Search

Background: Shared Lives (adult placement) is a model of community‐based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer. It is an established but small‐scale service used mainly by adults with learning disabilities. However, little research has been conducted about whether and in what ways this model can support people to live well. Method: This article presents findings from outcome measures focused on well‐being for a sample of 39 people supported by Shared Lives in England. Fifteen semistructured interviews were also conducted by peer/coresearchers to supplement the quantitative data. Data collection took place between June 2017 and September 2018. Findings: Findings indicated that people using Shared Lives generally had good outcomes across all of the measures. All of those interviewed identified areas of their life where Shared Lives had made a positive difference, particularly with relationships and activities. Conclusions: Limitations to the research mean that more work is needed to fully understand the role Shared Lives plays in supporting people to live well and in comparison to other forms of community support. Accessible summary: It is important that people with learning disabilities have choices and control over where they live.Shared Lives is a service that is mainly used by adults with learning disabilities, people are matched with a carer and they live with or visit them.Shared Lives appears to support people to have good lives or live well.Most of the people supported by Shared Lives in this research were comfortable and happy.Shared Lives should be included as one of the support options offered to adults with learning disabilities and their families. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a viral illness, many patients admitted to hospital are prescribed antibiotics, based on concerns that COVID-19 patients may experience secondary bacterial infections, and the assumption that they may respond well to antibiotic therapy. This has led to an increase in antibiotic use for some hospitalised patients at a time when accumulating antibiotic resistance is a major global threat to health. Procalcitonin (PCT) is an inflammatory marker measured in blood samples and widely recommended to help diagnose bacterial infections and guide antibiotic treatment. The PEACH study will compare patient outcomes from English and Welsh hospitals that used PCT testing during the first wave of the COVID-19 pandemic with those from hospitals not using PCT. It will help to determine whether, and how, PCT testing should be used in the NHS in future waves of COVID-19 to protect patients from antibiotic overuse. PEACH is a retrospective observational cohort study using patient-level clinical data from acute hospital Trusts and Health Boards in England and Wales. The primary objective is to measure the difference in antibiotic use between COVID-19 patients who did or did not have PCT testing at the time of diagnosis. Secondary objectives include measuring differences in length of stay, mortality, intensive care unit admission, and resistant bacterial infections between these groups. [ABSTRACT FROM AUTHOR]

Summary: This analysis is the largest population‐based study to date to provide contemporary and comprehensive epidemiological estimates of all third edition of the International Classification of Diseases for Oncology (ICD‐O‐3) coded Langerhans cell histiocytosis (LCH) from England. People of all ages were identified from the National Cancer Registration Dataset using ICD‐O‐3 morphologies 9751–9754 for neoplasms diagnosed in 2013–2019. A total of 658 patients were identified, of whom 324 (49%) were children aged <15 years. The age‐standardised incidence rate was 4.46 (95% confidence interval [CI] 3.99–4.98) per million children and 1.06 (95% CI 0.94–1.18) per million adults aged ≥15 years. Prevalence of LCH was 9.95 (95% CI 9.14–10.81) per million persons at the end of 2019. The 1‐year overall survival (OS) was 99% (95% CI 97%–100%) for children and 90% (95% CI 87%–93%) for adults. Those aged ≥60 years had poorer OS than those aged <15 years (hazard ratio [HR] 22.12, 95% CI 7.10–68.94; p < 0.001). People in deprived areas had lower OS than those in the least deprived areas (HR 5.36, 95% CI 1.16–24.87; p = 0.03). There will inevitably be other environmental factors and associations yet to be identified, and the continued standardised data collection will allow further evaluation of data over time. This will be increasingly important with developments in LCH management following the large collaborative international trials such as LCH IV. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the fourth Be Clear on Cancer (BCoC) 'Blood in Pee' (BiP) campaign (July to September 2018) on bladder and kidney cancer symptom awareness and outcomes in England. Methods: In this uncontrolled before and after study, symptom awareness and reported barriers to GP attendance were assessed using panel and one‐to‐one interviews. The Health Improvement Network (THIN), National Cancer Registration and Analysis Service (NCRAS) and NHS Cancer Waiting Times (CWT) data were analysed to assess the impact on GP attendances, urgent cancer referrals, cancer diagnoses and 1‐year survival. Analyses used Poisson, negative binomial and Cox regression. Results: Symptom awareness and intention to consult a GP after one episode of haematuria increased following the campaign. GP attendance with haematuria (rate ratio (RR) 1.17, 95% confidence interval (CI): 1.07–1.28) and urgent cancer referrals (RR 1.18 95% CI: 1.08–1.28) increased following the campaign. Early‐stage diagnoses increased for bladder cancer (difference in percentage 2.8%, 95% CI: −0.2%–5.8%), but not for kidney cancer (difference −0.6%, 95% CI: −3.2%–2.1%). Conclusions: The fourth BCoC BiP campaign appears to have been effective in increasing bladder cancer symptom awareness and GP attendances, although long‐term impacts are unclear. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate sepsis on undergraduate programmes in medicine (BMBS), dentistry (BDS) and dental therapy (BScDTH) at a university in England. Materials and Methods: The study was carried out at the Faculty of Health, University of Plymouth. Questionnaires consisting of a series of closed and open‐ended items were designed for students and faculty by a group of academics. Following a pilot, participants were invited to complete the questionnaires online. Data collection and analyses were completed over a period of 3 months. Results: A total of 71 students responded, including 43 were on the BDS programme, 21 on BMBS and 7 on BScDTH. The vast majority were aged between 18–24 years old (n = 61), with 9 reporting being between 25–44 years old. Of the 14 staff who responded, 13 were aged between 35 and 54 years old, with one respondent reporting being aged 25–34. The participants reported their perceptions regarding the teaching and clinical exposure of students to sepsis patients; availability of resources for students and patients to raise sepsis awareness. Students across all programmes reported limited clinical exposure to management of sepsis and lack of confidence in recognising early signs of sepsis in patients. The agreement profile between programmes only differed significantly for recognition of sepsis risk item (χ(6, n = 71) = 26.187, p < 0.001), with BDS students disagreeing with the item to a larger extent than BMBS and BScDTH students. Students and staff reported similar perceptions regarding information available to students and patients. Responses to open‐ended items provided several suggestions for improvements in the teaching of students and raising public awareness on sepsis. Conclusion: This study identified several areas related to sepsis teaching which require improvements across all programmes. The key issues highlighted by the students included limited clinical exposure to sepsis patients and lack of confidence in recognising early signs of sepsis. [ABSTRACT FROM AUTHOR]

