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Background Pain is the most common and bothersome symptom experienced by people with hidradenitis suppurativa (HS) and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Objectives To perform a scoping review of pain measurement in randomized control trials (RCTs) of painful skin conditions (PSCs) and use of the pain numerical rating scale (NRS) and visual analogue scale (VAS) in rheumatoid arthritis RCTs, to inform the efforts of HISTORIC to reach consensus on how to measure pain intensity in HS trials. Methods A search was conducted on several publication databases. Inclusion criteria were RCTs with a minimum of 10 participants that measured pain intensity. Results Pain NRS and VAS were used in 68% of PSC trials. Respectively, 77% and 87% of PSC and rheumatoid arthritis RCTs did not specify the recall window. The commonest recall window in PSCs when specified was 24 h. In total, 33% of PSC trials assessed maximum pain intensity and 3% average pain intensity, while 87% of rheumatoid arthritis trials did not provide details. Pain data were reported as mean difference by 76% of PSC trials and 75% of rheumatoid arthritis trials. Respectively, 10% and 11% of PSC and rheumatoid arthritis studies reported pain as the percentage of patients reaching a desirable state and only 1% and 2% reported number needed to treat. Conclusions While pain NRS and VAS are standard methods to measure pain intensity in PSCs, key details such as the recall window are often omitted and there is no consensus on how to report pain NRS data. What is already known about this topic? Pain is the most burdensome symptom experienced by patients with hidradenitis suppurativa and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). What does this study add? Our review shows substantial variation in how pain numerical rating scale (NRS) and visual analogue scale are utilized in clinical trials. This variation restricts meta-analysis of pain intensity results.There is a need for consensus regarding the recall window for pain NRS and maximum vs. average pain, and whether current pain should be measured.

BackgroundDespite the accumulation of research papers on aspirin and cancer, there is doubt as to whether or not aspirin is an acceptable and effective adjunct treatment of cancer. The results of several randomised trials are awaited, and these should give clear evidence on three common cancers: colon, breast and prostate. The biological effects of aspirin appear likely however to be of relevance to cancer generally, and to metastatic spread, rather than just to one or a few cancers, and there is already a lot of evidence, mainly from observational studies, on the association between aspirin and survival in a wide range of cancers.AimsIn order to test the hypothesis that aspirin taking is associated with an increase in the survival of patients with cancer, we conducted a series of systematic literature searches to identify clinical studies of patients with cancer, some of whom took aspirin after having received a diagnosis of cancer.ResultsThree literature searches identified 118 published observational studies in patients with 18 different cancers. Eighty-one studies report on aspirin and cancer mortality and 63 studies report on all-cause mortality. Within a total of about a quarter of a million patients with cancer who reported taking aspirin, representing 20%-25% of the total cohort, we found aspirin to be associated with a reduction of about 20% in cancer deaths (pooled hazard ratio (HR): 0.79; 95% confidence intervals: 0.73, 0.84 in 70 reports and a pooled odds ratio (OR): 0.67; 0.45, 1.00 in 11 reports) with similar reductions in all-cause mortality (HR: 0.80; 0.74, 0.86 in 56 studies and OR: 0.57; 0.36, 0.89 in seven studies). The relative safety of aspirin taking was examined in the studies and the corresponding author of every paper was written to asking for additional information on bleeding. As expected, the frequency of bleeding increased in the patients taking aspirin, but fatal bleeding was rare and no author reported a significant excess in fatal bleeds associated with aspirin. No author mentioned cerebral bleeding in the patients they had followed.ConclusionsThere is a considerable body of evidence suggestive of about a 20% reduction in mortality in patients with cancer who take aspirin, and the benefit appears not to be restricted to one or a few cancers. Aspirin, therefore, appears to deserve serious consideration as an adjuvant treatment of cancer, and patients with cancer, and their carers, have a right to be informed of the available evidence.

Introduction Diverse communities - people with dementia, intellectual disabilities (ID) and religious beliefs, have lower rates in accessing palliative and hospice care services (Johnson, 2013). Healthcare providers also encounter problems in delivering appropriate services to these communities (Koffman, 2014). Aim To identify the barriers to accessing and delivering hospice care services for diverse communities. Method A rapid review was conducted using a systematic search protocol. The search yielded 95 relevant titles from which 34 were screened for data extraction and 23 met the inclusion criteria. Thematic approach was used for data analysis. Results The overall barriers identified were mainly physical, psycho-social and economic. People with dementia were challenged by the uncertainty of their survival time. Their lack of awareness of service facilities, availability and financial circumstances hindered them accessing hospice care. Difficulties associated with prognostication; communication; inadequate medical interventions; and appropriateness of palliative care intervention were the main barriers for those providing palliative care to this group. For individuals with ID, social, emotional and cognitive issues (patient understanding, capacity to consent etc.) were the main factors affecting palliative care provision. The main barriers for services providers were lack of guidelines and support, access to general healthcare facilities and internal staffing issues. For those with specific religious beliefs, unwillingness to involve outsiders, being well supported by their religious community, distrust of medical establishments and unawareness of the need and availability of services were the main barriers. Lack of diversity among health care staff and resource constraints were barriers to service delivery. Conclusions Addressing specific needs of diverse communities would encourage better utilisation of hospice care.

