Beta-blocker usage and prostate cancer survival:A nested case-control study in the UK Clinical Practice Research Datalink cohort

Background: Recent laboratory and epidemiological evidence suggests that beta-blockers could inhibit prostate cancer progression. Methods: We investigated the effect of beta-blockers on prostate cancer-specific mortality in a cohort of prostate cancer patients. Prostate cancer patients diagnosed between 1998 and 2006 were identified from the UK Clinical Practice Research Database and confirmed by cancer registries. Patients were followed up to 2011 with deaths identified by the Office of National Statistics. A nested case-control analysis compared patients dying from prostate cancer (cases) with up to three controls alive at the time of their death, matched by age and year of diagnosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression. Results: Post-diagnostic beta-blocker use was identified in 25% of 1184 prostate cancer-specific deaths and 26% of 3531 matched controls. There was little evidence (P=0.40) of a reduction in the risk of cancer-specific death in beta-blocker users compared with non-users (OR=0.94 95% CI 0.81, 1.09). Similar results were observed after adjustments for confounders, in analyses by beta-blocker frequency, duration, type and for all-cause mortality. Conclusions: Beta-blocker usage after diagnosis was not associated with cancer-specific or all-cause mortality in prostate cancer patients in this large UK study.

How Prepared are UK Medical Graduates for Practice? Final report from a programme of research commissioned by the General Medical Council

This programme of research aimed to understand the extent to which current UK medical graduates are prepared for practice. Commissioned by the General Medical Council, we conducted: (1) A Rapid Review of the literature between 2009 and 2013; (2) narrative interviews with a range of stakeholders; and (3) longitudinal audio-diaries with Foundation Year 1 doctors. The Rapid Review (RR) resulted in data from 81 manuscripts being extracted and mapped against a coding framework (including outcomes from Tomorrow's Doctors (2009) (TD09)). A narrative synthesis of the data was undertaken. Narrative interviews were conducted with 185 participants from 8 stakeholder groups: F1 trainees, newly registered trainee doctors, clinical educators, undergraduate and postgraduate deans and foundation programme directors, other healthcare professionals, employers, policy and government and patient and public representatives. Longitudinal audio-diaries were recorded by 26 F1 trainees over 4 months. The data were analysed thematically and mapped against TD09. Together these data shed light onto how preparedness for practice is conceptualised, measured, how prepared UK medical graduates are for practice, the effectiveness of transition interventions and the currently debated issue of bringing full registration forward to align with medical students’ graduation. Preparedness for practice was conceptualised as both a long- and short-term venture that included personal readiness as well as knowledge, skills and attitudes. It has mainly been researched using self-report measures of generalised incidents that have been shown to be problematic. In terms of transition interventions: assistantships were found to be valuable and efficacious for proactive students as team members, shadowing is effective when undertaken close to employment/setting of F1 post and induction is generally effective but of inconsistent quality. The August transition was highlighted in our interview and audio-diary data where F1s felt unprepared, particularly for the step-change in responsibility, workload, degree of multitasking and understanding where to go for help. Evidence of preparedness for specific tasks, skills and knowledge was contradictory: trainees are well prepared for some practical procedures but not others, reasonably well prepared for history taking and full physical examinations, but mostly unprepared for adopting an holistic understanding of the patient, involving patients in their care, safe and legal prescribing, diagnosing and managing complex clinical conditions and providing immediate care in medical emergencies. Evidence for preparedness for interactional and interpersonal aspects of practice was inconsistent with some studies in the RR suggesting graduates were prepared for team working and communicating with colleagues and patients, but other studies contradicting this. Interview and audio-diary data highlights concerns around F1s preparedness for communicating with angry or upset patients and relatives, breaking bad news, communicating with the wider team (including interprofessionally) and handover communication. There was some evidence in the RR to suggest that graduates were unprepared for dealing with error and safety incidents and lack an understanding of how the clinical environment works. Interview and audio-diary data backs this up, adding that F1s are also unprepared for understanding financial aspects of healthcare. In terms of being personally prepared, RR, interview and audio diary evidence is mixed around graduates’ preparedness for identifying their own limitations, but all data points to graduates’ difficulties in the domain of time management. In terms of personal and situational demographic factors, the RR found that gender did not typically predict perceptions of preparedness, but graduates from more recent cohorts, graduate entry students, graduates from problem based learning courses, UK educated graduates and graduates with an integrated degree reported feeling better prepared. The longitudinal audio-diaries provided insights into the preparedness journey for F1s. There seems to be a general development in the direction of trainees feeling more confident and competent as they gain more experience. However, these developments were not necessarily linear as challenging circumstances (e.g. new specialty, new colleagues, lack of staffing) sometimes made them feel unprepared for situations where they had previously indicated preparedness.