Objective: More than a third of women diagnosed with breast cancer in England, and over half of those who die from it, are over 70. The Be Clear on Cancer Breast Cancer in Women over 70 Campaign, running three times, 2014–2018, aimed to promote early diagnosis of breast cancer in England by raising symptom awareness and encouraging women to see their general practitioner (GP) without delay. We sought to establish whether the third campaign had successfully met its aims. Methods: Metrics covering the patient pathway, including symptom awareness, attending a GP practice with symptoms, urgent GP referral, diagnosis and stage of cancer, were assessed using national cancer databases and two household surveys. Results: The third campaign was associated with an increase in urgent cancer referrals, and therefore mammograms and ultrasounds performed. This was associated with an increase in breast cancers diagnosed. There was a delayed effect on GP attendances. Awareness of breast cancer prevalence for the 70‐and‐over age group improved. Impact on these metrics diminished across successive campaigns. Conclusions: Future campaigns should focus on harder‐to‐reach women and include GPs as targets as this campaign showed a potential to affect referral behaviour. [ABSTRACT FROM AUTHOR]

Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare hyper‐inflammatory condition with poor outcomes. Objectives: Few population‐based estimates of the incidence and survival in adults exist. We aimed to provide these data for England. Methods: We used population‐based linked data from primary care, secondary care, cancer registries and mortality databases in England to identify people diagnosed with HLH between 1 January 2000 and 31 December 2016. We calculated annual incidence rates by age and sex, modelled change in incidence over time with Poisson regression, calculated overall 1‐year survival using Kaplan–Meier methods and estimated adjusted hazard ratios (HRs) of death using a Cox proportional hazards model. Results: We identified 214 patients with HLH. The reported age and sex‐adjusted incidence increased twofold over the period, from around one to around two per million. Incidence was highest in those below 1 year (14.6 per million) and ≥75 years (2.2 per million), and lowest in those aged 15–44 years (0.8 per million). One‐year survival varied by age and sex from 77% (95% confidence interval [CI] 63%–86%) in those <15 years to 30% (95% CI 14%–49%) in those ≥75. In patients with haematological cancer, the adjusted HR for death was 2.60 (95% CI 1.45–4.66) compared to patients with no malignant or rheumatological disease. Conclusion: The incidence of HLH diagnosis in England has increased between 2000 and 2016 and occurs in all ages with varying underlying diseases. One‐year survival varies substantially, being particularly poor in those aged over 75 years and those with haematological malignancy. [ABSTRACT FROM AUTHOR]

