Variation in ambulance call rates for care homes in Torbay, UK

Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1/4/12 and 31/7/13. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21 to 0.89; 0.03 to 2.45). Nursing homes had a lower call rate than residential homes (adjusted rate ratio (ARR) 0.29; 95% CI: 0.22 to 0.40 ; p<0.001); care homes failing the quality and suitability of management standard had a lower call rate compared to those who passed (ARR 0.67; 95% CI: 0.50 to 0.90; p=0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23 to 1.96; p<0.001). These findings require replication in other regions to establish their generalisability and further investigation is required to determine the extent to which callrate variability reflects the different needs of resident populations or differences in care home policies and practice

Use of Endocrine Therapy for Breast Cancer Risk Reduction: ASCO Clinical Practice Guideline Update

To update the ASCO guideline on pharmacologic interventions for breast cancer risk reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for breast cancer risk reduction.; An Expert Panel conducted targeted systematic literature reviews to identify new studies.; A randomized clinical trial that evaluated the use of anastrozole for reduction of estrogen receptor-positive breast cancers in postmenopausal women at increased risk of developing breast cancer provided the predominant basis for the update.; In postmenopausal women at increased risk, the choice of endocrine therapy now includes anastrozole (1 mg/day) in addition to exemestane (25 mg/day), raloxifene (60 mg/day), or tamoxifen (20 mg/day). The decision regarding choice of endocrine therapy should take into consideration age, baseline comorbidities, and adverse effect profiles. Clinicians should not prescribe anastrozole, exemestane, or raloxifene for breast cancer risk reduction to premenopausal women. Tamoxifen 20 mg/day for 5 years is still considered standard of care for risk reduction in premenopausal women who are at least 35 years old and have completed childbearing. Data on low-dose tamoxifen as an alternative to the standard dose for both pre- and postmenopausal women with intraepithelial neoplasia are discussed in the Clinical Considerations section of this article. Additional information is available at www.asco.org/breast-cancer-guidelines

An objective framework to test the quality of candidate indicators of good environmental status

This is the final version. Available from the publisher via the DOI in this record.Large efforts are on-going within the EU to prepare the Marine Strategy Framework Directive's (MSFD) assessment of the environmental status of the European seas. This assessment will only be as good as the indicators chosen to monitor the 11 descriptors of good environmental status (GEnS). An objective and transparent framework to determine whether chosen indicators actually support the aims of this policy is, however, not yet in place. Such frameworks are needed to ensure that the limited resources available to this assessment optimize the likelihood of achieving GEnS within collaborating states. Here, we developed a hypothesis-based protocol to evaluate whether candidate indicators meet quality criteria explicit to the MSFD, which the assessment community aspires to. Eight quality criteria are distilled from existing initiatives, and a testing and scoring protocol for each of them is presented. We exemplify its application in three worked examples, covering indicators for three GEnS descriptors (1, 5, and 6), various habitat components (seaweeds, seagrasses, benthic macrofauna, and plankton), and assessment regions (Danish, Lithuanian, and UK waters). We argue that this framework provides a necessary, transparent and standardized structure to support the comparison of candidate indicators, and the decision-making process leading to indicator selection. Its application could help identify potential limitations in currently available candidate metrics and, in such cases, help focus the development of more adequate indicators. Use of such standardized approaches will facilitate the sharing of knowledge gained across the MSFD parties despite context-specificity across assessment regions, and support the evidence-based management of European seas.European Union: 7th Framework ProgrammeNatural Environment Research Council (NERC)UK Department for Environment, Food and Rural Affair

The implementation of initial data populations of environmental data and creation of a primary working database

Biological and environmental changes are creating a growing demand for historical and global data sets. Comparing up-to-date ecological and biological findings with historical statements has become a major part of scientific work in the field of ecology. This evaluation and comparison procedure is very time-consuming while the availability of raw data is very low. Comparisons between original findings – if available – require a lot of work from print publication to digitalization or transformation to appropriate data formats. The effective use of working capacity is a general issue and has become important, should the use of information technologies be invoked to minimize time-wasting copy and paste operations. In this paper we aim to present a working repository for terrestrial biological data. The implementation of this type of data repository will provide various services to participating scientists as long as the final aim is the publication of these repositories. Furthermore, the security and long-term availability of environmental data is an issue of increasing importance to the scientific community. Unrepeatable sampling events and any data thus obtained are precious in time series analysis. For this reason, a well-structured storage of data is necessary for easy accessibility, retrieval and comparability. This is an important issue for the community of environmental scientists. The need to construct and implement repositories should prevail against all hitches and we are therefore describing our on-going task with the primary population of this kind of data repository. A biological and ecological information system is a matter of public interest and should also be a key issue for ecologists

Follow-up of cancer in primary care versus secondary care: systematic review

Background Cancer follow-up has traditionally been undertaken in secondary care, but there are increasing calls to deliver it in primary care. Aim To compare the effectiveness and cost-effectiveness of primary versus secondary care follow-up of cancer patients, determine the effectiveness of the integration of primary care in routine hospital follow-up, and evaluate the impact of patient-initiated follow-up on primary care. Design of study Systematic review. Setting Primary and secondary care settings. Method A search was carried out of 19 electronic databases, online trial registries, conference proceedings, and bibliographies of included studies. The review included comparative studies or economic evaluations of primary versus secondary care follow-up, hospital follow-up with formal primary care involvement versus conventional hospital follow-up, and hospital follow-up versus patient-initiated or minimal follow-up if the study reported the impact on primary care. Results There was no statistically significant difference for patient wellbeing, recurrence rate, survival, recurrence-related serious clinical events, diagnostic delay, or patient satisfaction. GP-led breast cancer follow-up was cheaper than hospital follow-up. Intensified primary health care resulted in increased home-care nurse contact, and improved discharge summary led to increased GP contact. Evaluation of patient-initiated or minimal follow-up found no statistically significant impact on the number of GP consultations or cancer-related referrals. Conclusion Weak evidence suggests that breast cancer follow-up in primary care is effective. Interventions improving communication between primary and secondary care could lead to greater GP involvement. Discontinuation of formal follow-up may not increase GP workload. However, the quality of the data in general was poor, and no firm conclusions can be reached