Objective – Evidence from systematic reviews a decade ago suggested that face-to-face and online methods to provide information literacy training in universities were equally effective in terms of skills learnt, but there was a lack of robust comparative research. The objectives of this review were (1) to update these findings with the inclusion of more recent primary research; (2) to further enhance the summary of existing evidence by including studies of blended formats (with components of both online and face-to-face teaching) compared to single format education; and (3) to explore student views on the various formats employed. Methods – Authors searched seven databases along with a range of supplementary search methods to identify comparative research studies, dated January 1995 to October 2016, exploring skill outcomes for students enrolled in higher education programs. There were 33 studies included, of which 19 also contained comparative data on student views. Where feasible, meta-analyses were carried out to provide summary estimates of skills development and a thematic analysis was completed to identify student views across the different formats. Results – A large majority of studies (27 of 33; 82%) found no statistically significant difference between formats in skills outcomes for students. Of 13 studies that could be included in a meta-analysis, the standardized mean difference (SMD) between skill test results for face-to-face versus online formats was -0.01 (95% confidence interval -0.28 to 0.26). Of ten studies comparing blended to single delivery format, seven (70%) found no statistically significant difference between formats, and the remaining studies had mixed outcomes. From the limited evidence available across all studies, there is a potential dichotomy between outcomes measured via skill test and assignment (course work) which is worthy of further investigation. The thematic analysis of student views found no preference in relation to format on a range of measures in 14 of 19 studies (74%). The remainder identified that students perceived advantages and disadvantages for each format but had no overall preference. Conclusions – There is compelling evidence that information literacy training is effective and well received across a range of delivery formats. Further research looking at blended versus single format methods, and the time implications for each, as well as comparing assignment to skill test outcomes would be valuable. Future studies should adopt a methodologically robust design (such as the randomized controlled trial) with a large student population and validated outcome measures.

Background:Women with autoimmune rheumatic diseases (ARDs) find it difficult to get information and support with family planning, pregnancy, and early parenting. A systematic approach to prioritising research is required to accelerate development and evaluation of interventions to meet the complex needs of this population. Methods:A Nominal Group Technique (NGT) exercise was carried out with lay and professional stakeholders (n=29). Stakeholders were prepared for debate through presentation of available evidence. Stakeholders completed three tasks to develop, individually rank, and reach consensus on research priorities: Task 1 – mapping challenges and services using visual timelines; Task 2 - identifying research topics; Task 3 - individually ranking research topics in priority order. Results of the ranking exercise were fed back to the group for comment. Results:The main themes emerging from Task 1 were the need for provision of information, multi-disciplinary care, and social and peer support. In Task 2, 15 research topics and 58 sub-topics were identified around addressing the challenges and gaps in care identified during Task 1. In Task 3, a consensus was reached on the ten research topics that should be given the highest priority. These were individually ranked, resulting in the following order of priorities (from 1 – highest to 10 – lowest): 1. Shared decision-making early in the care pathway; 2. Pre-conception counseling; 3. Information about medication use during pregnancy/breastfeeding; 4. Personalised care planning; 5. Support for partners/family members; 6. Information about local support/disease specific issues; 7. Shared decision-making across the care pathway; 8. Peer-support; 9. Social inequalities in care, and; 10. Guidance on holistic/alternative therapies. Conclusions:This systematic approach to identification of research priorities from a multi-disciplinary and lay perspective indicated that activities should focus on development and evaluation of interventions that increase patient involvement in clinical decision-making, multi-disciplinary models of care, and timely provision of information.

This review will aim to establish if there is strong evidence to suggest a student preference for delivery format within information literacy teaching. This research supports and builds on research previously undertaken by Cardiff University (Weightman et al., 2017). Weightman et al (2017) addressed the effect of face-to-face or online learning specifically on learning outcomes. This review specifically focuses on the effects of these methods, and blended formats, on student preference. This research informs teaching practice specifically within Cardiff University’s library service but also teaching practice generally. A comprehensive systematic literature search was undertaken in four databases: Library, Information Science and Technology Abstracts (LISTA), British Education Index, ERIC and Scopus. Seven new papers were identified to update the previous discussions on student preference of information literacy teaching format (Weightman et al., 2017). Critical appraisal was undertaken of these newly identified papers. Weightman et al.’s (2017) systematic review suggested that there was no student preference in relation to delivery format. Of the seven new papers identified in this review, two (DaCosta, 2007; Gorman & Staley, 2018) show a slight preference for format; one for online and one for face-to-face although there are limitations to the studies. Of the five remaining studies (Craig & Friehs, 2013; Kelly, 2017; Lag, 2016; Lapidus et al., 2012; Matlin & Lantzy, 2017) all showed a comparable experience between formats, although limitations of these studies are also acknowledged. The update search and appraisal of the literature concurs with previous conclusions (Weightman et al., 2017) that experiences are comparable and student preference is generally neutral in relation to delivery format. Student learning outcomes and student preference are comparable regardless of format (Weightman et al., 2017).