Background: A two-phase 'respiratory symptoms' mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit.Method: A prospectively planned pre-post evaluation was done using routinely collected data on 15 metrics, including GP attendance, GP referral, emergency presentations, cancers diagnosed (five metrics), cancer stage, investigations (two metrics), outpatient attendances, inpatient admissions, major lung resections and 1-year survival. The primary analysis compared 2015 with 2017. Trends in metrics over the whole period were also considered. The effects of the campaign on awareness of lung cancer symptoms were evaluated using bespoke surveys.Results: There were small favourable statistically significant and clinically important changes over 2 years in 11 of the 15 metrics measured, including a 2.11% (95% confidence interval 1.02-3.20, p < 0.001) improvement in the percentage of lung cancers diagnosed at an early stage. However, these changes were not accompanied by increases in GP attendances. Furthermore, the time trends showed a gradual change in the metrics rather than steep changes occurring during or after the campaigns.Conclusion: There were small positive changes in most metrics relating to lung cancer diagnosis after this campaign. However, the pattern over time challenges whether the improvements are wholly attributable to the campaign. Given the importance of education on cancer in its own right, raising awareness of symptoms should remain important. However further research is needed to maximise the effect on health outcomes. [ABSTRACT FROM AUTHOR]

Background: People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation.Methods: Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20-99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects.Results: For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing "degree-level qualification and higher" to "no qualification" and EHR = 0.74 [0.56;0.97] comparing "apprenticeships and vocational qualification" to "no qualification", adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing "managerial/professional occupations" to "manual/technical," and EHR = 0.81 [0.63;1.06] comparing "intermediate" to "manual/technical", adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects.Conclusions: Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice. [ABSTRACT FROM AUTHOR]

November 2019 saw the release of A Blueprint for Children's Social Care (hereafter the Blueprint) in England. The Blueprint proposes introducing the Buurtzorg model of community nursing into the child protection social work in England, and received widespread interest and publicity. Buurtzorg is a Dutch community nursing agency that is based on a specific model of small self-managing and non-hierarchal teams. The authors of the Blueprint suggest that rapid and large-scale introduction of Buurtzorg into child protection social work would overcome many of the longstanding issues facing the profession in England. However, there are serious limitations to the suggestions outlined in the Blueprint and the Buurtzorg model does not translate well to child protection social work in England. Drawing on the work of Mark Fisher, this article examines the Blueprint under three core themes: consent and consensus, links with other neoliberal projects and failing forward. Ultimately, it is shown that the Blueprint can be considered part of a wider project of implementing neoliberal policies and market solutions to children's social care in England, a process that is increasingly being led by large, profit-driven global consultancy firms. [ABSTRACT FROM AUTHOR]

Objective: A regional 'Be Clear on Cancer' (BCoC) campaign developed by Public Health England aimed to promote public awareness of key abdominal cancer symptoms in people aged 50 years and over. Methods: Data were analysed for metrics at different stages in the patient care pathway including public awareness, GP attendance and referrals, to cancer diagnosis. Results: There was significantly higher recognition of the BCoC abdominal campaign in the campaign region compared to the control area (Post Campaign/Control, n = 401/406; 35% vs. 24%, p < 0.05). The campaign significantly improved knowledge of 'bloating' as a symptom (p = 0.03) compared to pre‐campaign levels. GP attendances for abdominal symptoms increased significantly by 5.8% (p = 0. 03), although the actual increase per practice was small (average 16.8 visits per week in 2016 to 17.7 in 2017). Urgent GP referrals for suspected abdominal cancer increased by 7.6%, compared to a non‐significant change (0.05%) in the control area. For specific abdominal cancers, the number diagnosed were similar to or higher than the median in the campaign area but not in the control area in people aged 50 and over: colorectal (additional n = 61 cancers), pancreatic (additional n = 102) and stomach cancers (additional n = 17). Conclusions: This campaign had a modest impact on public awareness of abdominal cancer symptoms, GP attendances and cancers diagnosed. [ABSTRACT FROM AUTHOR]

Summary: We assessed the validity of coded healthcare data to identify cases of haemophagocytic lymphohistiocytosis (HLH). Hospital Episode Statistics (HES) identified 127 cases within five hospital Trusts 2013–2018 using ICD‐10 codes D76.1, D76.2 and D76.3. Hospital records were reviewed to validate diagnoses. Out of 74 patients, 73 were coded D76.1 or D76.2 (positive predictive value 89·0% [95% Confidence Interval {CI} 80·2–94·9%]) with confirmed/probable HLH. For cases considered not HLH, 44/53 were coded D76.3 (negative predictive value 97·8% [95% CI 88·2–99·9%]). D76.1 or D76.2 had 68% sensitivity in detecting HLH compared to an established active case‐finding HLH register in Sheffield. Office for National Statistics (ONS) mortality data (2003–2018) identified 698 patients coded D76.1, D76.2 and D76.3 on death certificates. Five hundred and forty‐one were coded D76.1 or D76.2 of whom 524 (96·9%) had HLH in the free‐text cause of death. Of 157 coded D76.3, 66 (42·0%) had HLH in free text. D76.1 and D76.2 codes reliably identify HLH cases, and provide a lower bound on incidence. Non‐concordance between D76.3 and HLH excludes D76.3 as an ascertainment source from HES. Our results suggest electronic healthcare data in England can enable population‐wide registration and analysis of HLH for future research. [ABSTRACT FROM AUTHOR]