Post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific survival: a nested case-control study in a breast cancer cohort from the UK Clinical Practice Research Datalink

INTRODUCTION: Recent observational studies indicate that post-diagnostic use of aspirin in breast cancer patients may protect against cancer progression perhaps by inhibiting cyclooxygenase-2 dependent mechanisms. Evidence also supports a crucial role for interactions between tumour cells and circulating platelets in cancer growth and dissemination, therefore, use of low-dose aspirin may reduce the risk of death from cancer in breast cancer patients.

METHODS: A cohort of newly diagnosed breast cancer patients (1998 to 2006) were identified in the UK Clinical Practice Research Datalink (and confirmed by cancer registry linkage). Cancer-specific deaths were identified up to 2011 from Office for National Statistics mortality data. A nested case-control analysis was conducted using conditional logistic regression to compare post-diagnostic aspirin exposure using General Practice prescription data in 1,435 cases (breast cancer deaths) with 5,697 controls (matched by age and year of diagnosis).

RESULTS: After breast cancer diagnosis, 18.3% of cancer-specific deaths and 18.5% of matched controls received at least one prescription for low-dose aspirin, corresponding to an odds ratio (OR) of 0.98 (95% CI 0.83, 1.15). Adjustment for potential confounders (including stage and grade) had little impact on this estimate. No dose response relationship was observed when the number of tablets was investigated and no associations were seen when analyses were stratified by receipt of prescriptions for aspirin in the pre-diagnostic period, by stage at diagnosis or by receipt of prescriptions for hormone therapy.

CONCLUSIONS: Overall, in this large population-based cohort of breast cancer patients, there was little evidence of an association between receipt of post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific death. However, information was not available on medication compliance or over-the-counter use of aspirin, which may have contributed to the null findings.

The Changing Context for Planning Education in the UK and the Prospects for Research-Led, Practice-Engaged Teaching

The UK’s Royal Town Planning Institute (RTPI) celebrates its centenary in 2014, marking 100 years of close relationships between university-based Planning Schools and a professional body focussed on planning practice. During this period, the context for university education and the very idea of planning has changed dramatically contributing to a continual renegotiation of the relationships between the planning profession and the educational institutions it accredits. These changes have been particularly acute in the last ten years where a number of factors have forced a rapid change in the nature of planning education in the UK. This has included a boom and then slump in the number of planning students linked to the national economic situation, a reorganisation of many planning schools and their merger with cognate disciplines such as geography and an increased focus of research output, rather than professional engagement the key institutional indicator of success. This last factor adds a particularly new dimension to the profession-university relationship, which could potentially lead to either a straining of tensions or a synergy through research-led teaching that could significantly benefit both.

This paper will briefly review the evolution of UK planning schools and the co-evolution of the main ideas informing planning education. It will then describe the current profile of UK planning schools, based on an extensive national survey conducted on behalf of the Royal Town Planning Institute. The paper will then critically review the main challenges and opportunities facing UK Planning Schools in the context of changes in both planning practice and higher education. It will then move on to the concept of research-led teaching, drawing on current practice in the UK and review how well this concept serves students and the idea of developing reflective planning practitioners. Finally, the paper will seek to draw broad lessons from the experience of the UK and reflect on the type of planning education that can best serve planning professions in a variety of international contexts in the future.

A research-based approach to exploring the adoption of novel UK-based concrete test methods in Chinese construction sector

As part of a UK-China science bridge project - a UK government funded initiative linking leading universities and businesses in selective partnering countries in 2009 a collaborative research programme was initiated between Queen's University and the Research Institute of High Performance Concrete (part of the Central Research Institute of Building and Construction) in Beijing.

For further details email b.magee@ulster.ac.uk

Cyber Security Research: a vision for the UK: Finance challenges

Invited talk, representing the Royal Society

Gaining ethical approvals to undertake sexual health research with young people in the UK: Applying a 'Children's Rights Based Approach'

