older care home residents, but physical activity levels in this population are low. Several reasons beyond the individual resident but related to care home contextual factors may explain low PA in care homes To date, contextual factors influencing PA in care homes have been poorly addressed in interventions. Wider care home context (social, cultural, and environmental factors) must be considered in future interventions.</p

Missileborne Artificial Vision System (MAVIS)

Several years ago when INTEL and China Lake designed the ETANN chip, analog VLSI appeared to be the only way to do high density neural computing. In the last five years, however, digital parallel processing chips capable of performing neural computation functions have evolved to the point of rough equality with analog chips in system level computational density. The Naval Air Warfare Center, China Lake, has developed a real time, hardware and software system designed to implement and evaluate biologically inspired retinal and cortical models. The hardware is based on the Adaptive Solutions Inc. massively parallel CNAPS system COHO boards. Each COHO board is a standard size 6U VME card featuring 256 fixed point, RISC processors running at 20 MHz in a SIMD configuration. Each COHO board has a companion board built to support a real time VSB interface to an imaging seeker, a NTSC camera, and to other COHO boards. The system is designed to have multiple SIMD machines each performing different corticomorphic functions. The system level software has been developed which allows a high level description of corticomorphic structures to be translated into the native microcode of the CNAPS chips. Corticomorphic structures are those neural structures with a form similar to that of the retina, the lateral geniculate nucleus, or the visual cortex. This real time hardware system is designed to be shrunk into a volume compatible with air launched tactical missiles. Initial versions of the software and hardware have been completed and are in the early stages of integration with a missile seeker

Research note – barriers and solutions to linking and using health and social care data in Scotland

Integration of health and social care will require integrated data to drive service evaluation, design, joint working and research. We describe the results of a Scottish meeting of key stakeholders in this area. Potential uses for linked data included understanding client populations, mapping trajectories of dependency, identifying at risk groups, predicting required capacity for future service provision, and research to better understand the reciprocal interactions between health, social circumstances and care. Barriers to progress included lack of analytical capacity, incomplete understanding of data provenance and quality, intersystem incompatibility and issues of consent for data sharing. Potential solutions included better understanding the content, quality and provenance of social care data; investment in analytical capacity; improving communication between data providers and users in health and social care; clear guidance to systems developers and procurers; and enhanced engagement with the public. We plan a website for communication across Scotland on health and social care data linkage, educational resources for front line staff and researchers, plus further events for training and information dissemination. We believe that these processes hold lessons for other countries with an interest in linking health and social care data, as well as for cross-sector data linkage initiatives in general.</p