Summary: Mark Fisher's Capitalist Realism, published in 2009, has been recognised as one of the most important contributions chronicling the rise, application and consequences of neoliberalism. However, Fisher's ideas have until now only garnered passing mention in the study of neoliberalism in children and families social work in England, despite there being extensive research, argument and publication on the subject more broadly. This article attempts to rectify this gap and apply Fisher's theory to the recent reforms in children and families social work in England. Findings: The article applies Fisher's commentary on the co-option of language, invoking crisis, bureaucracy and proposing change to implement no change, to the reforms in children and families social work that began with the implementation of Reclaiming Social Work in 2008. Since that time, the original architects of Reclaiming Social Work have gained significant positions of power and influence and been instrumental in introducing neoliberal reforms throughout children and families social work in England. Applications: Through applying the approach and concepts of Mark Fisher, this article concludes that it is possible to determine that the current reforms are, at their core, neoliberal in nature and driven by an ideological imperative to transform children and families social work in England into a neoliberal edifice, with less public sector and state input and oversight and an increase in the influence of 'not-for-profits', charities and international for-profit consultancies. [ABSTRACT FROM AUTHOR]

The Be Clear on Cancer (BCoC) campaigns have run in England since 2010. They aim to raise awareness of possible cancer symptoms, encouraging people to consult a general practice with these symptoms. Our study provides an overview of the impact of 11 national campaigns, for bowel, lung, bladder and kidney, breast and oesophago‐gastric cancers. We synthesised existing results for each campaign covering seven clinical metrics across the patient pathway from primary care attendances to one‐year net survival. For each metric, "before" and "after" periods were compared to assess change potentially related to the campaign. Results show that primary care attendances for campaign‐related symptoms increased for 9 of 10 campaigns and relevant urgent referrals for suspected cancer increased above general trends for 9 of 11 campaigns. Diagnostic tests increased for 6 of 11 campaigns. For 7 of 11 campaigns, there were increases in cancer diagnoses resulting from an urgent referral for suspected cancer. There were sustained periods where more cancers were diagnosed than expected for 8 of 10 campaigns, with higher than expected proportions diagnosed at an early stage for sustained periods for 4 of 10 campaigns. There was no impact on survival. In summary, there is evidence that the BCoC campaigns impact help‐seeking by patients and referral patterns by general practitioners, with some impact on diagnosis (incidence and stage). There was no clear evidence of impact on survival. What's new? Starting in 2010, the "Be Clear on Cancer" public awareness campaigns in England have promoted awareness of possible cancer symptoms, encouraging people with these symptoms to seek help without delay. This study is the first to evaluate the impact of 11 national campaigns for bowel, lung, bladder and kidney, breast, and oesophago‐gastric cancers on multiple points of the patient pathway. Evidence shows that the campaigns influence help‐seeking by patients and primary care referral patterns, with some impact on diagnosis (incidence and stage) but no impact on survival. The findings have potential implications for the design and sequencing of future campaigns. [ABSTRACT FROM AUTHOR]