Oceanic biogeochemical characteristic maps identified with holistic use of satellite, model and data

This is the final published version.Ocean province level plankton community exhibit heterogeneity across Arctic, Nordic, Atlantic Gyre and Southern Ocean provinces. GreenSeas research is an international FP7 consortium that includes Arctic, Atlantic and Southern Ocean based research teams who are analysing the planktonic ecosystem. We are looking at how the planktonic ecosystem responds to environmental and climate change. Using Earth Observation monitoring data we report new results on identifying generic plankton characteristics observable at a province level, and also touch on spatial and temporal trends that are evident using a holistic analysis framework. Using advanced statistical methods this framework compares and combines Earth Observation information together with an in-situ Oceanic plankton Analytical Database and up to 40 year ocean general circulation biogeochemical model (OGCBM) time series of the equivalent plankton and sea-state measures of this system. Specifically, we outline the use of the GreenSeas Analytical Database, which is a harmonised set of Oceanic in-situ plankton and sea-state measures covering different cruises and time periods. The Analytical Database information ranges from plankton community, primary production, nutrient cycling to physical sea state temperature and salinity measures. The combined analysis utilises current, 10 year+ Earth Observations of ocean colour and sea surface temperature metrics and interprets these together with biogeochemical model outputs from PELAGOS, ERSEM & NORWECOM model runs to help identify planktonic based biomes. Generic planktonic characteristic maps that are equivalently observable in both the Earth Observations and numerical models are reported on. Both ocean surface and sub-surface signals are analysed together with relevant Analytical Database biome extracts. We present the current results of this inter-comparison & discuss challenges of identifying the province level plankton dominance with the satellite, model and data. In particular we discuss the strategic importance of systematically analysing the knowledge present in the existing key long term Oceanic observation platforms through such holistic analysis frameworks. These maps help to enhance and improve current biogeochemical models, our understanding of the plankton community structure and predictions used for future assessment of climate change

There are no whole truths in meta-analyses: all their truths are half truths

In a recent letter, Thomsen & Wernberg (2015) rean-alyzed data compiled for our recent paper (Lyonset al., 2014). In that paper, we examined the effectsof macroalgal blooms and macroalgal mats on sevenimportant measures of community structure and eco-system functioning and explored several ecologicaland methodological factors that might explain someof the variation in the observed effects. Thomsen &Wernberg (2015) re-analyzed two small subsets of the data, focusing on experimental studies examining effects of blooms/mats on invertebrate abundance.Their analyses revealed two interesting patterns.First, they showed that macroalgal blooms reducedthe abundance of communities that Thomsen andWernberg categorized as ‘mainly infauna’, whileincreasing the abundance of communities categorized as ‘mainly epifauna’. Second, they showed that theimpacts of macroalgal blooms on ‘mainly infauna’communities increased with algal density in experiments that included multiple levels of algal density.These findings, as well as the conclusions that Thomsen & Wernberg (2015) draw from them, are largely consistent with our own expectations and interpretations. However, we also feel that some caution is required when interpreting the results of their analyses

Why honey is effective as a medicine. 1. Its use in modern medicine

Honey has been used as a medicine for thousands of years and its curative properties are well documented. However, modern medicine turned its back on honey and it is only now, with the advent of multi-resistant bacteria, that the antibiotic properties of honey are being rediscovered

Guidelines on Chemotherapy in Advanced Stage Gynecological Malignancies: An Evaluation of 224 Professional Societies and Organizations

BACKGROUND: Clinical practice guidelines are important for guiding practice, but it is unclear if they are commensurate with the available evidence. METHODS: We examined guidelines produced by cancer and gynecological societies and organizations and evaluated their coverage of and stance towards chemotherapy for advanced stage disease among 4 gynecological malignancies (breast, ovarian, cervical, endometrial cancer) where the evidence for the use of chemotherapy is very different (substantial and conclusive for breast and ovarian cancer, limited and suggesting no major benefit for cervical and endometrial cancer). Eligible societies and organizations were identified through systematic internet searches (last update June 2009). Pertinent websites were scrutinized for presence of clinical practice guidelines, and relative guidelines were analyzed. RESULTS: Among 224 identified eligible societies and organizations, 69 (31%) provided any sort of guidelines, while recommendations for chemotherapy on advanced stage gynecological malignancies were available in 20 of them. Only 14 had developed their own guideline, and only 5 had developed guidelines for all 4 malignancies. Use of levels of evidence and grades of recommendations, and aspects of the production, implementation, and timeliness of the guidelines did not differ significantly across malignancies. Guidelines on breast and ovarian cancer utilized significantly more randomized trials and meta-analyses. Guidelines differed across malignancies on their coverage of disease-free survival (p = 0.033), response rates (p = 0.024), symptoms relief (p = 0.005), quality of life (p = 0.001) and toxicity (p = 0.039), with breast and ovarian cancer guidelines typically covering more frequently these outcomes. All guidelines explicitly or implicitly endorsed the use of chemotherapy. CONCLUSIONS: Clinical practice guidelines are provided by the minority of professional societies and organizations. Available guidelines tend to recommend chemotherapy even for diseases where the effect of chemotherapy is controversial and recommendations are based on scant evidence