This paper (co-written with Dr Maria Lohan, Dr Carmel Kelly & Professor Laura Lundy) will describe the ethical review process to undertake health research in the UK, and explain an approach that can help researchers deal with ethical and methodological dilemmas in their research. Ethical review is necessary to ensure researchers and participants are protected, yet the requirement to ‘pass’ numerous committees may be challenging particularly for health researchers who work with vulnerable groups and sensitive topics. The inclusion of these groups/topics is crucial if health researchers are to understand health disparities and implement appropriate interventions with health benefits for vulnerable populations. It is proposed that to overcome ethical and methodological challenges and pitfalls, researchers must implement strategies that advocate for, and increase the participation of, vulnerable populations in health research. A ‘children’s rights based approach’ using participatory methodology will be described that draws on the jurisprudence of international law, (United Nations Convention on the Rights of the Child, 1989) and provides a framework that may empower ethics committees to carry out their function confidently. The role of the researcher, framed within the context of doctoral level study, will be reviewed in terms of the investment required and benefits of utilising this approach. It will be argued that adopting this approach with vulnerable groups, not only guarantees their meaningful participation in the research process and permits their voices to be heard, but also offers ethics committees an internationally agreed upon legal framework, ratified by their governing States, from which to fulfil their obligations and resolve their ethical dilemmas. Increasing the representation and participation of vulnerable groups in health research can inform the development of health policy and practice based on ‘insider knowledge’ that better engages with and more adequately reflects their specific needs. This is likely to yield numerous health, social and economic benefits for all of society through the delivery of more equitable, effective and sustainable services.

A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis

Background: Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. Objective: This literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA. Methods: A two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1). Results: 25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being '. instruction on how to perform the behaviour', '. demonstration of the behaviour', '. behavioural practice', '. credible source', '. graded tasks' and '. body changes'. Conclusion: Results demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted.

Post-diagnostic oral bisphosphonate use and colorectal cancer mortality: a population-based cohort study within the UK Clinical Practice Research Datalink

Background:We conducted the first study to investigate post-diagnostic oral bisphosphonates use and colorectal cancer-specific mortality.

Methods:Colorectal cancer patients were identified from the National Cancer Data Repository (1998–2007) and linked to the UK Clinical Practice Research Datalink, providing prescription records, and Office of National Statistics mortality data. Time-dependent Cox regression models investigated colorectal cancer-specific mortality in post-diagnostic bisphosphonate users.

Results:Overall, in 4791 colorectal cancer patients, there was no evidence of an association between bisphosphonate use and colorectal cancer-specific mortality (adjusted hazard ratio=1.11; 95% confidence interval 0.80, 1.54) or with drug frequency or type.

Conclusions:In this novel population-based cohort study, post-diagnostic bisphosphonate use was not associated with longer rates of colorectal cancer survival.

Research in Progress: Medical Research Council United Kingdom Refractory Asthma Stratification Programme (RASP-UK)

The UK Refractory Asthma Stratification Programme(RASP-UK) will explore novel biomarker stratificationstrategies in severe asthma to improve clinicalmanagement and accelerate development of newtherapies. Prior asthma mechanistic studies have notstratified on inflammatory phenotype and theunderstanding of pathophysiological mechanisms inasthma without Type 2 cytokine inflammation is limited.RASP-UK will objectively assess adherence tocorticosteroids (CS) and examine a novel compositebiomarker strategy to optimise CS dose; this will alsoaddress what proportion of patients with severe asthmahave persistent symptoms without eosinophilic airwaysinflammation after progressive CS withdrawal. There will be interactive partnership with the pharmaceutical industry to facilitate access to stratified populations for novel therapeutic studies.

β-Blocker usage and colorectal cancer mortality:a nested case-control study in the UK Clinical Practice Research Datalink cohort

BACKGROUND: Epidemiological and laboratory studies suggest that β-blockers may reduce cancer progression in various cancer sites. The aim of this study was to conduct the first epidemiological investigation of the effect of post-diagnostic β-blocker usage on colorectal cancer-specific mortality in a large population-based colorectal cancer patient cohort.

PATIENTS AND METHODS: A nested case-control analysis was conducted within a cohort of 4794 colorectal cancer patients diagnosed between 1998 and 2007. Patients were identified from the UK Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with a colorectal cancer- specific death (data from the Office of National Statistics death registration system) were matched to five controls. Conditional logistic regression was applied to calculate odds ratios (OR) and 95% confidence intervals (95% CIs) according to β-blocker usage (data from GP-prescribing records).

RESULTS: Post-diagnostic β-blocker use was identified in 21.4% of 1559 colorectal cancer-specific deaths and 23.7% of their 7531 matched controls, with little evidence of an association (OR = 0.89 95% CI 0.78-1.02). Similar associations were found when analysing drug frequency, β-blocker type or specific drugs such as propranolol. There was some evidence of a weak reduction in all-cause mortality in β-blocker users (adjusted OR = 0.88; 95% CI 0.77-1.00; P = 0.04) which was in part due to the marked effect of atenolol on cardiovascular mortality (adjusted OR = 0.62; 95% CI 0.40-0.97; P = 0.04).

CONCLUSIONS: In this novel, large UK population-based cohort of colorectal cancer patients, there was no evidence of an association between post-diagnostic β-blocker use and colorectal cancer-specific mortality.