Background: The 2009 pandemic H1N1 (A(H1N1)pdm09) influenza A virus (IAV) has replaced the previous seasonal H1N1 strain in humans and continues to circulate worldwide. The comparative performance of inactivated A(H1N1)pdm09 influenza vaccines remains of considerable interest. The objective of this study was to evaluate the efficacy of two licensed A(H1N1)pdm09 inactivated vaccines (AS03B adjuvanted split virion Pandemrix from GlaxoSmithKline and referred here as (V1) and non‐adjuvanted whole virion Celvapan from Baxter and referred here as (V2)) in ferrets as a pre‐clinical model for human disease intervention. Methods: Naïve ferrets were divided into two groups (V1 and V2) and immunised intramuscularly with two different A/California/07/2009‐derived inactivated vaccines, V1 administered in a single dose and V2 administered in 2 doses separated by 21 days. Six weeks after the first immunisation, vaccinated animals and a non‐vaccinated control (NVC) group were intra‐nasally challenged with 106.5 TCID50 of the isolate A/England/195/2009 A(H1N1)pdm09 with 99.1% amino acid identity to the vaccine strain. Clinical signs, lung histopathology, viral quantification and antibody responses were evaluated. Results and Conclusions: Results revealed important qualitative differences in the performance of both inactivated vaccines in relation to protection against challenge with a comparable virus in a naive animal (ferret) model of human disease. Vaccine V1 limited and controlled viral shedding and reduced lower respiratory tract infection. In contrast, vaccine V2 did not control infection and animals showed sustained viral shedding and delayed lower respiratory infection, resulting in pulmonary lesions, suggesting lower efficacy of V2 vaccine. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified.Methods: An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes.Findings: Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age>40, male, non-white ethnicity, oxygen saturations<93%, radiological severity score>3, neutrophil count>8.0 x109/L, CRP>40 mg/L, albumin<34 g/L, creatinine>100 µmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4.Interpretation: Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials. [ABSTRACT FROM AUTHOR]

Background: Patient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care. Little attention has been paid to understanding how patient experience feedback can act as a prompt to reflection in practice in the clinical setting. Objective: We aimed to identify the ways in which different types of patient experience feedback act as a trigger or prompt for engagement in reflection in clinical practice in acute hospital settings and identify important considerations for enhancing the value of patient experience data for reflective learning. Methods: We conducted an ethnographic study in eight acute care units in three NHS hospital trusts in England, including 140 hours of observations and 45 semi‐structured interviews with nursing, medical and managerial staff working in acute medical units and intensive care units. The data were analysed thematically. Findings: We distinguished between formal patient experience data sources: data purposively collected and collated to capture the patient experience of care, generally at organizational level, including surveys, complaints and comments; and informal sources of feedback on the patient experience recognized by staff alongside the formal data. We also identified patient narratives as an 'in between' source of data. The impact of different types of patient feedback in triggering reflection primarily depended on the extent to which the feedback was experienced as personally relevant, meaningful and emotionally salient. Discussion: Patient experience feedback is multi‐faceted, but our study suggests that all types of feedback could be harnessed more effectively to prompt reflection. [ABSTRACT FROM AUTHOR]

This article investigates responses to EU public procurement directives in Norway, England and Germany, with a particular focus on health and social services. We used a comparative national patterns approach to analyse parliamentary debates, consultative statements, the media and interviews with stakeholders. The literature contains prominent arguments suggesting that health and social service governance regimes are converging on the liberal model. Some authors argue that with its focus on policies which create markets, the EU is a driving force with an increasing relevance for market-based governance practices. However, the role of EU legislation is unclear as procurement regimes in relation to the governance of health and social services constitute a highly ambiguous terrain. Our study enabled us to show that the form of the debate is highly dependent on path-dependent mechanisms and the degree of openness of the national political system that provides channels for interests to be articulated. Indeed, the Norwegian case study serves as an excellent example of why marketisation has not advanced to the degree predicted in the literature: an inclusive and open political system and a strong non-profit health and service sector meant that the non-profit groups managed to turn the debate in their favour. [ABSTRACT FROM AUTHOR]

Background Summary statistics comparing the stage at diagnosis of geographically defined populations of cancer patients are increasingly used in public reporting to monitor geographical inequalities but may be confounded by patient case mix. We explore the impact of case-mix adjustment on a publicly reported measure of early stage at diagnosis in England. Methods We analyzed data used for publicly reported statistics about the stage of patients diagnosed with 1 of 11 solid tumours in 2015 in England, including information on cancer site (bladder, breast, colon, rectum, kidney, lung, melanoma, non-Hodgkin lymphoma, ovarian, prostate, endometrial), age, gender, income deprivation and population-based commissioning organization. We investigated how cancer site and other patient characteristics influence organizational comparisons and attainment of early-stage targets (≥60% of all cases diagnosed in TNM stages I–II). Results Adjusting for patient case mix reduced between-organization variance by more than 50%, resulting in appreciable discordance in organizational ranks (Kendall's tau = 0.53), with 18% (37/207) of organizations being reclassified as meeting/failing the early-stage target due to case mix. Conclusion Summary statistics on stage of cancer diagnosis for geographical populations currently used as public health surveillance tools to monitor organizational inequalities need to account for patient sociodemographic characteristics and cancer site case mix. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical role of general practice over time in diagnostic pathways for patients with cancer.Aim: To examine sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.Design and Setting: Analysis of Routes to Diagnosis data, 2006-2015, for patients with cancer in England.Method: The authors estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to accident and emergency (AE-EP), by patient sex, age, deprivation group, and year of diagnosis using multivariable regression.Results: Among 554 621 patients presenting as emergencies, 24% (n = 130 372) presented as GP-EP, 62% as AE-EP (n = 346 192), and 14% (n = 78 057) through Other-EP sub-routes. Patients presenting as emergencies were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%, n = 17 364, in 2006; 17%, n = 9155 in 2015), while that of AE-EP increased (55%, n = 31 049 to 68%, n = 36 868).Conclusion: Patients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals. [ABSTRACT FROM AUTHOR]