BACKGROUND: Aspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin. METHODS: In a systematic literature review we identified reports of randomised controlled trials of aspirin in which both total GI bleeding events and bleeds that led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. A meta-analyses was then performed to estimate the risk of fatal gastrointestinal bleeding attributable to low-dose aspirin. RESULTS: Eleven randomised trials were identified in the literature search. In these the relative risk (RR) of 'major' incident GI bleeding in subjects who had been randomised to low-dose aspirin was 1.55 (95% CI 1.33, 1.83), and the risk of a bleed attributable to aspirin being fatal was 0.45 (95% CI 0.25, 0.80). In all the subjects randomised to aspirin, compared with those randomised not to receive aspirin, there was no significant increase in the risk of a fatal bleed (RR 0.77; 95% CI 0.41, 1.43). CONCLUSIONS: The majority of the adverse events caused by aspirin are GI bleeds, and there appears to be no valid evidence that the overall frequency of fatal GI bleeds is increased by aspirin. The substantive risk for prophylactic aspirin is therefore cerebral haemorrhage which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer.

This paper outlines the results of a project carried out in Wales in 2010 looking at how extensively young Welsh speakers used the language within their social networks. A study of 200 young people aged 13-18 years was conducted in four Welsh medium secondary schools, two in south east Wales and two in north west Wales. An on-line questionnaire was used to gather information about the young people’s family and educational background, the language of their home, their self-perceived language ability, their use of Welsh and English in different social contexts, and their use of Welsh and English in emails, texting and social networking sites. Then a series of focus groups discussed these issues in more depth. We found that almost 90 per cent of the young people interviewed used Social Networking Sites regularly, and the language they used on these sites reflected to a large extent the language they used with contacts in the real world. There was some evidence that Social Networking Sites afforded young people in the more Anglicised areas of Wales the opportunity to use Welsh on a daily basis, and thus the use of Social Networking Sites can be useful in maintaining a minority language. However, it is necessary to consider innovative ways of encouraging young people to use it within their favoured social media.

This paper outlines the results of a project carried out in Wales between 2003-2005, looking at the social networks and language use of young people aged 13-17 years. Twenty four participants were studied in twelve different areas of Wales, making a total sample group of 288. The participants were selected on the basis of their own Welsh language competence and that of their parents. The resulting network configurations across the various locations portrayed quite different responses regarding the young people’s use of the Welsh language. The major determinant of the Welsh language density of the networks was the language used by the respondent in the home. The analysis of the data allowed the development of a typology of locations distinguished by the incidence of the use of Welsh in different social networks. Three types of communities emerged – firstly, those which integrate dominant language speakers; secondly, communities containing two distinct language groups; and thirdly, communities where Welsh is rapidly being assimilated into the normative context where English is the predominant language.

The role of the home and family/caregivers is commonly acknowledged as being central to securing the intergenerational socialisation of minority languages. Research evidence demonstrates that the survival or demise of minority languages crucially depends upon the extent to which the language is passed on from one generation to the next within the household context. In Wales, there is a marked lack of parental success in ensuring children's acquisition and use of Welsh, particularly in cases when one parent speaks Welsh and the other not. Such a trend, should it continue, seriously threatens the future of the Welsh language. In this paper, we discuss the results of a recent research project carried out with 12 families in Wales, where the factors that affect the language socialisation of babies and young children within mixed language households were studied in depth. This study represents the first stage of a longitudinal study of language socialisation of children within mixed language families in Wales.

Neither sociolinguists nor the sociology of language have taken seriously the role of language in the labour market. This paper aims to consider the specific nature of the class structure in a peripheral economy in Wales, and the role of language in the creation of class fractions. Drawing upon data from research carried out in Gwynedd at the end of the 1980s, the work focuses on the new middle class which, on account of being both employers of labour whilst at the same time being employees of capital, are in a contradictory class location within the class structure and may be expected to orientate either upwards towards the bourgeoisie or downwards towards the proletariat. The cultural division of labour within the peripheral economy in Wales involves a tendency for the private sector management to be non‐Welsh, being drawn from the English core, whereas the public sector management contains a significant number of Welsh speakers. Employing social relationships as an indicator of class orientati...

In Wales, there is considerable concern that an inadequate proportion of young children are being brought up speaking Welsh in the home, particularly in homes with only one Welsh-speaking parent, to ensure the future vitality of Welsh as a language of the home, family, and community. This article investigates to what extent young children's Welsh language socialisation in “mixed-language” families depends on whether the mother or the father is the Welsh speaker. On the basis of the first stage of a longitudinal ethnographic study, we found that Welsh-speaking parents who valued Welsh highly were more likely to create opportunities for their children's Welsh language socialisation in the home. This would appear to be true for both Welsh-speaking mothers and fathers in mixed-language households.