CLINICAL TRIALS NUMBER: NCT00888797.

The Changing Context for Planning Education in the UK and the Prospects for Research-Led, Practice-Engaged Teaching

The UK’s Royal Town Planning Institute (RTPI) has celebrated its centenary in 2014, marking 100 years of close relationships between university-based planning schools and a professional body focused on planning practice. During this period, the context for university education and the very idea of planning have changed dramatically contributing to a continual renegotiation of the relationships between the planning profession and the educational institutions it accredits. These changes have been particularly pronounced in the last 10 years where a number of factors have forced a rapid change in the nature of planjavascript:void(0);ning education in the UK. This has included a boom and then slump in the number of planning students linked to the dynamics of national economic situation, a reorganization of many planning school curricula, and their merger with cognate disciplines such as geography and an increased focus on research output, rather than professional engagement as the key indicator of institutional success. This last factor adds a particularly new dimension to the profession-university relationship, which could potentially lead to either straining of tensions or a synergy through research-led teaching that could significantly benefit both. This chapter will briefly review the evolution of UK planning schools and of the main ideas informing planning education. It will then describe the current profile of UK planning schools, based on an extensive national survey conducted on behalf of the Royal Town Planning Institute. The paper will then critically review the main challenges and opportunities facing UK planning schools in the context of changes in both planning practice and higher education. It will then move on to the concept of research-led teaching, drawing on current practice in the UK and review how well this concept serves students and the idea of developing reflective planning practitioners. Finally, the paper will seek to draw broad lessons from the experience of the UK and reflect on the type of planning education that can best serve planning professions in a variety of international contexts in the future.

Progress and Research in Cybersecurity - Supporting a resilient and trustworthy system for the UK

Executive summary
Digital systems have transformed, and will continue to transform, our world. Supportive government policy, a strong research base and a history of industrial success make the UK particularly well-placed to realise the benefits of the emerging digital society. These benefits have already been substantial, but they remain at risk. Protecting the benefits and minimising the risks requires reliable and robust cybersecurity, underpinned by a strong research and translation system.
Trust is essential for growing and maintaining participation in the digital society. Organisations earn trust by acting in a trustworthy manner: building systems that are reliable and secure, treating people, their privacy and their data with respect, and providing credible and comprehensible information to help people understand how secure they are.
Resilience, the ability to function, adapt, grow, learn and transform under stress or in the face of shocks, will help organisations deliver systems that are reliable and secure. Resilient organisations can better protect their customers, provide more useful products and services, and earn people’s trust.
Research and innovation in industry and academia will continue to make important contributions to creating this resilient and trusted digital environment. Research can illuminate how best to build, assess and improve digital systems, integrating insights from different disciplines, sectors and around the globe. It can also generate advances to help cybersecurity keep up with the continued evolution of cyber risks.
Translation of innovative ideas and approaches from research will create a strong supply of reliable, proven solutions to difficult to predict cybersecurity risks. This is best achieved by maximising the diversity and number of innovations that see the light of day as products.
Policy, practice and research will all need to adapt. The recommendations made in this report seek to set up a trustworthy, self-improving and resilient digital environment that can thrive in the face of unanticipated threats, and earn the trust people place in it.
Innovation and research will be particularly important to the UK’s economy as it establishes a new relationship with the EU. Cybersecurity delivers important economic benefits, both by underpinning the digital foundations of UK business and trade and also through innovation that feeds directly into growth. The findings of this report will be relevant regardless of how the UK’s relationship to the EU changes.
Headline recommendations
● Trust: Governments must commit to preserving the robustness of encryption, including end-to-end encryption, and promoting its widespread use. Encryption is a foundational security technology that is needed to build user trust, improve security standards and fully realise the benefits of digital systems.
● Resilience: Government should commission an independent review of the UK’s future cybersecurity needs, focused on the institutional structures needed to support resilient and trustworthy digital systems in the medium and longer term. A self-improving, resilient digital environment will need to be guided and governed by institutions that are transparent, expert and have a clear and widely-understood remit.
● Research: A step change in cybersecurity research and practice should be pursued; it will require a new approach to research, focused on identifying ambitious high-level goals and enabling excellent researchers to pursue those ambitions. This would build on the UK's existing strengths in many aspects of cybersecurity research and ultimately help build a resilient and trusted digital sector based on excellent research and world-class expertise.
● Translation: The UK should promote a free and unencumbered flow of cybersecurity ideas from research to practical use and support approaches that have public benefits beyond their short term financial return. The unanticipated nature of future cyber threats means that a diverse set of cybersecurity ideas and approaches will be needed to build resilience and adaptivity. Many of the most valuable ideas will have broad security benefits for the public, beyond any direct financial returns.