This paper considers the situation of the English voluntary sector in relation to austerity-driven social policies. Existing characterisations are outlined and it is argued that the quantitative evidence used to represent the situation of these organisations to date has been partial because it relies too narrowly on financial resource input measures. We argue that the situation of these organisations needs to be conceptualised in a more holistic way and, to initiate a move in this direction, we identify and explicate two relevant dimensions: the perceived capacity of organisations to rely on volunteers for support (a non-financial resource input); and their perception of the effect of the policy climate in shaping their capacity to flourish, including their ability to perform multiple roles beyond service provision alone. We draw on an original mixed methods empirical study undertaken in England in 2015 to operationalise these dimensions, combining qualitative interviews with national ‘policy community’ members with a large scale on-line survey of social policy charities. We find a complex and variegated situation that, while acknowledging the fundamental importance of financial resource pressures, also points to the salience of the volunteering situation, and to the relevance of the challenging policy climate that these organisations have to navigate. [ABSTRACT FROM AUTHOR]

Background: Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.Methods: Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.Results: Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.Conclusion: Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels-both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations. [ABSTRACT FROM AUTHOR]

There are many drivers for change and innovation in adult social care and one of the most significant is the personalisation agenda; however, whilst resources are always limited, this does have its roots in a more relaxed financial climate than currently prevails. This article draws on findings from a scoping study which aimed to identify future areas for research to assist councils in developing and commissioning personalised services. Twenty local authorities were surveyed and in three case study areas, interviews and focus groups conducted with staff and service users to explore progress with personalisation and identify innovative practice. Although, at the time of the study, the impact of resource reductions had yet to be felt, budget cuts were seen as a potential impediment to future developments. The innovative practice identified demonstrated approaches to tackling some of the challenges of personalising social care and a commitment from practitioners and commissioners to find ways to do this. However, it remains to be seen whether the cold financial climate results in a top-down prescriptive approach to personalisation or leads to local innovation to enable people to make decisions about their needs. [ABSTRACT FROM AUTHOR]

Background:The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis.Methods:All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006-2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0-1, 1-3, 3-6, and 6-12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined.Results:More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP.Conclusion:Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for. [ABSTRACT FROM AUTHOR]

Background:Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis.Methods:Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006-2008, is categorised into one of eight 'Routes to Diagnosis'.Results:Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival.Conclusion:Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis. [ABSTRACT FROM AUTHOR]

Multiple placement transitions have been associated with poorer psychosocial outcomes for children growing up in local authority care. However, although there is an expanding literature examining the risk and protective factors connected with placement breakdown, very few studies have explored the quality of the move experience for those most closely involved with it. Our study considered how young people, foster carers and social workers made sense of unplanned placements’ endings. Bringing together the lived experiences of these key stakeholders in the placement system added a novel dimension to existing research knowledge. What emerged from our analysis was evidence of a pervasive and shared emotional experience; all of the participants were affected by the breakdown irrespective of age, experience, or professional role. However, despite many commonalities, there was also a strong sense of fragmentation between the groups, which was characterised by discourses of mistrust and miscommunication. This meant that emotional reactions to the breakdown were often suppressed or dismissed, resentments built-up and attempts to find a solution were thwarted by silence or angry recrimination. These findings raise real challenges for practice and policy development. In particular, they stress the importance of shared and meaningful dialogue between all key stakeholders within the social care system, the need for more effective and timely support when placements are in crisis and opportunities for those most closely involved with the placement breakdown to process the emotional experience. [ABSTRACT FROM PUBLISHER]

The author reflects on the First National Personality Disorder Congress in which the attendees' task was to present three active facets of the National Personality Disorder Development Programme, including children and young people, community mental health, and the offender population. The author offers an overview of the program's three active facets and briefly discusses the significance of the order of the articles within the issue.

This paper describes a project carried out within the University of Sunderland's Department of Computing, Engineering and Technology during the 2008/9 academic year to investigate the potential for the use of LEGO Mindstorms NXT robots in the teaching of basic programming skills to undergraduate students. The project's initial proposal and context is discussed, with potential benefits identified and feedback methods outlined. The paper then describes of students and evaluates the student feedback and results obtained. In addition, a number of spin-off projects are the operational issues encountered when the project was implemented for two separate cohorts described which have provided additional benefits to students, the department and local schoolchildren. The paper concludes by outlining future work which is being carried out at the University of Sunderland as a result of this project. [ABSTRACT FROM AUTHOR]

This article draws on qualitative research that explores the concept of public value in the delivery of sport services by the organization Sport England. The research took place against a backdrop of shifting priorities following the award of the 2012 Olympic Games to London. It highlights the difficulties that exist in measuring the qualitative nature of the public value of sport and suggests there is a need to understand better the idea. Research with organizations involved alongside Sport England in the delivery of sport is described. This explores the potential to create a public value vision, how to measure it and how to focus public value on delivery beyond the aim of 'sport for sports sake' and more towards 'sport for the greater good'. The article argues that this represents a game of 'two halves' in which the first half focuses on 2012 with the second half concerned with its legacy. [ABSTRACT FROM AUTHOR]

The identification of a number of clench-nails and roves in Anglo-Saxon cemeteries suggest the deliberate deposition of boat fragments and tokens in burial. The distribution of this practice, centred on 6th- to early 7th-century Kent, contrasts with that of the more commonly discussed form of boat-burial known particularly from 7th-century East Anglia. In this paper the characteristics of this burial rite are considered from a number of identified examples to provide for a preliminary typology of 'pseudo-boat-burials' and rove-graves. In conclusion, an interpretation is offered to account for their use in early Anglo-Saxon England, and the preferential deposition in Kent. [ABSTRACT FROM AUTHOR]

Background Peer-marking has been suggested as a method to enhance self-directed learning and reflection, although whether this improves performance is unclear. This study evaluated the impact of peer-marking on examination performance and investigated its reliability and acceptability to students. Methods First-year medical students were randomised to peer-marking using a model answer or no intervention (control arm). Student scores were compared with tutor-marked scores. Two months later, students completed a summative assessment and performance was compared between students randomised to peer-marking and the control arm. A focus group was held with students in the intervention arm to capture their experiences and attitudes. Results A total of 289 of 568 students consented to participate and 147 were randomised to peer-marking (142 controls). Students randomised to peer-marking achieved marginally higher examination marks (1.5% difference, 95% CI −0.8% to 3.9%, P = 0.19) than controls (adjusting for year and in-course assessment), although this may have been due to chance. Students were harsher markers than the tutors. Focus group analysis suggested that students valued peer-marking, although concerns about passing judgement on a colleague's work were expressed. Conclusions Peer-marking did not have a substantial effect on examination performance, although a modest effect cannot be excluded. Students gained insight into examination technique but may not have gained deeper knowledge. Given its potential positive educational value, further work is required to understand how peer-marking can be used more effectively to enhance the learning experience. [ABSTRACT FROM AUTHOR]

Foot problems may be one of the lesser known complications of diabetes, but they have a major impact on people with the condition. The NHS National Diabetes Support Team has produced a guide to diabetic foot services and this article will look at some of the key areas in diabetic foot care today which are also outlined in the guide. The key areas are: prevention and screening, care pathways, multidisciplinary teams, and workforce and staff skills. Examples of how some of these issues are being tackled in England are featured in the article as case studies. [ABSTRACT FROM AUTHOR]

A small outbreak of the gypsy moth, Lymantria dispar (L.), was discovered in June 1995 in the South Woodford area of northeast London, near Epping Forest. The origin of this outbreak remains unknown, but the eggs may have been transported from continental Europe, where major outbreaks occurred in the early 1990s. A risk assessment concluded that severe defoliation by this forest pest was unlikely to occur in the UK under current climatic conditions, but if the gypsy moth did become established, then sporadic damage to amenity tree species could be expected. Therefore an eradication programme was undertaken, which involved determining the extent of the outbreak area via population monitoring, and chemical treatments of any larval infestations, to prevent further spread. A series of targeted publicity campaigns was carried out with the aim of raising public awareness of the pest in the wider outbreak area. Details of gypsy moth finds (egg masses and larvae) and pheromone trap catches (adult males) are given for the years 1995 - 2003. Pheromone traps were maintained at a relatively high density ( c. 188 per 1 km 2 ) in the immediate outbreak area--and similarly in an adjacent portion of the Epping Forest--and it remains a possibility that some mating disruption has occurred. Although Lymantria dispar persists at this site, the numbers of adult male moths trapped has declined markedly in comparison to the first 2 years (1995 - 1996). The outbreak is, however, continuing to persist at a very low level and may be becoming more widely dispersed, albeit very sparsely. It is also possible that observed population trends in terms of pheromone trap catches reflect a natural population cycle, and for these reasons work is continuing in an attempt to eradicate this damaging broadleaf tree pest from the UK. [ABSTRACT FROM AUTHOR]

In 1999 South Lancashire Health Authority published their Oral Health Improvement Plan in which they specifically identified drug users as a target group. In this paper the authors outline the development of a project, which aimed to improve access to dental services for this group. Essential to the relative success of the project was the inclusion of drug users and service providers at the outset. In addition perceived barriers, which exist between drug users and the profession have started to be broken down. [ABSTRACT FROM AUTHOR]

The article discusses the history of three picture frames at the Ashmolean Museum in Oxford, England and their association to the artists Elias Ashmole and Grinling Gibbons. Examination of the frames ornamenting the portraits show that the oil gilding has been crudely applied over numerous cracks, losses and old damages but they were retouched using bronze paint. However, despite all the damages in the frame, these frames remarkably show an excellent work of art and craftsmanship of the artists.

The article announces the opening of the Science & Society Picture Library by Chris Smith, secretary of state for Culture, Media and Sport, at the Science Museum in London, England. The exhibition features the collection of images of objects, paintings, prints, engravings and other illustration from the collections of three museums which comprises the National Museum of Science and Industry. In addition, it also displays 300,000 images made from the Museum's own resources.

The article discusses the restoration and reinstallation of the Victoria and Albert Museum in London, England. The Ceramics Gallery was designed by Francis Fowke to provide the climax of the museum experience with Neo-Renaissance paintings by painter F. W. Moody. Moreover, the Department of National Heritage has agreed to support the restoration of the interiors to recover the original Ceramics Gallery.

The article reviews the Beaulieu Motorworks exhibition at the National Motor Museum in Hampshire, England in March 1997.

The article reviews the exhibition "The art of the Picture Frame" at the National Portrait Gallery in London, England held from November 15, 1996 to February 8, 1997.

The article reviews the art exhibition "The Art of the Picture Frame," at National Portrait Gallery in London, England from November 1966 to February 1997.

The article focuses on the changes made by museum designer Piers Gough to the National Portrait Gallery's structure in London, England. This change in emphasis has manifested in the substantially greater freedom which has been accorded to the museum designer. In the construction, Gough worked closely with the curators of the gallery's 19th and 20th century collections. The entire First Floor has been redesigned to provide a setting of portraits of the period 1837-1960.

The article offers information on "An Earth-shattering Experience," the first phase of the new Earth Galleries at the National History Museum in London, England. Its overall concept and design brief have been evolved by Giles Clarke and Robert Bloomfield, and the Visions of Earth display in the RTZ Atrium was designed by Neal Potter Design Associates. The Earth Galleries are designed to stimulate and promote the desire to know more about earth sciences.

The article offers information about exhibitions that showed fine English picture frames in 1996 in London, England. These exhibitions include "Dynasties: Painting in Tudor and Jacobean England 1530-1630," "In Trust for the Nation: Painting from National Trust House," and "Richard & Maria Cosway&x#2014;Regency Artists of Taste and Fashion."

The article discusses the contribution of art collector William Hamilton to the collections of the British Museum in London, England. According to the author, Hamilton contributed to the growing antiquities collection of the British Museum which he had instigated. Hamilton also became a Trustee of the British Museum who bought the Warwick Vase as the centerpiece of the collection purchased from him.

The article reports on the developments and changes of the British Museum in preparation for its 250th anniversary celebration in England in 2003. Some of the developments and changes include the appointment of Sir Norman Foster as their consultant architect and building improvements for British Library and other existing museum structures. The primary goal of the development program is to maintain quality in preserving art collection found in the museum.

The article reviews the exhibition "A Bellini from Birmingham" at the National Gallery in London, England from September-November 1993.

The article focuses on the exhibition facilities of museums. There are no large uninterrupted spaces suitable for the display of monumental works of art in Washington. The combination of low ceiling heights and poor access which afflicts the Washington art exhibition venues is duplicated in London, England. The Grand Palais in Paris, France would appear to come closest in providing all things for all exhibitions mostly by virtue of historical accidents and sheer size.

The article reports on the display of Far Eastern art at the Victoria and Albert Museum and British Museum in London, England. Victoria and Albert Museum has made much play of its three-year program of market research and development by which it sets out to identify and answer the questions about objects most often asked by visitors. The Joseph E. Hotung Gallery of Oriental Antiquities and Asahi Shimbun Gallery at British Museum has restored the first floor gallery with Edwardian display cases.